基于CT参数的肾上腺恶性肿瘤切除术难度预测模型的建立

孙世伟; 王晋垚; 杨彬; 岳鹏; 王越; 姚伟; 牛向南; 张雁钢

doi:10.13201/j.issn.1001-1420.2023.10.007

基于CT参数的肾上腺恶性肿瘤切除术难度预测模型的建立

- 1.
  山西医科大学第三医院(山西白求恩医院，山西医学科学院，同济山西医院)泌尿外科(太原，030032)
- 2.
  山西白求恩医院(山西医学科学院，同济山西医院，山西医科大学第三医院)泌尿外科
- 3.
  华中科技大学同济医学院附属同济医院泌尿外科

详细信息

通讯作者: 张雁钢，E-mail：urozyg@163.com

中图分类号: R736.6

收稿日期: 2023-01-31

刊出日期: 2023-10-06

Prediction model of the difficulty of adrenalectomy based on computed tomography parameters

- 1.
  Department of Urology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China
- 2.
  Department of Urology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University
- 3.
  Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology

More Information

Corresponding author: ZHANG Yangang, E-mail: urozyg@163.com

Received Date: 31 January 2023

Publish Date: 06 October 2023

摘要

摘要: 目的建立基于CT参数的肾上腺恶性肿瘤切除术难度预测模型，指导术者完善术前评估手术难度。方法回顾性分析2014年8月—2021年12月就诊于山西白求恩医院并行手术治疗的75例肾上腺恶性肿瘤患者的临床资料。通过单因素logistic回归与逐步回归法多因素logistic回归筛选独立影响因素，构建列线图，采用ROC曲线分析列线图的预测效能，采用C指数和Bootstrap自抽样法验证列线图的区分度和一致性。结果肾上腺恶性肿瘤切除术难度独立影响因素有：肿瘤最大径、梅奥评分、肿瘤血管贴附、肿瘤下极到肾上极的距离。根据筛选结果构建模型，C指数为0.924，临床决策曲线提示可提高25%的患者净获益率，说明模型预测效果良好。结论肿瘤最大径、梅奥评分、肿瘤血管贴附、肿瘤下极到肾上极的距离是肾上腺恶性肿瘤切除术难度的独立影响因素，根据该结果构建的机器学习模型有着良好的预测性能，有助于术者评估手术难度，从而个体化完善术前准备，降低手术风险，提高患者获益。
- 肾上腺 /
- 恶性肿瘤 /
- 预测模型 /
- 危险因素 /
- 列线图
Abstract: Objective To establish a model to predict the difficulty of adrenalectomy based on computed tomography parameters and to guide the surgeons to improve the preoperative evaluation of the difficulty of adrenalectomy.Methods A retrospective analysis of 75 patients with malignant adrenal tumors treated in Shanxi Bethune Hospital from August 2014 to December 2021 was made. The independent influencing factors were screened by univariate logistic regression and stepwise multivariate logistic regression, and the nomogram was constructed. The ROC curve was used to analyze the prediction efficiency of the nomogram. The C-index and bootstrap self-sampling method were used to verify the discrimination and consistency of the nomogram.Results Adhesion of tumors to vessels, tumor diameter, distance from adrenal tumor to upper pole of kidney, and Mayo adhesive probability were selected as independent influencing factors. According to the results, the model was constructed. The C-index was 0.924. The decision curve analysis suggested that the net benefit rate of patients could be increased by about 25%, indicating that the prediction effect of the model was good.Conclusion Adhesion of tumors to vessels, tumor diameter, distance from adrenal tumor to upper pole of kidney, and Mayo adhesive probability are independent influencing factors in the difficulty of adrenalectomy for malignant tumors. The model based on the results has good predictive performance and is helpful for the surgeon to evaluate the difficulty of surgery to individualize and improve preoperative preparation, reduce the risk of surgery, and provide more benefit for patients.
- adrenal glands /
- malignant neoplasms /
- prediction model /
- risk factors /
- nomogram

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图 1 肾上腺恶性肿瘤手术难度的影响因素的森林图

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图 2 肾上腺恶性肿瘤手术难度预测模型的列线图及验证

下载: 全尺寸图片幻灯片

表 1 基线资料表例(%)，X±S，M(P₂₅, P₇₅)

变量	总队列(75例)	手术		t/Z/χ²	P值
变量	总队列(75例)	较易(41例)	较难(34例)	t/Z/χ²	P值
术前参数
年龄/岁	48.55±15.75	46.56±15.74	50.94±15.64	-1.203	0.233
性别				0.054	0.817
男	43(57.3)	24(55.8)	19(44.2)
女	32(42.7)	17(53.1)	15(46.9)
BMI/(kg/m²)	23.28±3.30	22.95±3.27	23.67±3.35	-0.938	0.351
患侧				0.001	0.980
左侧	31(41.3)	17(54.8)	14(45.2)
右侧	44(58.7)	24(54.5)	20(45.5)
高血压史				0.547	0.460
无	34(45.3)	17(50.0)	17(50.0)
有	41(54.7)	24(58.5)	17(41.5)
糖尿病史				0.300	0.584
无	62(82.7)	33(53.2)	29(46.8)
有	13(17.3)	8(61.5)	5(38.5)
冠心病史				0.068	0.794
无	68(90.7)	38(55.9)	30(44.1)
有	7(9.3)	3(42.9)	4(57.1)
脑梗史				0.009	0.924
无	67(89.3)	36(53.7)	31(46.3)
有	8(10.7)	5(62.5)	3(37.5)
高脂血症				0.001	0.999
无	71(94.7)	39(54.9)	32(45.1)
有	4(5.3)	2(50.0)	2(50.0)
肿瘤史				2.984	0.084
无	66(88.0)	39(59.1)	27(40.9)
有	9(12.0)	2(22.2)	7(77.8)
手术史				1.939	0.585
无	46(61.3)	28(60.9)	18(39.1)
后腹手术史	17(22.7)	8(47.1)	9(52.9)
经腹手术史	5(6.7)	2(40.0)	3(60.0)
其他手术史	7(9.3)	3(42.9)	4(57.1)
肿瘤最大径/mm	47.00(35.10，69.10)	40.80(32.00，52.00)	66.50(48.45，91.80)	4.326	< 0.001
DAK/mm	-27.90(-48.80，-18.00)	-23.20(-28.80，-14.40)	-43.70(-52.57，-26.63)	3.672	< 0.001
DARP/mm	4.50(-3.90，14.40)	8.00(0.00，18.75)	0.80(-10.30，6.80)	3.065	0.002
DGV/mm	1.00(0.00，4.00)	2.00(0.00，5.00)	0.00(0.00，3.75)	1.804	0.059
ATV				6.776	0.009
无	41(54.7)	28(68.3)	13(31.7)
有	34(45.3)	13(38.2)	21(61.8)
MAP/分				14.857	0.011
0	6(8.0)	6(100.0)	0(0)
1	4(5.3)	2(50.0)	2(50.0)
2	10(13.3)	9(90.0)	1(10.0)
3	35(46.7)	17(48.6)	18(51.4)
4	14(18.7)	6(42.9)	8(57.1)
5	6(8.0)	1(16.7)	5(83.3)
术前Hb/(g/L)	131.88±22.12	135.93±23.02	127.00±20.24	1.765	0.082
术中术后参数
手术时间/min	155.00(121.00，205.00)	125.00(96.00，151.00)	217.50(185.00，256.75)	5.955	< 0.001
出血量/mL	100.00(20.00，500.00)	30.00(0.00，100.00)	500.00(200.00，800.00)	6.125	< 0.001
切除范围				1.027	0.311
部分切	66(88.0)	38(57.6)	28(42.4)
全切	9(12.0)	3(33.3)	6(66.7)
术式				6.452	0.040
后腹腔镜	49(65.3)	31(63.3)	18(36.7)
经腹腹腔镜	16(21.3)	8(50.0)	8(50.0)
开放手术	10(13.3)	2(20.0)	8(80.0)
病理类型				6.042	0.049
PPGL	56(74.7)	35(62.5)	21(37.5)
皮质癌	12(16.0)	3(25.0)	9(75.0)
转移癌	7(9.3)	3(42.9)	4(57.1)
分组				0.246	0.620
训练集	53(70.7)	25(47.2)	28(52.8)
验证集	22(29.3)	9(40.9)	13(59.1)

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