_video 辅助胸腔镜肺叶切除术治疗 IA 期肺腺癌复发和转移的预测列线图。

Nomogram for predicting recurrence and metastasis of stage IA lung adenocarcinoma treated by videoassisted thoracoscopic lobectomy.

机构信息

Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, China; Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education, School of Basic Medical Science, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou, China.

出版信息

Asian J Surg. 2022 Dec;45(12):2691-2699. doi: 10.1016/j.asjsur.2022.01.010. Epub 2022 Feb 10.

DOI:10.1016/j.asjsur.2022.01.010

PMID:35153141

Abstract

OBJECTIVE

This study aimed to construct a nomogram to effectively predict recurrence and metastasis in patients with stage 1A lung adenocarcinoma after video-assisted thoracoscopic surgery (VATS) lobectomy.

METHODS

Our study included 337 patients. The 3-year recurrence-free survival rate and the 5-year recurrence-free survival (5-RFS) rate were analyzed. Multivariate Cox proportional hazards regression was conducted to identify independent risk factors. We established a nomogram and performed Harrell's Concordance index, calibration plots, integrated discrimination improvement, and decision curve analyses to assess its discrimination and calibration.

RESULTS

The median follow-up time was 45 months. In a multivariate analysis, tumor diameter, pathological subtype, preoperative carcinoembryonic antigen level, and preoperative CYFRA21-1 level were independent prognostic factors for RFS (P < 0.05). These risk factors were used to construct a nomogram to predict postoperative recurrence and metastasis in these patients. Internal verification was performed using the bootstrap method. The C-index was 0.946 (95% confidence interval: 0.923-0.970), indicating that the model had a good predictive performance. Using the nomogram and X-tile software, the patients were divided into two groups: the high-risk (5-RFS rate, 0.10-0.90) and low-risk groups (5-RFS rate, 0.90-0.99); the difference in the RFS rate between the groups was significant (χ2 = 86.705, P < 0.001).

CONCLUSIONS

Our nomogram had a better predictive ability for recurrence and metastasis in patients with stage 1A lung adenocarcinoma after VATS lobectomy resection than the Tumor-Node-Metastasis staging system and other predictive models. This nomogram can help provide individualized treatment strategies and follow-up times.

摘要

目的

本研究旨在构建一个列线图，以有效预测接受电视辅助胸腔镜手术（VATS）肺叶切除术后 1A 期肺腺癌患者的复发和转移。

方法

本研究纳入了 337 例患者。分析了 3 年无复发生存率和 5 年无复发生存率（5-RFS）。采用多变量 Cox 比例风险回归分析确定独立的危险因素。我们建立了一个列线图，并进行了 Harrell 的一致性指数、校准图、综合判别改善和决策曲线分析，以评估其判别和校准能力。

结果

中位随访时间为 45 个月。多变量分析显示，肿瘤直径、病理亚型、术前癌胚抗原水平和术前细胞角蛋白 19 片段 21-1 水平是 RFS 的独立预后因素（P<0.05）。这些危险因素被用于构建一个列线图，以预测这些患者术后的复发和转移。内部验证采用 bootstrap 方法。C 指数为 0.946（95%置信区间：0.923-0.970），表明该模型具有良好的预测性能。使用列线图和 X-tile 软件，将患者分为两组：高风险组（5-RFS 率为 0.10-0.90）和低风险组（5-RFS 率为 0.90-0.99）；两组间 RFS 率差异有统计学意义（χ2=86.705，P<0.001）。