[1]李 峥,李 宁,单梦杰,等.基于炎症反应评分系统的宫颈癌患者预后不良风险列线图预测模型构建及验证[J].陕西医学杂志,2025,54(5):618-621,626.[doi:DOI:10.3969/j.issn.1000-7377.2025.05.008]
　LI Zheng,LI Ning,SHAN Mengjie,et al.Construction and validation of a nomogram prediction model for the risk of adverse prognosis in cervical cancer patients based on the inflammatory response scoring system[J].,2025,54(5):618-621,626.[doi:DOI:10.3969/j.issn.1000-7377.2025.05.008]
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基于炎症反应评分系统的宫颈癌患者预后不良风险列线图预测模型构建及验证
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《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
54
期数:
2025年5期
页码:
618-621,626
栏目:
临床研究
出版日期:
2025-05-05

文章信息/Info

Title:
Construction and validation of a nomogram prediction model for the risk of adverse prognosis in cervical cancer patients based on the inflammatory response scoring system
作者:
李 峥1; 李 宁2; 单梦杰2; 马 梅2; 王立群3
(1.蚌埠医科大学,安徽 蚌埠 233000; 2.安徽医科大学附属宿州医院妇科,安徽 宿州 234000; 3.蚌埠医科大学第一附属医院妇科,安徽 蚌埠 233004)
Author(s):
LI Zheng1; LI Ning2; SHAN Mengjie2; MA Mei2; WANG Liqun3
(1.Bengbu Medical University,Bengbu 233000,China; 2.Department of Gynecology,Suzhou Hospital of Anhui Medical University,Suzhou 234000,China; 3.Department of Gynecology,the First Affiliated Hospital of Bengbu Medical University,Bengbu 233004,China)
关键词:
宫颈癌;  全身炎症评分;  中性粒细胞与淋巴细胞比值;  血小板与淋巴细胞比值;  纤维蛋白原;  C-反应蛋白;  预测模型
Keywords:
Cervical cancer;  Systemic inflammation score;  NLR;  PLR;  Fibrinogen;  CRP;  Prediction model
分类号:
R 737.33
DOI:
DOI:10.3969/j.issn.1000-7377.2025.05.008
文献标志码:
A
摘要:
目的:探讨基于炎症反应评分系统构建及验证宫颈癌患者预后不良风险列线图预测模型。方法:选取175例宫颈癌患者,并分为建模组(123例)和验证组(52例)。术后随访3年,根据有无复发、远处转移、死亡将建模组患者分为预后不良组(37例)和预后良好组(86例)。比较不同预后患者全身炎症评分(SIS)、中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、纤维蛋白原(FIB)以及C-反应蛋白(CRP)。宫颈癌患者预后不良的影响因素采用Logistic回归分析; R软件构建列线图风险预测模型; 列线图模型的预测效能通过绘制受试者工作特征(ROC)曲线、校准曲线、决策曲线进行分析。结果:不同预后患者基线资料比较差异无统计学意义(均P>0.05)。预后不良组SIS评分、NLR、PLR、CRP高于预后良好组,FIB低于预后良好组(均P<0.05)。SIS评分、NLR、PLR、FIB、CRP是宫颈癌患者预后不良的独立影响因素(均P<0.05)。构建列线图风险预测模型,该模型预测验证组患者预后不良的曲线下面积(AUC)、敏感度及特异度分别为0.899、94.23%、70.16%。校正曲线与理想曲线(对角线)拟合效果理想,斜率为0.978,行Hosmer-Lemeshow拟合优度检验无统计学差异(P>0.05)。决策曲线显示该模型在0.12～0.98阈值范围内有良好的临床有效性。结论:SIS评分、NLR、PLR、FIB、CRP是宫颈癌患者预后不良的影响因素,基于这些指标构建列线图风险预测模型对患者预后具有较好的预测效能。
Abstract:
Objective:To construct and validate a nomogram prediction model based on inflammatory response scoring system for assessing the risk of poor prognosis in cervical cancer patients.Methods:A total of 175 cervical cancer patients were selected and divided into a modeling group(123 cases)and a validation group(52 cases).Patients were followed up for 3 years after surgery and categorized into poor-prognosis(37 cases)and good-prognosis groups(86 cases)based on recurrence,distant metastasis,or death.Comparisons were made between patients with different prognoses regarding the SIS,NLR,PLR,FIB and CRP.Logistic regression analysis was used to identify risk factors for poor prognosis in cervical cancer patients.The nomogram risk prediction model was constructed using R software,and its predictive performance was evaluated using receiver operating characteristic(ROC)curves,calibration curves and decision curve analysis.Results:There were no significant differences in baseline characteristics between patients with different prognoses(all P>0.05).The poor-prognosis group had higher SIS scores,NLR,PLR and CRP levels and lower FIB levels compared to the good-prognosis group(all P<0.05).SIS score,NLR,PLR,FIB and CRP were identified as independent risk factors for poor prognosis(all P<0.05).The nomogram model demonstrated an AUC of 0.899,sensitivity of 94.23%,and specificity of 70.16% in predicting poor prognosis in the validation group.The calibration curve showed good agreement with the ideal curve(slope=0.978),and the Hosmer-Lemeshow goodness-of-fit test revealed no significant differences(P>0.05).Decision curve analysis indicated that the model had good clinical validity within the threshold range of 0.12 to 0.98.Conclusion:SIS score,NLR,PLR,FIB and CRP are risk factors for poor prognosis in cervical cancer patients.The nomogram prediction model based on these indicators provides effective prognostic prediction for patients.

参考文献/References:

[1] 陈庆,李乙航,赵金燕,等.微小核糖核酸34a与沉默信息调节因子1在宫颈癌组织中的表达及相关性研究[J].陕西医学杂志,2023,52(8):1089-1092,1105.
[2] 王磊,杨碧锋,陈剑.外周血NLR、PLR和血清CEA、SCCA联合检测预测宫颈癌放化疗后复发及转移的临床价值[J].中国性科学,2024,33(10):73-77.
[3] 赵雅文,董頔,薛茜文,等.术前外周血中NLR、PLR、LMR与早期宫颈癌患者预后的相关性研究[J].新疆医科大学学报,2020,43(8):997-1003.
[4] 周志华.机器学习[M].北京:清华大学出版社,2016:441.
[5] SHOKA M,KANDA M,ITO S,et al.Systemic inflammation score as a predictor of pneumonia after radical resection of gastric cancer:Analysis of a multi-institutional dataset[J].Dig Surg,2020,37(5):401-410.
[6] 欧丽滢,马俊楠,陈茵,等.血小板/淋巴细胞比值、术前中性粒细胞/淋巴细胞比值、淋巴细胞/单核细胞比值在宫颈癌预后中的临床意义分析[J].中国性科学,2022,31(12):76-80.
[7] LORUSSO D,COLOMBO N,DUBOT C,et al.Pembrolizumab plus chemotherapy for advanced and recurrent cervical cancer:Final analysis according to bevacizumab use in the randomized KEYNOTE-826 study[J].Ann Oncol,2025,36(1):65-75.
[8] 王欣,李永霞,胡丹,等.术前外周血中性粒细胞与淋巴细胞比率、血小板与淋巴细胞比率与宫颈癌的相关性研究[J].兰州大学学报(医学版),2020,46(5):55-60.
[9] 朱辉,闫益芬,原孟.宫颈癌根治术后患者高危型HPV载量与NLR、PLR水平及术后复发的相关性[J].中国病原生物学杂志,2022,17(8):951-954.
[10] 李小琴,宋楠昊,石永军,等.外周血NLR、PLR、SCC、CA125和CYFRA21-1在早期宫颈鳞癌诊断中的价值[J].检验医学与临床,2022,19(10):1302-1305.
[11] TEWARI K S,COLOMBO N,MONK B J,et al.Pembrolizumab or placebo plus chemotherapy with or without bevacizumab for persistent,recurrent,or metastatic cervical cancer:Subgroup analyses from the KEYNOTE-826 randomized clinical trial[J].JAMA Oncol,2024,10(2):185-192.
[12] 张余飞,刘云琴,臧春宝,等.NLR和PLR对局部晚期宫颈癌病人接受根治性放疗预后评估的价值[J].蚌埠医学院学报,2022,47(12):1686-1689.
[13] 盛雷鸣,欧阳淦露,舒佩,等.宫颈癌患者术后基线外周血NLR和PLR预后评估价值探讨[J].中华肿瘤防治杂志,2022,29(8):584-591.
[14] 寇翰林,何丽杰,张贺平.基于T淋巴细胞B淋巴细胞及NK细胞分析腹腔镜下保留盆腔自主神经的根治性子宫切除术治疗早期宫颈癌的效果[J].中国妇幼保健,2024,39(3):564-567.
[15] RAMIREZ P T,ROBLEDO K P,FRUMOVITZ M,et al.LACC trial:Final analysis on overall survival comparing open versus minimally invasive radical hysterectomy for early-stage cervical cancer[J].J Clin Oncol,2024,42(23):2741-2746.
[16] 崔金涛,田霞,许建生,等.动态增强磁共振成像参数联合CEA、NLR、PLR对宫颈癌患者新辅助化疗疗效的预测价值[J].现代生物医学进展,2024,24(11):2169-2172,2196.
[17] 常丰葛,张柯,纪云.术前NLR、PLR及血清CEA水平在宫颈癌预后评估中的临床价值[J].实用癌症杂志,2022,37(5):739-742.
[18] SALANI R,MCCORMACK M,KIM Y M,et al.A non-comparative,randomized,phase Ⅱ trial of atezolizumab or atezolizumab plus tiragolumab for programmed death-ligand 1-positive recurrent cervical cancer(SKYSCRAPER-04)[J].Int J Gynecol Cancer,2024,34(8):1140-1148.
[19] 冯敏娟,蔡东阁,李虹.转录因子7-like 2在宫颈癌中表达水平及其与顺铂化疗敏感性关系研究[J].陕西医学杂志,2024,53(10):1335-1339.
[20] LI W,MA L,LI F,et al.Effects of bone marrow sparing radiotherapy on acute hematologic toxicity for patients with locoregionally advanced cervical cancer:A prospective phase Ⅱ randomized controlled study[J].Radiat Oncol,2024,19(1):46.
[21] 惠玉洁,朱林凤,李卫民,等.宫颈癌患者血清微小RNA-195、双皮质素样激酶1、鳞状细胞癌抗原表达水平与临床病理特征及预后相关性研究[J].陕西医学杂志,2024,53(5):696-699.
[22] 冯方方,吴琼,鲁昌辉.清宫排毒汤治疗宫颈癌疗效及对患者肿瘤细胞上皮间质转化的影响[J].陕西中医,2021,42(2):187-191.
[23] BIRRER M,LI G,YUNOKAWA M,et al.Bintrafusp alfa for recurrent or metastatic cervical cancer after platinum failure:A nonrandomized controlled trial[J].JAMA Oncol,2024,10(9):1204-1211.
[24] 伍健,杜芝霖,秦远,等.治疗前白蛋白与纤维蛋白原比值对根治性放化疗宫颈癌患者预后的价值[J].肿瘤预防与治疗,2023,36(7):564-575.
[25] 陈十昔,赵彦,韩宁宁,等.白头翁汤保留灌肠联合rhGM-CSF治疗Ⅱ～Ⅲ期宫颈癌盆腔放疗所致急性放射性直肠炎疗效及对患者炎症反应的影响[J].陕西中医,2020,41(1):46-49.

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备注/Memo

备注/Memo:
[基金项目]国家自然科学基金资助项目(81973658)
更新日期/Last Update: 2025-05-05