Li Q, Zhang J, Su J B, Jin Z C, Wu Y H, Cai Z Q, Si S B, Deng Y, Zhang D, Geng Z M
Department of Hepatobiliary Surgery,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China.
Department of Industrial Engineering,School of Mechanical Engineering,Northwestern Polytechnical University,Xi'an 710072,China.
Zhonghua Wai Ke Za Zhi. 2021 Apr 1;59(4):272-278. doi: 10.3760/cma.j.cn112139-20201224-00876.
To evaluate the related factors of gallstones related gallbladder intraepithelial neoplasia(GBIN) and establish the prediction models for gallstones related GBIN. The clinicopathological data of 750 patients who underwent cholecystectomy for gallstones at Department of Hepatobiliary Surgery of the First Affiliated Hospital of Xi'an Jiaotong University from January 2013 to December 2018 and the postoperative pathological examination showed chronic cholecystitis or GBIN were analyzed retrospectively,including 150 cases of gallstones with GBIN and 600 cases of gallstones with chronic cholecystitis.There were 264 males and 486 females with age of (51.3±14.5) years (range: 18 to 90 years).The related factors for gallstones related GBIN were screened by χ test and Logistic regression model,and the prediction models were established based on independent related factors and internal validation was conducted.The original data were randomly divided into a training cohort(526 cases) and a validation cohort(224 cases) at a ratio of 7∶3,and the nomogram and tree augmented naïve Bayes were conducted to establish the prediction model for gallstones related GBIN.The consistency index(C-index),calibration chart,area under the receiver operating characteristic curve(AUC) and confusion matrix were used to evaluate the prediction performance of the two models. Univariate analysis showed that age,gallstones history(years),gallbladder size,whether the gallbladder mucosa smooth or not,whether the gallbladder wall thickened or not,gallstones diameter,and number of gallstones were related factors for the occurrence of gallstones related GBIN (χ²=19.957,8.599,9.724,9.301,8.341,15.288,9.169,all <0.05).Multivariate analysis showed that age (=2.23,95%:1.50-3.31,<0.01),gallbladder size (=2.11,95%:1.17-3.80,=0.013),whether the gallbladder mucosa smooth or not (=1.80,95%=1.13-2.88,=0.014),gallstones diameter(=2.98,95%:1.71-5.21,<0.01),and number of gallstones (=2.14,95%=1.34-3.42,<0.01) were independent related factors for the occurrence of gallstones related GBIN; the C-index of the nomogram in training cohort and validation cohort were 0.708 and 0.696,respectively.The AUC of the two models in training cohort were 70.60% and 70.73%,and in validation cohort were 68.14% and 67.47%,respectively.The accuracy of the two models in training cohort were 69.96% and 70.72%,and in validation cohort were 66.96% and 67.41%,respectively. Age,gallbladder size,whether the gallbladder mucosa smooth or not,gallstones diameter and number of gallstones are independent related factors for the occurrence of gallstones related GBIN,and the nomogram and tree augmented naïve Bayes prediction models based on the above factors can be used to predict the occurrence of GBIN.
评估胆囊结石相关的胆囊上皮内瘤变(GBIN)的相关因素,并建立胆囊结石相关GBIN的预测模型。回顾性分析2013年1月至2018年12月在西安交通大学第一附属医院肝胆外科因胆囊结石行胆囊切除术且术后病理检查显示为慢性胆囊炎或GBIN的750例患者的临床病理资料,其中胆囊结石合并GBIN患者150例,胆囊结石合并慢性胆囊炎患者600例。男性264例,女性486例,年龄(51.3±14.5)岁(范围:18至90岁)。采用χ²检验和Logistic回归模型筛选胆囊结石相关GBIN的相关因素,基于独立相关因素建立预测模型并进行内部验证。将原始数据按7∶3的比例随机分为训练队列(526例)和验证队列(224例),采用列线图和树增强朴素贝叶斯建立胆囊结石相关GBIN的预测模型。采用一致性指数(C指数)、校准图、受试者操作特征曲线下面积(AUC)和混淆矩阵评估两种模型的预测性能。单因素分析显示,年龄、胆结石病史(年)、胆囊大小、胆囊黏膜是否光滑、胆囊壁是否增厚、胆结石直径和胆结石数量是胆囊结石相关GBIN发生的相关因素(χ²=19.957、8.599、9.724、9.301、8.341、15.288、9.169,均<0.05)。多因素分析显示,年龄(β=2.23,95%CI:1.50 - 3.31,P<0.01)、胆囊大小(β=2.11,95%CI:1.17 - 3.80,P=0.013)、胆囊黏膜是否光滑(β=1.80,95%CI=1.13 - 2.88,P=0.014)、胆结石直径(β=2.98,95%CI:1.71 - 5.21,P<0.01)和胆结石数量(β=2.14,95%CI=1.34 - 3.42,P<0.01)是胆囊结石相关GBIN发生的独立相关因素;训练队列和验证队列中列线图的C指数分别为0.708和0.696。两种模型在训练队列中的AUC分别为70.60%和70.73%,在验证队列中分别为68.14%和67.47%。两种模型在训练队列中的准确率分别为69.96%和70.72%,在验证队列中分别为66.96%和67.41%。年龄、胆囊大小、胆囊黏膜是否光滑、胆结石直径和胆结石数量是胆囊结石相关GBIN发生的独立相关因素,基于上述因素的列线图和树增强朴素贝叶斯预测模型可用于预测GBIN的发生。