摘要
目的基于logistic回归分析探讨非小细胞肺癌(NSCLC)化疗发生骨髓抑制的危险因素并建立预测模型。方法以2017年9月至2019年12月汕头市潮阳区大峰医院收治的120例NSCLC病人为研究对象,以Ⅱ级及以上骨髓抑制的病人定为观察组(52例),I级及以下的病人定为对照组(68例),对两组病人的一般资料和治疗情况进行单因素分析,对两组差异有统计学意义的单因素进行非条件logistic多因素回归分析,探究NSCLC病人发生骨髓抑制的危险因素并建立预测模型。重新纳入100例NSCLC病人采用该模型进行预测,计算该模型的敏感度和特异度,并采用ROC曲线判定其预测价值。结果两组在年龄、体质量指数(BMI)、肿瘤临床分期、是否发生骨髓/骨转移、治疗前白细胞是否降低(<4.0×10^(9))、轻度白蛋白水平低下(30~40g/L)、曾接受化疗次数、3周内是否进行了放疗上差异有统计学意义(P<0.05),在性别、吸烟史、化疗方案上差异无统计学意义(P>0.05)。经logistic回归分析,年龄、发生骨髓/骨转移、治疗前白细胞降低、轻度白蛋白水平低下、化疗方案等5个指标/变量为骨髓抑制的影响因素(P<0.05)。logistic回归模型:logi(tP)=0.486+1.213X1+1.781X2+0.611X3+0.682X4-0.246X5,其中自变量:X1为年龄(≥60岁),X2为发生骨髓/骨转移,X3为治疗前白细胞数<4.0×10^(9),X4为TP化疗方案,X5为GP或AP化疗方案。基于该模型进行ROC分析,其AUC为0.812,标准误0.028,95%CI:0.758~0.867。对重新纳入的100例NSCLC病人进行分析,其预测的敏感度为92.68%,特异度83.05%,Kappa系数为0.806。结论年龄、发生骨髓/骨转移、治疗前白细胞降低、白蛋白水平低下、3周内进行了放疗是骨髓抑制的危险因素,该模型有望用于化疗前风险预测,对高危病人进行干预治疗。
Objective To study the risk factors and prediction methods of myelosuppression in non-small cell lung cancer(NSCLC)based on logistic regression analysis.Methods A total of 120 NSCLC patients admitted to Dafeng Hospital,Chaoyang District,Shantou City from September 2017 to December 2019 were selected as study objectives.Patients with myelosuppression of gradeⅡand above were selected as the observation group(52 cases),and those with I and below were designated as control group(68 cases).The basic information and treatment of two groups were compared for single factor analysis,and the significantly different single factor were analyzed by non-conditional logistic regression analysis,the risk factors for myelosuppression and the forecast model were established.A total of 100 new NSCLC patients were forecasted by this model.The sensitivity and specificity of the model were calculated,and the predictive value was determined by ROC curve.Results There were statistically significant differences in age,BMI,clinical stage of tumor,bone marrow/bone metastasis,leukocyte reduction before treatment(<4.0×10^(9)),low level of albumin(30-40 g/L),times of chemotherapy,whether radiotherapy was carried out within 3 weeks(P<0.05).There were no statistically significant differences in gender,smoking history and chemotherapy plan(P>0.05).According to the logistic regression analysis,age,bone marrow/bone metastasis,leucopenia before treatment,low level of albumin and chemotherapy were the influencing factors(P<0.05).Logistic regression model:logit(P)=0.486+1.213x1+1.781x2+0.611x3+0.682x4-0.246x5,of which independent variable:X1 was age(≥60 years old),X2 was bone marrow/bone metastasis,X3 was leucocyte number before treatment<4.0×10^(9),X4 was TP chemotherapy,X5 was GP or AP chemotherapy.ROC analysis based on this model showed that AUC was 0.812,standard error is 0.028,95%CI:0.758~0.867.The sensitivity,specificity and kappa coefficient were 92.68%,83.05%and 0.806,respectively.Conclusion Age,bone marrow/bone metastasis,leukocyte red
作者
吴晓文
黄银梅
邱潮锋
WU Xiaowen;HUANG Yinmei;QIU Chaofeng(Department of Oncology,Hospital,Chaoyang District of Shantou,Shantou,Guangdong 515154,China;Department of Respiratory Medicine,Dafeng Hospital,Chaoyang District of Shantou,Shantou,Guangdong 515154,China)
出处
《安徽医药》
CAS
2021年第5期894-898,共5页
Anhui Medical and Pharmaceutical Journal
