结直肠肛门外科2025，Vol.31Issue(6)：558-564,7.DOI:10.19668/j.cnki.issn1674-0491.2025.06.010
基于结肠镜诊断的结直肠癌根治术后复发影响因素分析及列线图预测模型构建
Analysis of influencing factors for recurrence after radical resection of colorectal cancer based on colonoscopy diagnosis and construction of a nomogram prediction model
杜方伶 1杨志娟 1吴肖 2罗恒 3陈婷 3聂燕1
作者信息
- 1. 中国人民解放军空军军医大学第一附属医院消化内镜中心 陕西 西安 710032
- 2. 中国人民解放军空军军医大学第一附属医院消化外科 陕西 西安 710032
- 3. 中国人民解放军空军军医大学第一附属医院麻醉与围术期医学科 陕西 西安 710032
- 折叠
摘要
Abstract
Objectives To investigate the influencing factors for recurrence after radical resection of colorectal cancer based on colonoscopy diagnosis and to construct a nomogram prediction model.Methods A total of 146 patients who underwent radical colorectal cancer resection in the Department of Digestive Surgery of the First Affiliated Hospital of People's Liberation Army Air Force Medical University from July 2020 to June 2022 were selected as the study subjects.Univariate and multivariate logistic regression analyses were used to identify factors influencing recurrence after radical resection.A nomogram prediction model was constructed based on significant variables.Internal validation was per-formed using the bootstrap method.The model's discrimination,calibration,and clinical utility were evaluated using the receiver operating characteristic(ROC)curve,calibration curve,and decision curve analysis.Results During the 2-year postoperative follow-up,recurrence occurred in 43 of the 146 patients,with a recurrence rate of 29.5%(43/146).The pro-portions of lymphovascular invasion,perineural invasion,TNM stage(Ⅱ-Ⅲ),lymph node metastasis(N1-N2),depth of inva-sion(T2-T3),and preoperative TNF-α levels in the recurrence group were higher than those in the non-recurrence group,while the preoperative IFN-γ level was lower than that in the non-recurrence group(P＜0.05).Multivariate logistic regres-sion analysis showed that lymphovascular invasion and lymph node metastasis were independent risk factors for recur-rence(P＜0.05),while a preoperative IFN-γ level＞68.75 pg/mL was a protective factor(P＜0.05).The C-index of the no-mogram prediction model was 0.842,and the area under the ROC curve was 0.867(95%CI:0.793-0.941).The calibration curve slope approached 1(χ²=7.215,P=0.514).Decision curve analysis showed that using this nomogram to predict re-currence risk provided significant clinical net benefit when the threshold probability for patients ranged from 0.08 to 0.85.Conclusion Lymphovascular invasion and lymph node metastasis are independent risk factors for recurrence after radical colorectal cancer resection,while a preoperative IFN-γ level＞68.75 pg/mL is a protective factor.The constructed nomogram prediction model demonstrates good discriminatory performance and can be used to assist in identifying high-risk patients and optimizing individualized postoperative management and interventions.关键词
结直肠癌/结肠镜/结直肠癌根治术/复发/危险因素/列线图Key words
colorectal cancer/colonoscopy/radical resection of colorectal cancer/recurrence/risk factors/nomogram分类
医药卫生引用本文复制引用
杜方伶,杨志娟,吴肖,罗恒,陈婷,聂燕..基于结肠镜诊断的结直肠癌根治术后复发影响因素分析及列线图预测模型构建[J].结直肠肛门外科,2025,31(6):558-564,7.
