| 底盼盼,李歆,刘丽洁,等.老年非小细胞癌病人术后“教科书式结局”的影响因素及预后价值分析[J].安徽医药,2024,28(5):971-976. |
| 老年非小细胞癌病人术后“教科书式结局”的影响因素及预后价值分析 |
| Influencing factors and prognostic value of textbook outcome in elderly patients with non-small cell lung cancer |
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| DOI：10.3969/j.issn.1009-6469.2024.05.026 |
| 中文关键词: 癌，非小细胞肺 手术 教科书式结局 预测模型 生存 |
| 英文关键词: Carcinoma,non-small-cell lung Surgery Textbook outcome Predictive model Survival |
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| 中文摘要: |
| 目的分析老年非小细胞肺癌( NSCLC)病人行根治性手术后达成“教科书式结局”(TO)的影响因素，并探讨 TO对病人预后的影响。方法收集 2012年 1月至 2017年 12月石家庄市妇幼保健院接受手术的 555例临床分期为 Ⅰ~Ⅱ期的老年 NSCLC病人的临床资料，根据是否达成 TO分为 TO组与非 TO组。应用 logistic回归模型分析影响 TO达成的独立危险因素，构建列线图预测模型。模型的预测效能与一致性通过受试者操作特征( ROC)曲线与一致性曲线评估。应用 Kaplan-Meier生并存曲线与 Cox回归模型评价 TO的预后价值。结果 555例 NSCLC病人中， 372例( 67.0%)成功达成 TO。与未达成 TO的病人相比，达成 TO者的年龄较小、多为女性、吸烟者较少、共病指数较小、术前第 1秒用力呼气量占预计值百分比( FEV1%)与一氧化碳弥散量占预计值百分比( DLCO%)较高、多接受胸腔镜手术并且肿瘤多为腺癌( P<0.05)。多因素分析结果表明，性别、病指数、术前 DLCO%与手术方式是 TO达成的独立影响因素( P<0.05)。结合以上 4个因素构建的列线图预测模型具有一定的共预测效能(AUC=0.74)与较好的一致性(Hosmer-Lemeshow P=0.287)。生存分析显示，达成 TO的病人其术后生存显著优于未达成 TO的病人( P<0.05)并且 TO是术后生存的独立影响因素( P<0.05)。结论年龄、性别、 DLCO%与手术方式是影响老年 NSCLC病人在接受肺癌根，治术后达成 TO的独立预测因素，同时达成 TO的病人具有显著更好的预后。 |
| 英文摘要: |
| Objective To investigate the influencing factors and prognostic value of textbook outcome (TO) in elderly patients with non-small cell lung cancer (NSCLC).Methods Five hundred and fifty-five elderly patients with clinical stage Ⅰ-Ⅱ NSCLC, who un-derwent surgery in the Maternal and Child Health Center of Shijiazhuang between January 2012 and December 2017, were included. Pa-tients were classified into the TO and non-TO groups. Logistic regression model was used to identify the independent risk factors for TO and a nomogram was then constructed. The predictive accuracy and good fit of the nomogram were evaluated by the receiver operatingcharacteristic (ROC) curve and calibration curve, respectively. Kaplan-Meier survival curve and Cox regression model were used to ex-plore the prognostic value of TO.Results Of the 555 NSCLC patients, 372 (67.0%) achieved TO. Compared with the non-TO group, patients in the TO group were more likely to be younger, female, non-smokers, who have lower Charlson comorbidity index (CCI) and higher preoperative FEV1% and DLCO% , and most of them underwent thoracoscopic surgeries, and had adenocarcinomas (P<0.05).Multivariate analysis results revealed that gender, CCI, preoperative DLCO%, and surgical approach were independent risk factors forTO (P<0.05). A nomogram then established on the basis of these 4 factors had a good predictive accuracy (AUC=0.74) and good-fit (Hosmer-Lemeshow P=0.287). Survival analysis showed that patients who achieved TO had a significantly better prognosis (P<0.05), and that TO was an independent risk factor for survival (P<0.05).Conclusion Age, gender, DLCO%, and surgical option were inde-pendent predictors of TO in elderly patients with NSCLC after surgery. The prognosis was significantly better in patients who achievedTO than in those who did not. |
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