结肠息肉癌变的危险因素分析和风险预测模型构建OA

Objective To analyze the risk factors of colon polyps canceration and construct a risk prediction model for colon polyps canceration.Methods The clinicopathological data of 1029 patients with complete data who underwent colonic polypectomy under colonoscopy in the First Affiliated Hospital of Anhui Medical University from January 2020 to October 2022 were retrospectively analyzed.According to the pathological results,they were divided into cancerous group and non-cancerous group.Univariate analysis was performed on the clinical data of the two groups,and the indicators with statistical significance in univariate analysis were included in multivariate logistic regression analysis to screen out the independent risk factors for colon polyps canceration.Based on the independent risk factors,a risk prediction model for canceration in patients with colon polyps was constructed.Bootstrap resampling was used to verify the model internally,and the receiver operating characteristic curve(ROC curve)was drawn to evaluate the accuracy of the nomogram.The consistency of the prediction model was judged by Hosmer-Lemeshow(H-L)and calibration curve test.The clinical effectiveness of the model was evaluated by clinical decision curve.Results Among the 1029 patients,336 patients were in the cancerous group and 693 patients in the non-cancerous group.There were statistically significant differences in body mass index,history of other intestinal diseases,history of gallbladder surgery,history of appendectomy,number of polyps,maximum diameter of polyps,location of polyps,blood glucose,serum total cholesterol,serum high-density lipoprotein cholesterol and serum low-density lipoprotein cholesterol between the two groups(P＜0.05).Multivariate logistic regression analysis showed that no history of appendectomy,polyps diameter＞1 cm,number of polyps ≥3,and polyp in transverse colon or sigmoid colon were independent risk factors for polyps canceration(P＜0.05).The cancer risk prediction model was constructed as follows:y=-4.517-2.578×(history of appendectomy)+1.807×(number of polyps ≥3)+3.145×(polyps diameter＞1 cm)-1.023×(transverse colon polyps)+0.541×(sigmoid colon polyps).The area under the ROC curve(AUC)of the prediction model was 0.876,95％CI(0.855-0.898),and AUC=0.877,95％CI(0.860-0.880)in the validation group.The H-L test showed that the goodness of fit of the model was high(P=0.627,x2=6.184),and the calibration curve of the nomogram was close to the reference line.Conclusion No history of appendectomy,polyps diameter＞l cm,number of polyps ≥3,and polyp in transverse colon or sigmoid colon are independent risk factors for colon polyps canceration.The prediction model based on this has good predictive value.