中国普通外科杂志2024，Vol.33Issue(2)：219-226,8.DOI:10.7659/j.issn.1005-6947.2024.02.008
基于血脂异常及相关因素的肝内胆管癌发生风险列线图预测模型构建
Construction of a nomogram predictive model for the risk of intrahepatic cholangiocarcinoma based on dyslipidemia and related factors
摘要
Abstract
Background and Aims:Intrahepatic cholangiocarcinoma(ICC)is insidious in onset and progresses rapidly,often causing patients to miss the optimal surgical window when diagnosed.The mechanism underlying ICC occurrence remains unclear,potentially involving multiple factors,and dyslipidemia currently is identified as one of the risk factors.Therefore,this study was conducted to investigate the association between dyslipidemia and other risk factors with the occurrence of ICC,and to construct a nomogram prediction model,so as to facilitate early prevention for high-risk individuals for ICC and ultimately reduce the incidence rate. Methods:A retrospective analysis was conducted on 5 906 liver surgery patients admitted in the Department of General Surgery of Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,from January 2015 to January 2023.Among them,ICC patients and non-cancer patients were designated as the case group and control group,respectively.Basic data and biochemical indicators were collected before treatment.Lipid indexes and other risk factors were included in univariate and multivariate regression analyses to identify independent risk factors for ICC occurrence.A nomogram prediction model was constructed to assess the impact of each factor.The clinical predictive performance of the nomogram model was evaluated using receiver operating characteristic(ROC)curve,calibration curve,and decision curve. Results:A total of 351 ICC patients and 2 145 non-cancer patients were included.Univariate analysis showed that the sex,age,and the proportion of diabetes,hypertension,cirrhosis,hepatitis B,history of bile duct stones,and history of schistosomiasis,as well as the serum triglycerides,serum total cholesterol,and serum high-density lipoprotein cholesterol(HDL-C)levels were significantly different between the two groups(all P＜0.05).Logistic multivariate regression analysis revealed that age,hypertension,diabetes,hepatitis B,cirrhosis,and low blood HDL-C(＜0.83 mmol/L)were independent risk factors for ICC occurrence,while a history of intrahepatic bile duct stones was a protective factor against ICC occurrence(all P＜0.05).A nomogram prediction model for ICC occurrence constructed based on these risk factors had an area under the ROC curve of 0.771(95％CI=0.744-0.797,P＜0.001).The calibration curve showed good fit between the predicted and actual curves,and the decision curve indicated that the model had good clinical benefits and efficacy at risk thresholds of approximately 0.1-0.4,and its performance surpassed that of a single indicator. Conclusion:Low blood HDL-C is closely associated with ICC occurrence.The nomogram prediction model constructed based on low blood HDL-C and other six factors can provide references for the prevention and clinical treatment of ICC.关键词
胆管肿瘤/胆管,肝内/血脂异常/危险因素/列线图Key words
Bile Duct Neoplasms/Bile Ducts,Intrahepatic/Dyslipidemias/Risk Factors/Nomograms分类
医药卫生引用本文复制引用
徐铮澳,梁霄..基于血脂异常及相关因素的肝内胆管癌发生风险列线图预测模型构建[J].中国普通外科杂志,2024,33(2):219-226,8.基金项目
国家自然科学基金基金资助项目(82072625) （82072625）
浙江省科技厅"领雁"计划基金资助项目(2024C03049) （2024C03049）
浙江省卫生健康重大科技计划重大基金资助项目(WKJ-ZJ-2407) （WKJ-ZJ-2407）
浙江省杭州市科技局农业与社会发展领域重点基金资助项目(20231203A09). （20231203A09）
