肿瘤预防与治疗2026，Vol.39Issue(9)：734-744,11.DOI:10.3969/j.issn.1674-0904.2026.09.002
基于肠屏障、免疫功能及术后疲劳指标构建腹腔镜结肠癌术后不良预后的列线图预测模型
Developing a Nomogram Prediction Model for Poor Prognosis after Laparo-scopic Colon Cancer Surgery Based on Gut Barrier Function,Immune Status,and Fatigue Indicators
摘要
Abstract
Objective:The short-term poor prognosis rate after laparoscopic colon cancer surgery is relatively high.The existing assessment system relies solely on pathological indicators and lacks comprehensive evaluations of body functions such as intestinal barrier,cellular immunity,and postoperative fatigue.This study integrates multiple objective indicators to screen independent risk factors for poor prognosis after 6 months of surgery,constructs a visual prediction nomogram and completes internal and external validations,quantifies the gain in model predictive efficacy brought by the new functional in-dicators,and provides a quantitative tool for stratified intervention of high-risk patients in clinical practice.Methods:A total of 420 patients who underwent laparoscopic radical resection for colon cancer in our hospital from July 2024 to January 2025 were selected as the modeling set.These patients were divided into the poor prognosis group(79 cases)and the good progno-sis group(341 cases)based on whether they developed adverse outcomes 6 months after the surgery.Another 120 patients admitted to our hospital from February 2025 to July 2025 were selected as the external validation group.The intestinal barri-er,immune function,postoperative fatigue(Inventory of Cancer Fatigue Scale,ICFS),and clinical pathological indicators were tested.Key variables were selected through univariate analysis and Lasso regression.A multivariate Logistic regression model was constructed and a nomogram was developed.The discrimination,calibration,and clinical net benefit of the model were evaluated using the ROC curve,Hosmer-Lemeshow test,and decision curve analysis(DCA).The stability of the model was verified through external validation.The follow-up was completed by March 2026.Results:The training set showed 79 cases with poor prognosis(18.81%)and 341 cases with good prognosis(81.19%);the validation set showed 22 cases with poor prognosis(18.33%)and 98 cases with good prognosis(81.67%).Univariate analysis revealed that 20 indicators,in-cluding age,BMI,and tumor diameter,showed statistically significant differences(all P<0.001),and the trend was con-sistent in the validation set.Through Lasso regression and 10-fold cross-validation(optimal λ=0.085),seven key varia-bles were selected:pTNM stage,differentiation degree,vascular invasion,D-lactic acid(D-Lac),occludin,CD4+/CD8+,and ICFS on the third day after surgery.Multivariate Logistic regression showed that all the above variables were independent risk factors for poor prognosis 6 months after surgery(all P<0.001);among them,clinical stage Ⅲ～Ⅳ(OR=6.512,95%CI:3.485～12.163),poor differentiation(OR=4.701,95%CI:2.623～8.437),positive vascular invasion(OR=4.183,95%CI:2.391～7.312),elevated D-Lac(OR=1.244,95%CI:1.159～1.335),and elevated ICFS on the third day after surgery(OR=1.166,95%CI:1.114～1.221)were risk factors,while elevated occludin(OR=0.139,95%CI:0.072～0.267)and elevated CD4+/CD8+T lymphocyte ratio(CD4+/CD8+)were protective factors.Model performance verification:the AUC of the training set was 0.809(95%CI:0.733～0.884),with a sensitivity of 77.22%and a specificity of 80.35%;the AUC of the validation set was 0.738(95%CI:0.631～0.781),with a sensitiv-ity of 72.73%and a specificity of 79.59%.The Hosmer-Lemeshow test showed that the χ2 value of the training set was 6.884,P=0.549,and the χ2 value of the validation set was 5.927,P=0.641,indicating good model calibration.DCA confirmed that the model had significant net benefit within the probability range of 0.05～0.85(training set)and 0.06～0.83(validation set),with high clinical practicability.Conclusion:The nomogram model constructed based on intestinal barrier,immune function,postoperative fatigue and clinicopathological indicators exhibits good predictive performance for poor prognosis at 6 months after laparoscopic colon cancer surgery.It features favorable visual presentation and good clinical utility,and can be used for early identification and precise intervention of high-risk patients.Compared with the traditional clinicopathological model,this study confirmed that indicators of intestinal barrier,immune function and postoperative fatigue could significantly improve the predictive performance of the model,with evident clinical benefit.关键词
腹腔镜/结肠癌/肠屏障功能/细胞免疫/术后癌因性疲劳/不良预后/列线图/预测模型Key words
Laparoscope/Colon cancer/Intestinal barrier function/Cellular immunity/Postoperative cancer-related fa-tigue/Poor prognosis/Nomogram/Prediction model分类
医药卫生引用本文复制引用
席俊峰,王宏,刘毅..基于肠屏障、免疫功能及术后疲劳指标构建腹腔镜结肠癌术后不良预后的列线图预测模型[J].肿瘤预防与治疗,2026,39(9):734-744,11.基金项目
山西省大健康产业高质量发展科研专项课题(编号:DJKZXKT2023280) This study was supported by grants from Shanxi Federation of Social Sciences and Shanxi Association of Ex-perts and Scholars(No.DJKZXKT2023280). （编号:DJKZXKT2023280）
