Zhang Peng, Ma Xiaoying, Tian Zibin, Cui Zheng, Zhang Zhen, Mao Tao
Department of Gastroenterology, The Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao City, Shandong Province, 266000, China.
Department of Gastroenterology, Qingdao Municipal Hospital, Qingdao City, Shandong Province, China.
BMC Surg. 2025 Oct 31;25(1):512. doi: 10.1186/s12893-025-03265-1.
To develop and validate a prognostic model incorporating microRNA-1246 (miR-1246), high-mobility group box 1 (HMGB-1), α1-antitrypsin (A1AT), and inflammatory markers for predicting outcomes in early gastric cardia cancer after endoscopic submucosal dissection (ESD).
We retrospectively enrolled 280 patients with early gastric cardia cancer who underwent ESD between January 2021 and December 2023. Patients were divided into a training set (n = 196) and a validation set (n = 84) at a ratio of 7:3. Influencing factors were screened using univariate, Least Absolute Shrinkage and Selection Operator (LASSO), and multivariate logistic regression analyses in the training set. A nomogram was constructed, and the predictive performance was assessed using receiver operating characteristic (ROC) curves and calibration curves. Decision curve analysis (DCA) was used to evaluate the clinical value.
The incidence of poor prognosis was comparable between training (43.88%) and validation set (34.52%). Multivariate logistic regression analysis identified miR-1246, HMGB-1, A1AT, tumor necrosis factor-α (TNF-α), and Helicobacter pylori infection as independent risk factors for poor prognosis (All P < 0.05). The nomogram demonstrated acceptable discriminative ability, with AUC of 0.789 (95% CI: 0.701-0.877) in the training set and 0.735 (95% CI: 0.638-0.835) in the validation set. The sensitivity and specificity were 0.625 and 0.841 for the training set, and 0.481 and 0.786 for the validation set, respectively. Calibration curves indicated good agreement between predicted and observed probabilities.
The proposed prognostic model offers a practical tool for individualized risk assessment post-ESD. However, the clinical application warrants further validation in large-scale, multi-center prospective studies with long-term follow-up.
建立并验证一个包含微小RNA-1246（miR-1246）、高迁移率族蛋白B1（HMGB-1）、α1-抗胰蛋白酶（A1AT）和炎症标志物的预后模型，用于预测早期贲门胃癌内镜黏膜下剥离术（ESD）后的预后。
我们回顾性纳入了2021年1月至2023年12月期间接受ESD的280例早期贲门胃癌患者。患者按7:3的比例分为训练集（n = 196）和验证集（n = 84）。在训练集中，使用单因素、最小绝对收缩和选择算子（LASSO）以及多因素逻辑回归分析筛选影响因素。构建列线图，并使用受试者操作特征（ROC）曲线和校准曲线评估预测性能。采用决策曲线分析（DCA）评估临床价值。
训练集（43.88%）和验证集（34.52%）的预后不良发生率相当。多因素逻辑回归分析确定miR-1246、HMGB-1、A1AT、肿瘤坏死因子-α（TNF-α）和幽门螺杆菌感染为预后不良的独立危险因素（所有P < 0.05）。列线图显示出可接受的判别能力，训练集的AUC为0.789（95% CI：0.701 - 0.877），验证集的AUC为0.735（95% CI：0.638 - 0.835）。训练集的敏感性和特异性分别为0.625和0.841，验证集分别为0.481和0.786。校准曲线表明预测概率与观察概率之间具有良好的一致性。
所提出的预后模型为ESD术后个体化风险评估提供了一个实用工具。然而，其临床应用需要在大规模、多中心的长期随访前瞻性研究中进一步验证。
