老年Ⅳ期鳞状非小细胞肺癌患者1年内肺癌特异性死亡风险预测模型的建立和验证

Establishment and validation of a prediction model for risk of lung cancer-specific death within 1 year in elderly patients with stage Ⅳ squamous non-small cell lung cancer

中文关键词: 老年  非小细胞肺癌  鳞癌  Ⅳ期  列线图  肺癌特异性死亡  预后评估  临床决策

英文关键词: elderly  non-small cell lung cancer  squamous cell carcinoma  stage Ⅳ  nomogram  lung cancer-specific mortality  prognosis  clinical decision-making

中文摘要:

      目的 本研究旨在构建并验证一个列线图预测模型,用于评估Ⅳ期老年鳞状非小细胞肺癌(LUSC)患者在1年内发生肺癌特异性死亡的风险.方法 回顾性选取2021年1月—2023年10月于淮南东方医院集团肿瘤医院就诊的420例Ⅳ期老年LUSC患者的临床资料,按7∶3比例随机分为训练集(n=294)和验证集(n=126).通过单因素和多因素Lo-gistic 回归分析筛选独立预后因素,构建列线图模型并进行验证.结果 经多因素Logistic回归分析,男性(OR=2.41)、高龄(OR=1.07)、高 Grade 分级(Ⅱ 级 OR=16.94,Ⅲ级 OR=6.66)、肿瘤大小(OR=1.37)、骨转移(OR=3.63)、肝转移(OR=2.68)、脑转移(OR=4.33)及 IL-6(OR=1.16)、CYFRA21-1(OR=1.04)、SCC(OR=1.35)水平升高,为 1 年内肺癌特异性死亡的独立预测因素.列线图在训练集和验证集中的AUC分别为0.95(95％CI:0.93～0.97)和0.95(95％CI:0.90～0.99),校准曲线显示预测与实际风险高度一致(H-L检验P＞0.05),DCA证实模型在广泛阈值概率范围内具有临床净获益.结论 本研究构建的列线图模型可有效预测Ⅳ期老年LUSC患者1年内肺癌特异性死亡风险,为个体化预后评估和临床决策提供了实用工具.

英文摘要:

      Objective To establish and validate a nomogram prediction model for assessing the risk of lung cancer-spe-cific death within 1 year in elderly patients with stage Ⅳ lung squamous cell carcinoma(LUSC).Methods The clinical data from 420 elderly patients with stage Ⅳ LUSC treated in Cancer Hospital of Huainan Oriental Hospital Group between January 2021 and October 2023 were retrospectively collected.They were randomly divided into training cohort set(n=294)and vali-dation cohort set(n=126)in a 7∶3 ratio.Univariate and multivariate Logistic regression analyses were performed to identify independent prognostic factors.A nomogram model was constructed based on these factors and subsequently validated.Results Multivariate Logistic regression analysis identified the following as independent predictors of lung cancer-specific death within 1 year:male sex(OR=2.41),advanced age(OR=1.07),high histological grade(grade Ⅱ:OR=16.94;grade Ⅲ:OR=6.66),larger tumor size(OR=1.37),bone metastasis(OR=3.63),liver metastasis(OR=2.68),brain metastasis(OR=4.33),and elevated levels of IL-6(OR=1.16),CYFRA21-1(OR=1.04)and SCC(OR=1.35).The area under the receiver operating characteristic curve(AUC)of the nomogram was 0.95(95％CI:0.93-0.97)in the training set and 0.95(95％CI:0.90-0.99)in the validation set.The calibration curve demonstrated high consistency between predic-ted and actual risk(Hosmer-Lemeshow test,P＞0.05).Decision curve analysis(DCA)confirmed the model's clinical net benefit across a wide range of threshold probabilities.Conclusion The established nomogram effectively can predict the risk of lung cancer-specific death within 1 year in elderly patients with stage Ⅳ LUSC.It provides a practical tool for individualized prognostic assessment and clinical decision-making.