肺癌患者胸腔镜下肺叶切除术中转开胸风险列线图预测模型的构建

Construction of a nomogram prediction model for the risk of conversion to open chest during thoracoscopic lobectomy in lung cancer patients

摘要:

目的 构建肺癌患者胸腔镜下肺叶切除术中转开胸风险列线图预测模型。方法 选取2021年8月－2023年2月该院收治的肺癌胸腔镜下肺叶切除术患者160例，随机分为建模组（112例）和验证组（48例），根据是否中转开胸，将建模组分为开胸组和未开胸组；采用多因素Logistic回归模型，分析（Enter法）肺癌患者胸腔镜下肺叶切除术中转开胸的危险因素；采用R软件构建列线图模型，评估模型预测效能。结果 建模组112例中，有39例发生中转开胸，中转开胸率为34.82%。开胸组和未开胸组年龄、肺结核、肿瘤位置（肺上叶）和胸膜粘连比较，差异均有统计学意义（P < 0.05）。多因素Logistic回归分析结果显示，年龄 ≥ 65岁、肺结核、肿瘤位置（肺上叶）和胸膜粘连，是肺癌患者胸腔镜下肺叶切除术中转开胸的危险因素（P < 0.05）。验证建模组结果，绘制受试者操作特征曲线（ROC curve），曲线下面积（AUC）为0.857，区分度较好，H-L检验提示一致性良好（χ2 = 5.34，P = 0.502）。外部验证的AUC为0.917，区分度较好，H-L检验提示一致性良好（χ2 = 6.21，P = 0.414）。结论 年龄 ≥ 65岁、肺结核、肿瘤位置（肺上叶）和胸膜粘连，是肺癌患者胸腔镜下肺叶切除术中转开胸的危险因素，以此构建的列线图模型，具有良好的区分度和一致性，能直观地预测肺癌患者胸腔镜下肺叶切除术中转开胸的风险。

Abstract:

Objective Construction of a nomogram prediction model for the risk of conversion from thoracoscopic lobectomy to thoracotomy in patients with lung cancer.Methods 160 patients who underwent thoracoscopic lobectomy for lung cancer from August 2021 to February 2023 were selected and randomly divided into a modeling group (112 cases) and a validation group (48 cases), the modeling group was divided into an open-chest group and an non open-chest group according to whether or not they were converted to open-chest intraoperatively; Multivariate Logistic regression analysis (Enter method) was applied to analyze the risk factors of change to thoracotomy during thoracoscopic lobectomy for lung cancer patients; R software was applied to construct column chart models and evaluate the predictive performance of the models.Results In this study, 39 out of 112 lung cancer patients changed to thoracotomy during thoracoscopic lobectomy, with an incidence rate of 34.82%. There were statistical differences between the open-chest group and the non open-chest group in terms of age, pulmonary tuberculosis, tumor location (upper lobe of lung), and pleural adhesions (P < 0.05). The results of multivariate Logistic regression analysis showed that age ≥ 65 years, presence of tuberculosis, tumor location (upper lobe of lung), and presence of pleural adhesions were risk factors (P < 0.05). The validation results of the modeling group showed that the area under the receiver operator characteristic curve (ROC curve) (AUC) was 0.857, with a good discrimination, the H-L test showed a good consistency (χ² = 5.34, P = 0.502). The AUC of external validation was 0.917, with a good discrimination, the H-L test with a good consistency (χ² = 6.21, P = 0.414).Conclusion Age ≥ 65 years old, presence of pulmonary tuberculosis, tumor location (upper lobe of lung), and pleural adhesions are risk factors for change to thoracotomy in lung cancer patients undergoing thoracoscopic lobectomy. The column chart model constructed based on this has good discrimination and consistency, and can intuitively predict the risk of thoracoscopic lobectomy to change to thoracotomy in lung cancer patients.