Analysis of relative factors associated with lymph node metastasis in 1 085 patients with invasive lung adenocarcinoma and construction of a nomogram
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摘要:
目的 探究浸润性肺腺癌淋巴结转移与肺腺癌病理亚型等相关因素之间的关系。 方法 收集1 085例浸润性肺腺癌患者的相关临床病理资料，对其淋巴结转移情况与年龄、性别、病理亚型、肿瘤部位、肿瘤最大径、胸膜侵犯6项因素之间的关系进行分析。将单因素分析中有意义的变量纳入多因素Logistic回归模型中，以此为基础构建诺模图，并用一致性指数（C-index）、校正模型、受试者工作特征（ROC）曲线等对该模型进行评价。 结果 多因素非条件Logistic回归分析结果显示，年龄≤67岁（OR=1.599，P= 0.036）、病理亚型（OR=1.337，P < 0.001）、肿瘤部位（OR=1.162，P=0.027）、肿瘤最大径（OR=1.765，P < 0.001）、胸膜侵犯（OR=2.179，P < 0.001）为肺癌淋巴结转移的独立风险因素。应用上述因素构建诺模图，对该诺模图模型进行验证，C-index为0.860（95%CI：0.834~0.885），校正曲线有较好的一致性，ROC曲线下面积（AUC）为0.829（95%CI：0.799~0.858）。 结论 年龄≤67岁、病理亚型、肿瘤部位、肿瘤最大径及胸膜侵犯为肺腺癌淋巴结转移的风险因素，对淋巴结转移具有重要预测意义。本研究构建的诺模图预测模型预测能力较好。 -
关键词:
- 浸润性肺腺癌 /
- 淋巴结转移 /
- 病理亚型 /
- 诺模图 /
- 免试者工作特征曲线分析
Abstract:Objective To investigate the relationship between lymph node metastasis of lung adenocarcinoma and relative factors. Methods A total of 1 085 patients diagnosed with invasive lung adenocarcinoma were enrolled. The relationship between lymph node metastasis and relative factors, including age, sex, adenocarcinoma subtype, tumor location, tumor size and pleural invasion, was analyzed statistically. The relative factors were selected using a chi-square test for univariate analysis. Statistically significant prognostic factors were analyzed using a Logistic regression model. Based on this model, a nomogram was developed and evaluated using Harrell's concordance index (Cindex), calibration plots and a receiver operating characteristic curve (ROC). Results The results of multivariate unconditional Logistic regression analysis showed that age ≤67 years (OR=1.599, P=0.036), adenocarcinoma subtype (OR=1.337, P < 0.001), tumor location (OR= 1.162, P=0.027), tumor size (OR=1.765, P < 0.001) and pleural invasion (OR=2.179, P < 0.001) were independent risk factors for lymph node metastasis of lung adenocarcinoma. These factors were incorporated to construct a nomogram. Its C-index was 0.860 (95%CI: 0.834-0.885). The calibration curve showed excellent agreement between the predicted and observed risks of lymph node metastasis of lung adenocarcinoma. The area under the curve (AUC) of the ROC curve was 0.829 (95%CI: 0.799-0.858). Conclusions Age, adenocarcinoma subtype, tumor location, tumor size and pleural invasion were independent risk factors, significant for predicting lymph node metastasis of lung adenocarcinoma. A nomogram was constructed and validated to have a good predictive ability. -
图 1 预测肺腺癌淋巴结转移风险的诺模图模型
RUL：右上肺；RML：右中肺；RLL：右下肺；LUL：左上肺；LLL：左下肺；肿瘤最大径1为≤1.0 cm，2为1.0~1.5 cm，3为1.5~2.0 cm，4为2.0~2.5 cm，5为2.5~3.0 cm，6为≥3.0 cm
表 1 肺浸润性腺癌相关因素与淋巴转移之间的关系
n（%） 
表 2 非条件多因素Logistic回归分析
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