| 赵建红,岑红兵,杨志勇.远端与近端早期胃癌的临床病理特征差异及黏膜下层浸润的危险因素预测模型构建[J].肿瘤学杂志,2025,31(10):852-858. |
| 远端与近端早期胃癌的临床病理特征差异及黏膜下层浸润的危险因素预测模型构建 |
| Clinicopathological Features of Distal and Proximal Early Gastric Cancer and Development of A Risk Prediction Nomogram Model for Submucosal Invasion |
| 投稿时间：2025-03-04 |
| DOI：10.11735/j.issn.1671-170X.2025.10.B004 |
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| 中文关键词: 胃肿瘤 近端位置 早期 黏膜下层浸润 危险因素 列线图 |
| 英文关键词:gastric neoplasms proximal location early stage submucosal invasion risk factor Nomogram |
| 基金项目:湖北省卫生健康委员会科研项目（WJ2021M070） |
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| 中文摘要: |
| 摘 要：［目的］ 探讨远端与近端早期胃癌的组织病理学特征差异，并构建黏膜下层浸润的危险因素预测模型。［方法］回顾性分析2020年3月至2024年5月在长江大学附属黄冈市中心医院接受手术或内镜黏膜下剥离术（endoscopic submucosal dissection，ESD）的早期胃癌患者资料，按照肿瘤位置1∶1匹配，近端组和远端组各69例。比较近端组与远端组胃癌患者的临床病理特征；采用LASSO回归和多变量Logistic回归分析黏膜下层浸润发生的危险因素，并构建列线图预测模型。［结果］ 近端组胃癌患者弥漫型、黏膜下层浸润和外科手术患者比例显著高于远端组，且近端组手术时间更长（P均＜0.05）。与黏膜层浸润组（n=75）相比，黏膜下层浸润组（n=63）患者肿瘤直径更大，且近端位置、凹陷型、未分化、弥漫型和脉管侵犯患者比例更高（P均＜0.05）。经LASSO回归筛选和多变量Logistic回归分析，结果显示近端位置、肿瘤直径≥20 mm、脉管侵犯和凹陷型是黏膜下层浸润的独立危险因素。受试者工作特征曲线分析显示，以近端位置、肿瘤直径≥20 mm、脉管侵犯和凹陷型构建的列线图模型预测黏膜下层浸润的曲线下面积为0.77［95%置信区间（confidence interval，CI）：0.70～0.85］，同时Hosmer-Lemeshow拟合优度检验显示该模型拟合良好（χ2=4.862，P=0.433）。经临床决策曲线分析，当高风险阈值为0.05～0.90时，列线图模型预测黏膜下层浸润具有较好的净临床收益。［结论］ 与远端早期胃癌患者相比，近端患者弥漫型以及黏膜下层浸润的比例更高。近端位置、凹陷型、肿瘤直径和脉管侵犯是黏膜下层浸润的危险因素。近端患者因其较高的黏膜下层浸润风险，需要慎重的治疗决策。 |
| 英文摘要: |
| Abstract： ［Objective］ To investigate the clinicopathological features of distal and proximal early gastric cancer， and to develop a risk prediction model for submucosal invasion. ［Methods］ Clinical data of early gastric cancer patients who underwent surgery or endoscopic submucosal dissection (ESD) at Huanggang Central Hospital Affiliated to Yangtze University from March 2020 to May 2024 were analyzed retrospectively， including 69 cases of proximal tumors and 69 cases of distal tumors (patients were matched 1∶1 based on tumor location). The clinicopathological features were compared between patients with proximal and distal early gastric cancer. The risk factors of submucosal invasion were analyzed by LASSO regression and multivariate Logistic regression， and a Nomogram prediction model was developed. ［Results］ The proportion of diffuse type， submucosal invasion， surgical patients was significantly higher， and the operative time was longer in the proximal group than those in the distal group (all P<0.05). Compared to patients with mucosal invasion (n=75)， those with submucosal invasion (n=63) had a larger tumor diameter and a higher proportion of proximal location， depressed type， undifferentiated， diffuse type， and vascular invasion (all P<0.05). LASSO regression and multivariate Logistic regression analysis showed that proximal location， tumor diameter≥20 mm， lymphovascular invasion and depressed type were the independent risk factors for submucosal invasion (P<0.05). A risk prediction Nomogram model was constructed based on the above risk factors， and receiver operating characteristic curve analysis showed that the area under the curve (AUC) of the model for predicting submucosal invasion predicted was 0.77 ［95% confidence interval(CI)： 0.70~0.85］. And the Hosmer-Lemeshow goodness of fit test showed that the model was well fitted (χ2=4.862， P=0.433). According to clinical decision curve analysis， when the high risk threshold was 0.05~0.90， the nematic model had a good net clinical benefit in predicting submucosal invasion. ［Conclusion］ Compared to distal early gastric cancer patients， proximal patients have a higher proportion of diffuse type and submucosal invasion. Proximal location， depressed type， tumor diameter and lymphovascular invasion are risk factors for submucosal invasion. Therefore， proximal early gastric cancer requires careful treatment decisions due to its higher risk of submucosal invasion. |
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