摘要
目的探讨基于磁共振成像(MRI)检查的集成深度学习模型预测中低位直肠癌切除术应用直肠双吻合技术(DST)直线切割闭合器使用次数的临床价值。方法采用回顾性队列研究方法。收集2018年1月至2022年12月上海交通大学医学院附属瑞金医院收治的263例行低位前切除术(LAR)中低位直肠癌患者的临床病理资料(训练集);男183例,女80例;年龄为63(55,68)岁。另收集128例中低位直肠癌患者的临床病理资料(验证集);男83例,女45例;年龄为65(57,70)岁。训练集用于构建预测模型,验证集用于验证预测模型。观察指标:(1)训练集患者的临床病理特征。(2)影响训练集患者术中直线切割闭合器使用次数≥3次的因素分析。(3)预测模型的构建。(4)预测模型的效能评价。(5)预测模型的验证。偏态分布的计量资料以M(Q_(1),Q_(3))表示,组间比较采用Mann-Whitney U检验。计数资料以绝对数表示,组间比较采用χ2检验。单因素分析采用Logistic回归模型,多因素分析采用Logistic逐步回归模型。绘制受试者工作特征(ROC)曲线并计算曲线下面积(AUC)。AUC>0.75表示模型可接受。AUC比较采用Delong检验。结果(1)训练集患者的临床病理特征。263例患者中,48例术中直线切割闭合器使用次数≥3次,215例≤2次。48例术中直线切割闭合器使用次数≥3次和215例≤2次患者术前血清癌胚抗原>5μg/L、吻合口漏、肿瘤长径≥5 cm的例数分别为20、12、13例和56、26、21例,两者比较,差异均有统计学意义(χ^(2)=4.66,5.29,10.45,P<0.05)。(2)影响训练集患者术中直线切割闭合器使用次数≥3次的因素分析。多因素分析结果显示:术前血清癌胚抗原>5μg/L、肿瘤长径≥5 cm是影响术中直线切割闭合器使用次数≥3次的独立危险因素[优势比=2.26,3.39,95%可信区间(CI)为1.15~4.43,1.50~7.65,P<0.05]。(3)预测模型的构建。根据多因素分析结果,纳入术前血清癌胚抗原和肿�
Objective To investigate the clinical value of magnetic resonance imaging(MRI)based integrated deep learning model for predicting the times of linear staplers used in double stapling technique for middle-low rectal cancer resection.Methods The retrospective cohort study was conducted.The clinicopathological data of 263 patients who underwent low anterior resection(LAR)for middle-low rectal cancer in Ruijin Hospital of Shanghai Jiaotong University School of Medicine from January 2018 to December 2022 were collected as training dataset.There were 183 males and 80 females,aged 63(55,68)years.The clinicopathological data of 128 patients with middle-low rectal cancer were collected as validation dataset,including 83 males and 45 females,with age as 65(57,70)years.The training dataset was used to construct the prediction model,and the validation dataset was used to validate the prediction model.Observation indicators:(1)clinicopathological features of patients in the training dataset;(2)influencing factors for≥3 times using of linear staplers in the operation;(3)prediction model construction;(4)efficiency evaluation of prediction model;(5)validation of prediction model.Measurement data with skewed distribution were represented as M(Q_(1),Q_(3)),and Mann-Whitney U test was used for comparison between groups.Count data were expressed as absolute numbers,and comparison between groups was conducted using the chi-square test.Wilcoxon rank sum test was used for non-parametric data analysis.Univariate analysis was conducted using the Logistic regression model,and multivariate analysis was conducted using the Logistic stepwise regression model.The receiver operating characteristic(ROC)curve was draw and the area under the curve(AUC)was calculated.The AUC of the ROC curve>0.75 indicated the prediction model as acceptable.Comparison of AUC was conducted using the Delong test.Results(1)Clinicopathological features of patients in the training dataset.Of the 263 patients,there were 48 cases with linear staplers used in the operat
作者
付占威
蔡正昊
李树春
张鲁阳
臧潞
董峰
郑民华
马君俊
Fu Zhanwei;Cai Zhenghao;Li Shuchun;Zhang Luyang;Zang Lu;Dong Feng;Zheng Minhua;Ma Junjun
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2023年第9期1129-1138,共10页
Chinese Journal of Digestive Surgery
基金
上海市临床重点专科建设项目(shslczdzk00102)
上海交通大学“医工交叉”项目(YG 2019QNB24)。
关键词
直肠肿瘤
深度学习
预测模型
双吻合技术
磁共振成像
Rectal neoplasms
Deep-learning
Prediction model
Double stapling tech-nique
Magnetic resonance imaging
