早期胃癌ESD术后非治愈性切除预测模型的建立与验证OACSTPCD

Objective To establish a prediction model for non-curative resection in patients with early gastric cancer(EGC)who underwent endoscopic submucosal dissection(ESD),and to evaluate its predictive value.Methods Clinical data of EGC patients in the Second Hospital&Clinical Medical School,Lanzhou University from January 2014 to July 2023 were retrospectively collected.According to the postoperative patho-logical results of ESD,the patients were divided into curative resection group and non-curative resection group.Multifactorial Logistic regression analysis was used to screen the risk factors for non-curative resection after ESD surgery and establish a prediction model,and the model was evaluated using receiver operating characteristic(ROC)curves,calibration curves and clinical decision curve analysis.Results A total of 479 EGC patients who underwent ESD were included,with 60 cases in the non-curative resection group and 419 cases in the cura-tive resection group.The results of multifactorial Logistic regression analysis showed that the lesion diameter＞2cm(OR=3.017,95%CI:1.483-6.136,P=0.002),flat lesion morphology(OR=2.712,95%CI:0.774-9.497,P=0.043),undifferentiated/mixed histologic type(OR= 4.199,95%CI:1.621-10.872,P=0.003),and submucosal infiltration(OR= 30.329,95%CI:13.059-70.436,P＜0.001)were inde-pendent risk factors for non-curative resection after ESD in EGC patients.The area under the curve of ROC vali-dated within the column-line graph prediction model constructed accordingly was 0.867(95%CI:0.811-0.923),the calibration curve showed that the model had good calibration,and decision curve analysis showed the model had a good clinical usefulness.Conclusions The prediction model constructed based on lesion di-ameter,lesion morphology,histologic type,and depth of mucosal infiltration has good differentiation,calibra-tion,and clinical utility.This model is expected to assist in the early clinical screening of the population at high risk for noncurative resection after ESD in patients with EGC,and to provide a basis for the development of op-timal clinical decisions.