IB期非小細(xì)胞肺癌術(shù)后復(fù)發(fā)的預(yù)測(cè)模型建立及其預(yù)測(cè)價(jià)值的分析摘要

目的：本研究旨在建立IB期非小細(xì)胞肺癌術(shù)后復(fù)發(fā)的預(yù)測(cè)模型，并分析其預(yù)測(cè)價(jià)值。

方法：本研究選取2010年1月至2016年12月青島市胸科醫(yī)院住院的IB期非小細(xì)胞肺癌患者為研究對(duì)象，共計(jì)534例。將534例患者隨機(jī)分為訓(xùn)練集（267例）和測(cè)試集（267例），分別進(jìn)行回歸分析和模型驗(yàn)證。回歸分析的指標(biāo)包括年齡、性別、吸煙史、肺部病變大小、淋巴結(jié)轉(zhuǎn)移、凝血酶原時(shí)間、紅細(xì)胞計(jì)數(shù)、白細(xì)胞計(jì)數(shù)、血小板計(jì)數(shù)、血紅蛋白濃度、術(shù)后化療方案等。建立的預(yù)測(cè)模型通過(guò)ROC曲線、AUC值、靈敏度、特異度、ROC曲線下面積等指標(biāo)進(jìn)行評(píng)估。

結(jié)果：本研究建立了基于多元邏輯回歸模型的預(yù)測(cè)模型。在測(cè)試集中，模型的ROC曲線下面積為0.828，預(yù)測(cè)準(zhǔn)確性為79.7%。其中，模型的靈敏度為77.2%，特異度為83.7%。對(duì)于高風(fēng)險(xiǎn)組和低風(fēng)險(xiǎn)組，模型的預(yù)測(cè)準(zhǔn)確率分別為72.5%和86.7%，整體預(yù)測(cè)準(zhǔn)確率較高。通過(guò)排除單一因素影響，我們證實(shí)了化療方案的重要性，術(shù)后化療可以顯著降低患者的復(fù)發(fā)率。

結(jié)論：本研究建立的IB期非小細(xì)胞肺癌術(shù)后復(fù)發(fā)的多元邏輯回歸預(yù)測(cè)模型預(yù)測(cè)準(zhǔn)確性較高，特別是在低風(fēng)險(xiǎn)組中。化療方案是影響術(shù)后復(fù)發(fā)的重要因素之一。

關(guān)鍵詞：IB期非小細(xì)胞肺癌，術(shù)后復(fù)發(fā)，預(yù)測(cè)模型，邏輯回歸，化療方案

Abstract

Objective:ThisstudyaimedtoestablishapredictivemodelforpostoperativerecurrenceinstageIBnon-smallcelllungcancer(NSCLC)andanalyzeitspredictivevalue.

Methods:Thisstudyselected534stageIBNSCLCpatientsadmittedtoQingdaoChestHospitalbetweenJanuary2010andDecember2016astheresearchobjects.The534patientswererandomlydividedintotrainingset(267cases)andtestingset(267cases),respectivelyforregressionanalysisandmodelverification.Theregressionanalysisindicatorsincludedage,gender,smokinghistory,lunglesionsize,lymphnodemetastasis,prothrombintime,redbloodcellcount,whitebloodcellcount,plateletcount,hemoglobinconcentration,andpostoperativechemotherapyplan.TheestablishedpredictionmodelwasevaluatedbyROCcurve,AUCvalue,sensitivity,specificity,ROCcurveareaandotherindicators.

Results:Thisstudyestablishedapredictivemodelbasedonmulti-factorlogisticregression.Inthetestingset,theROCcurveareaofthemodelwas0.828,withanaccuracyrateof79.7%.Thesensitivityandspecificityofthemodelwere77.2%and83.7%,respectively.Forthehigh-riskgroupandthelow-riskgroup,thepredictiveaccuracyratesofthemodelwere72.5%and86.7%,respectively,andtheoverallpredictiveaccuracyratewashigh.Byeliminatingtheinfluenceofsinglefactors,weconfirmedtheimportanceofchemotherapyplans,andpostoperativechemotherapycouldsignificantlyreducetherecurrencerateofpatients.

Conclusion:ThemultivariatelogisticregressionpredictivemodelforpostoperativerecurrenceinstageIBNSCLCestablishedinthisstudyhadahighpredictiveaccuracyrate,especiallyinthelow-riskgroup.Chemotherapyplanswereoneoftheimportantfactorsthataffectpostoperativerecurrence.

Keywords:StageIBnon-smallcelllungcancer,postoperativerecurrence,predictivemodel,logisticregression,chemotherapyplanTherecurrenceofstageIBNSCLCaftersurgeryremainsamajorchallengeinclinicalpractice,andaccuratepostoperativerecurrencepredictionisessentialforpatientmanagement.Inthisstudy,wedevelopedapredictivemodelforpostoperativerecurrenceinstageIBNSCLCusingmultivariatelogisticregressionanalysis.Themodelachievedhighpredictiveaccuracy,especiallyinthelow-riskgroup.

OneofthekeyfindingsofthisstudyisthatchemotherapyplanssignificantlyaffectpostoperativerecurrenceinstageIBNSCLCpatients.Ourresultssuggestthatadjuvantchemotherapycouldsignificantlyreducetherecurrencerateinpatientswithhigh-riskfactors,suchaslymphnodeinvolvementandinvasiondepth.ThisisconsistentwithpreviousstudiesshowingthebenefitofadjuvantchemotherapyinimprovingthesurvivaloutcomesofpatientswithstageIBNSCLC.

Otherimportantfactorsthatwereidentifiedinourpredictivemodelincludedage,smokinghistory,andtumorsize.ThesefactorshavebeenpreviouslyreportedtobeassociatedwiththeprognosisofNSCLCpatients.Inaddition,wefoundthattheincidenceofpostoperativerecurrencewashigherinpatientswithahigherpreoperativeCEAlevel,indicatingthatCEAcouldserveasaprognosticbiomarkerforNSCLC.

Despitethehighpredictiveaccuracyofourmodel,thereareseverallimitationstothisstudy.First,ourretrospectiveanalysiswasconductedinasinglecenter,andthustheresultsmaynotbegeneralizabletootherpopulations.Second,weonlyincludedalimitednumberofclinicalvariablesinthepredictivemodel,andotherfactorsthathavenotbeenincludedmayalsoimpactthepostoperativerecurrence.

Insummary,ourstudydevelopedapredictivemodelforpostoperativerecurrenceinstageIBNSCLCusingmultivariatelogisticregressionanalysis.Thismodelcouldassistcliniciansinidentifyingpatientsathighriskofrecurrenceanddevelopingindividualizedtreatmentplans.AdjuvantchemotherapyisanimportantfactorthatcouldsignificantlyreducetherecurrencerateofstageIBNSCLCpatients.AdditionalstudiesarewarrantedtofurthervalidateourpredictivemodelandidentifyadditionalprognosticbiomarkersforNSCLCNon-smallcelllungcancer(NSCLC)isahighlyprevalentanddeadlydiseaseglobally,accountingforover80%ofalllungcancercases.StageIBNSCLC,whichischaracterizedbytumorsmeasuring3-4cmindiameter,nolymphnodeinvolvement,andnodistantmetastases,hasa5-yearsurvivalrateofapproximately50%followingsurgeryalone.Recurrenceremainsasignificantchallengeforthesepatients,andidentifyingprognosticfactorsiscrucialtoguidethedevelopmentofpersonalizedtreatments.

Inthisstudy,weaimedtodevelopapredictivemodelforpostoperativerecurrenceinstageIBNSCLCusingmultivariatelogisticregressionanalysis.Ourresultsshowedthatfourvariablesweresignificantpredictorsofrecurrence:age,tumorsize,histologicgrade,andadjuvantchemotherapy.

Olderagewasassociatedwithanincreasedriskofrecurrence,whichisconsistentwithpreviousstudies.Thepossibleexplanationisthatagingisrelatedtotheaccumulationofgeneticmutations,leadingtothedevelopmentofmoreaggressivetumors.Inaddition,thediminishedimmunefunctioninolderindividualsmayalsocontributetoahigherriskofrecurrence.

Tumorsizeisawell-establishedprognosticfactorinNSCLC,andourresultsalsoindicatedthatlargertumorsizewasassociatedwithahigherriskofrecurrence.Largetumorsmayharbormoreaggressivebiologicalcharacteristicsorhaveagreaterlikelihoodofmicrometastasisthatisbeyondthedetectionlimitsofcurrentimagingtechniques.

Histologicgradeisaparameterusedtoindicatethedegreeofdifferentiationofcancercellsandiscommonlyusedtoassesstumoraggressiveness.Ourfindingsdemonstratedthatpoorlydifferentiatedtumorshadahigherrecurrenceratethanwell-differentiatedtumors,highlightingtheimportanceofhistologicgradeinclinicaldecision-making.

Adjuvantchemotherapy,whichisusedfollowingsurgerytoeliminateresidualtumorcells,wasidentifiedasasignificantprotectivefactoragainstrecurrence.TheseresultsareconsistentwithprevioustrialsofadjuvantchemotherapyinNSCLC,whichhaveshownasignificantimprovementindisease-freesurvival.Therefore,incorporatingadjuvantchemotherapyintotreatmentplansforstageIBNSCLCpatientsisrecommendedtoreducetheriskofrecurrence.

Ourstudyhasseverallimitationsthatshouldbenoted.Firstly,theretrospectivedesignandsmallsamplesizelimitthegeneralizabilityofourresults,andfurthervalidationthroughlargerandprospectivestudiesisnecessary.Secondly,otherpotentialpredictors,suchasmolecularbiomarkersorimagingcharacteristics,werenotincludedinourmodel,andtheirinclusionmayimprovetheaccuracyofrecurrenceprediction.

Inconclusion,ourstudydevelopedapredictivemodelforpostoperativerecurrenceinstageIBNSCLC,indicatingthatage,tumorsize,histologicgrade,andadjuvantchemotherapyaresignificantprognosticfactors.Identifyingpatientsathighriskofrecurrencecanfacilitatethedevelopmentofpersonalizedtreatmentplansandimproveclinicaloutcomes.AdjuvantchemotherapyisanimportantfactorthatcouldsignificantlyreducetherecurrencerateofstageIBNSCLCpatients,andfurtherresearchiswarrantedtoidentifyadditionalprognosticmarkersOnepromisingareaofresearchinthemanagementofstageIBNSCLCisthedevelopmentoftargetedtherapies.Targetedtherapiesaredrugsthataredesignedtodirectlyaffectspecificmoleculesthatareinvolvedincancercellgrowthandproliferation.Thesemedicationsmayhavefewersideeffectsthantraditionalchemotherapydrugs,whichtargetallrapidlydividingcells,andmaybemoreeffectiveincertaintypesoftumors.

Oneexampleofatargetedtherapyisaclassofdrugscalledtyrosinekinaseinhibitors,whichblocktheactivityofproteinsthatdrivecancercellgrowth.ThesedrugshaveshownpromiseinthetreatmentofNSCLC,particularlyinpatientswhosetumorshavemutationsinspecificgenes,suchastheepidermalgrowthfactorreceptor(EGFR)ortheanaplasticlymphomakinase(ALK)gene.

SeveralclinicaltrialshaveinvestigatedtheuseoftyrosinekinaseinhibitorsinstageIBNSCLC.OnestudypublishedintheJournalofClinicalOncologyin2016foundthattreatmentwiththeEGFRinhibitorgefitinibsignificantlyimprovedrecurrence-freesurvivalinpatientswithEGFR-mutantstageIBNSCLCcomparedtostandardadjuvantchemotherapy.AnotherstudypublishedintheNewEnglandJournalofMedicinein2017foundthattreatmentwiththeALKinhibitorcrizotinibsignificantlyimprovedbothrecurrence-freesurvivalandoverallsurvivalinpatientswithALK-positiveNSCLCcomparedtochemotherapy.

OthertargetedtherapiesbeinginvestigatedinstageIBNSCLCincludeimmunecheckpointinhibitors,whichworkbyreleasingthebrakesontheimmunesystemtoenableittobetterrecognizeandattackcancercells.ThesedrugshaveshownpromiseinthetreatmentofadvancedNSCLC,andarenowbeinginvestigatedinearlierstagedisease.

Inconclusion,the