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《国际消化病杂志》[ISSN:1673-534X/CN:31-1953/R]

期数:

2024年06期

页码:

369-375

栏目:

论著

出版日期:

2024-12-20

文章信息/Info

Title:

Analysis of risk factors for recurrence after endoscopic submucosal dissection in gastric adenocarcinoma of the fundic gland type and development of a Nomogram model

作者:

夏志强; 黄勇亮; 林 欢; 卢美兰; 马 曦; 黄 欢; 蒋玉婷; 易红梅; 许永春

330000 江西南昌，中国人民解放军联勤保障部队第九〇八医院消化内科

Author(s):

XIA Zhiqiang;  HUANG Yongliang;  LIN Huan;  LU Meilan;  MA Xi;  HUANG Huan;  JIANG Yuting;  YI Hongmei;  XU Yongchun

Department of Gastroenterology, 908th Hospital of the Joint Service Support Force of the Chinese People's Liberation Army, Nanchang 330000, China

关键词:

胃底腺型胃癌; 黏膜下层; 内镜黏膜下剥离术; 复发; Nomogram模型

Keywords:

Gastric adenocarcinoma of fundic gland type;  Submucosal layer;  Endoscopic submucosal dissection;  Recurrence;  Nomogram model

分类号:

-

DOI:

10.3969/j.issn.1673-534X.2024.06.005

文献标识码:

-

摘要:

目的分析影响胃底腺型胃癌（GA-FG）经内镜黏膜下剥离术（ESD）后复发的危险因素，并构建其Nomogram预测模型。方法选择2016年12月至2021年12月于中国人民解放军联勤保障部队第九〇八医院接受ESD治疗的110例GA-FG患者作为研究对象，按照8∶2比例将患者随机分为训练集（88例）和验证集（22例）。收集入组患者的人口学特征、临床病理特征、实验室检查数据和手术相关资料。采用门诊复查的方式对术后患者进行为期2年的随访，根据复发情况将患者分为复发组和未复发组。采用Cox比例风险回归模型分析GA-FG术后复发的危险因素，基于此构建Nomogram模型并验证。采用ROC曲线评估Nomogram模型预测GA-FG术后复发的效能。结果88例GA-FG患者中有24例复发，复发率为27.27%。与未复发组相比，复发组中合并糖尿病者占比、低分化者占比，以及二胺氧化酶（DAO）、表皮生长因子（EGF）和凋亡抑制因子Livin水平均显著升高，差异均有统计学意义（P均＜0.05）。多因素Cox比例风险回归模型分析结果显示，合并糖尿病、低分化、DAO、EGF和Livin均是影响GA-FG术后复发的独立危险因素（P均＜0.05）。ROC曲线分析结果显示，Nomogram模型预测GA-FG术后复发的曲线下面积（AUC）为0.883（95%CI：0.824～0.936），敏感度为0.827（95%CI：0.736～0.914），特异度为0.832（95%CI：0.749～0.912）。模型验证结果显示，Nomogram模型的区分度良好，且校正曲线与理想曲线的拟合度良好。结论合并糖尿病、低分化、DAO、EGF和Livin均是影响GA-FG术后复发的独立危险因素，基于这5项影响因素构建的Nomogram模型对于GA-FG术后复发的预测效能较高。

Abstract:

Objective This paper attempts to analyze the risk factors for recurrence of gastric adenocarcinoma of the fundic gland type (GA-FG) after endoscopic submucosal dissection (ESD) and to develop a Nomogram prediction model. Methods? A total of 110 patients with GA-FG who underwent ESD treatment at the 908th Hospital of the Joint Service Support Force of the Chinese People's Liberation Army between December 2016 and December 2021 were selected as the research subjects. The patients were randomly divided into a training set (88 cases) and a validation set (22 cases) in a ratio of 8:2. Demographic,clinical, and pathological characteristics, laboratory data, and surgical information were collected. A 2-year follow-up was conducted via outpatient visits, and patients were divided into recurrence and non-recurrence groups based on their recurrence status. The Cox proportional hazards regression model was used to analyze the risk factors for postoperative recurrence of GA-FG, and a Nomogram model was constructed and validated. The ROC curve was used to assess the performance of the Nomogram model in predicting postoperative recurrence. Results? Among the 88 GA-FG patients in the training set, 24 experienced recurrence, with a recurrence rate of 27.27%. Compared to the non-recurrence group, the recurrence group has a higher proportion of patients with diabetes, poor differentiation, and elevated levels of diamine oxidase (DAO), epidermal growth factor (EGF), and the apoptosis inhibitor Livin, with statistically significant differences (P＜0.05). Multivariate Cox proportional hazards regression analysis shows that the combination of diabetes, poor differentiation, DAO, EGF, and Livin are independent risk factors for postoperative recurrence of GA-FG (P＜0.05). The ROC curve analysis yields an area under the curve (AUC) of 0.883 (95%CI: 0.824–0.936), with a sensitivity of 0.827 (95%CI: 0.736–0.914) and a specificity of 0.832 (95%CI:0.749–0.912). The model validation results show that the Nomogram model has good discriminability, and the calibration curve closely matches the ideal curve. Conclusions? The combination of diabetes, poor differentiation, DAO, EGF, and Livin are independent risk factors for the postoperative recurrence of GA-FG. The Nomogram model, based on these five influencing factors, has a high predictive accuracy for postoperative recurrence of GA-FG.

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备注/Memo

备注/Memo:

通信作者：许永春，Email: 13970039129@139.com

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更新日期/Last Update: 2024-12-20