中西医结合肝病杂志2025，Vol.35Issue(9)：1088-1092,5.DOI:10.3969/j.issn.1005-0264.2025.009.007
肝内胆管癌患者术后预后影响因素分析及列线图模型构建
Analysis of factors affecting postoperative prognosis in patients with intrahepatic cholangiocarcinoma and construction of nomogram model
摘要
Abstract
Objective:To explore the influencing factors of postoperative prognosis in patients with intrahepatic cholangiocarcinoma(ICC),and to construct a nomogram model.Methods:The clinical data of 360 patients with ICC who underwent radical resection in our hospital from March 2018 to March 2023 were retrospectively analyzed.They were randomly divided into modeling set(252 cases)and validation set(108 cases)according to the ratio of 7∶3.According to the prognosis of patients at one year after operation,the modeling set was divided into the poor prognosis group(98 cases)and a good prognosis group(154 cases).The general data of the two groups were compared.Multivariate Cox regression analysis was used to screen the prognostic factors of patients with ICC after operation,and a nomogram model was constructed.The predictive efficacy of the nomogram was verified by consistency index(C-index),calibration curve,and receiver operating characteristic(ROC)curve.Results:The incidence rate of poor prognosis in 360 ICC patients was 38.61%(139/360).The proportions of TNM stage Ⅲ,low tumor differentiation,multiple tumor number,lymph node metastasis,vascular invasion,vascular invasion,tumor maximum diameter>5 cm,carbohydrate antigen(CA19-9)>37 U/ml and carcinoembryonic antigen(CEA)>5 μg/L in the poor prognosis group were higher than those in the good prognosis group(P<0.05).Multivariate Cox regression analysis showed that TNM stageⅢ,poorly differentiated tumors,multiple tumors,lymph node metastasis,maximum tumor diameter>5 cm,CA19-9>37 U/ml and CEA>5 μg/L were risk factors for poor prognosis in ICC patients(P<0.05).Based on the above influencing factors,a nomogram model of postoperative poor prognosis of ICC patients was constructed.The results of Bootstrap method showed that the C-index of the modeling set and the validation set were 0.835 and 0.829 respectively.The calibration plot showed that the predicted probability was similar to the actual probability.The results of ROC curve showed that the area under the curve,sensitivity,and specificity of the nomogram in predicting the poor prognosis of ICC patients in the modeling set and validation set were 0.887,83.67%,82.47%and 0.861,82.93%,80.60%respectively.Conclusion:TNM stage,tumor differentiation,tumor number,lymph node metastasis,tumor maximum diameter,CA19-9,and CEA are all risk factors for poor prognosis of ICC patients after operation,and the nomogram model constructed according to this has good predictive value.关键词
肝内胆管癌/预后/影响因素/列线图Key words
intrahepatic cholangiocarcinoma/prognosis/influencing factors/nomogram分类
医药卫生引用本文复制引用
徐文会,李渊,刘竞航..肝内胆管癌患者术后预后影响因素分析及列线图模型构建[J].中西医结合肝病杂志,2025,35(9):1088-1092,5.基金项目
南阳市市级科技计划项目(No.JCQY017) （No.JCQY017）
