| 付超,胡延伟,张婉琼,等.胃癌根治术后腹膜复发的危险因素分析[J].安徽医药,2024,28(2):303-308. |
| 胃癌根治术后腹膜复发的危险因素分析 |
| Analysis of risk factors of peritoneal recurrence in patients with gastric cancer after radical surgery |
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| DOI：10.3969/j.issn.1009-6469.2024.02.020 |
| 中文关键词: 胃肿瘤 胃切除术 腹膜复发 列线图预测模型 化疗获益 |
| 英文关键词: Stomach neoplasms Gastrectomy Peritoneal recurrence Nomogram Chemotherapeutic benefits |
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| 中文摘要: |
| 目的探讨胃癌根治术后腹膜复发的危险因素。方法收集 2010年 1月至 2018年 12月邢台市中心医院接受胃癌根治术的 861例胃腺癌病人的一般资料，按 7∶3随机分为训练集( 603例)和测试集( 258例)并根据术后复发情况将全组病人分为腹膜复发组与非腹膜复发组。在训练集中，采用 logistic回归模型分析影响术后腹膜复发，的独立相关因素，并建立列线图预测模型。分别应用受试者操作特征( ROC)曲线与校准曲线在训练集与测试集中评估模型的预测准确性与一致性。根据列线图分数将全组病人分为 3个风险组，比较不同风险组的术后腹膜复发率与化疗获益。结果 861例胃癌病人中， 99例发生了术后腹膜复发。单因素分析显示，年龄、性别、组织学分级、 Lauren分型、 pT分期、 pN分期、脉管与神经侵犯、辅助化疗与术后腹膜复发显著相关( P<0.05)。基于向后逐步回归法的多因素分析显示，年龄 <60岁、女性、弥漫型肿瘤、病理分期晚期是术后腹膜复发的独立危险因素( P<0.05)。基于以上指标构建列线图预测模型，该模型在训练集与测试集中均具有良好的预测准确性 |
| 英文摘要: |
| Objective To investigate the risk factors for peritoneal recurrence in patients with gastric cancer (GC).Methods Data on 861 GC patients were collected in Xingtai Central Hospital fromJanuary 2010toDecember 2018. Patients were randomly classified into the training set (n=603) and testing set (n=258) in a ratio of 7∶3, and were classified into the peritoneal-recurrence (PR) and non-PR groups according to the recurrence status.Logistic regression model was used to identify the independent predictive factors for peri.toneal recurrence in the training set.A nomogram was then constructed based on these factors.The predictive accuracy and good fit ofthe nomogram were evaluated by the receiver operating characteristic curve and calibration curve in both training and testing sets, re.spectively. The entire cohort was divided into three risk groups according to the nomogram. The incidence rate of peritoneal recurrenceand chemotherapeutic benefits were compared among groups.Results Of the 861 GC patients,99 cases experienced peritoneal recur.rence.Univariate analysis revealed that age,gender,histological grade,Lauren type, pT stage, pN stage, lymphovascular invasion, neuralinvasion, and adjuvant chemotherapy were significantly associated with the risk of postoperative peritoneal recurrence (P<0.05). Multi.variate analysis with backward stepwise regression revealed that age <60 years, female gender, diffuse tumors, and advanced tumorswere independent risk factors for postoperative peritoneal recurrence (P<0.05). A nomogram constructed based on these factors demon. strated high predictive accuracy (AUC=0.83) and good fit (Hosmer-Lemeshow P>0.05). Based on the nomogram, the entire cohort was divided into the low-, middle-, and high-risk groups. The incidence rates of peritoneal recurrence in these three groups were 1.9%,17.3%, and 50.0%, respectively. The receipt of adjuvant chemotherapy failed to decrease the incidence rates of peritoneal recurrencein these three groups.Conclusion Age <60 years, female gender, diffuse tumors, and advanced tumors were independent risk factorsfor postoperative peritoneal recurrence in GC patients who received radical surgery. |
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