摘要
目的探讨基于CT检查影像组学食管癌根治术后吻合口增厚性质预测模型的构建及其应用价值。方法采用回顾性队列研究方法。收集2013年1月至2021年6月郑州大学第一附属医院收治202例食管鳞癌患者的临床病理资料;男147例,女55例;年龄为(63±8)岁。202例患者采用随机数法以7∶3比例随机分为训练集141例和验证集61例。患者均行食管癌根治术和CT增强检查。观察指标:(1)吻合口恶性增厚的影响因素分析。(2)预测模型构建与评估。(3)3种预测模型性能比较。运用Kolmogorov-Smirnov检验连续变量的正态性。正态分布的计量资料以x±s表示,组间比较采用t检验。偏态分布的计量资料以M(Q1,Q3)表示,组间比较采用Mann-Whintney U检验。计数资料以绝对数表示,组间比较采用χ2检验或Fisher确切概率法。采用Kappa检验和组内相关系数(ICC)评估2名医师CT主观征象和测量的CT数值变量一致性,Kappa值>0.6、ICC>0.6认为一致性较好。单因素分析采用对应的统计学方法。多因素分析采用Logistics逐步回归模型。绘制受试者工作特征(ROC)曲线,以曲线下面积(AUC)及Delong检验、决策曲线评估模型的诊断效能及临床实用性。结果(1)吻合口恶性增厚的影响因素分析。202例食管鳞癌患者中,吻合口恶性增厚97例,吻合口炎性增厚105例。2位医师CT主观征象和测量CT数值变量一致性,Kappa值和ICC均>0.6。多因素分析结果显示:吻合口最大厚度、增厚组织CT强化方式是食管癌根治术后吻合口恶性增厚的独立影响因素[风险比=1.46,3.09,95%可信区间(CI)为1.26~1.71,1.18~8.12,P<0.05]。(2)预测模型构建与评估。①临床预测模型:纳入多因素分析结果吻合口最大厚度、增厚组织CT强化方式构建临床预测模型。ROC曲线显示:临床预测模型训练集的AUC、准确度、灵敏度、特异度分别为0.86(95%CI为0.80~0.92)、0.77、0.77、0.80;验证集上述指标分别为0.78
Objective To investigate the predictive model construction of anastomotic thickening character after radical surgery of esophageal cancer based on computed tomogralphy(CT)radiomics and its application value.Methods The retrospective cohort study was conducted.The clinicopathological data of 202 patients with esophageal squamous cell carcinoma(ESCC)who were admitted to The First Affiliated Hospital of Zhengzhou University from January 2013 to June 2021 were collected.There were 147 males and 55 females,aged(63±8)years.Based on random number table,202 patients were assigned into training dataset and validation dataset at a ratio of 7:3,including 141 cases and 61 cases respectively.Patients underwent radical resection of ESCC and enhanced CT examination.Observation indicators:(1)influencing factor analysis of malignant anas-tomotic thickening;(2)construction and evaluation of predictive model;(3)performance comparison of 3 predictive models.The normality of continuous variables was tested by Kolmogorov-Smirnov method.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was analyzed using the t test.Measurement data with skewed distribution were represented as M(Q1,Q3),and comparison between groups was analyzed using the Mann-Whintney U test.Count data were represented as absolute numbers,and comparison between groups was analyzed using the chi-square test or Fisher's exact probability.The consistency between subjective CT features by two doctors and measured CT numeric variables was analyzed by Kappa test and intraclass correlation coefficient(ICC),with Kappa>0.6 and ICC>0.6 as good consistency.Univariate analysis was conducted by corresponding statistic methods.Multivariate analysis was conducted by Logistics stepwise regression model.The receiver operating characteristic(ROC)curve was drawn,and area under curve(AUC),Delong test,decision curve were used to evaluate the diagnostic efficiency and clinical applicability of model.Results(1)Influencing factor analysis of
作者
邢静静
柴亚如
詹鹏超
王芳
董军强
吕培杰
高剑波
Xing Jingjing;Chai Yaru;Zhan Pengchao;Wang Fang;Dong Junqiang;Lyu Peijie;Gao Jianbo(Department of Radiology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2023年第10期1233-1242,共10页
Chinese Journal of Digestive Surgery
基金
国家自然科学基金(81971615)。
关键词
食管肿瘤
鳞癌
体层摄影
X线计算机
放射组学
吻合口狭窄
吻合口复发
Esophageal neoplasms
Squamous cell carcinoma
Tomography,X-ray com-puted
Radiomics
Anastomotic stenosis
Anastomotic recurrence
