胃癌化疗患者营养不良的影响因素及风险预测模型构建

Influencing factors and construction of risk prediction model of malnutrition in patients with gastric cancer undergoing chemotherapy

  • 摘要:
    目的  分析胃癌化疗患者营养不良的影响因素,并构建列线图预测模型。
    方法  选取接受完整化疗的152例患者作为研究对象。在完整化疗结束后,依据营养评估结果分为营养良好组(n=46)与营养不良组(n=106)。采用Logistic回归分析筛选胃癌化疗患者营养不良的影响因素; 构建预测胃癌化疗患者营养不良风险的列线图模型,使用受试者工作特征(ROC)曲线、校准曲线验证列线图模型的区分度与一致性。
    结果  152例胃癌化疗患者中, 106例营养不良,发生率为69.74%。性别男(95%CI: 1.232~6.292, P=0.014)、化疗期间未肠外营养支持(95%CI: 1.528~7.781, P=0.003)、有低蛋白血症(95%CI: 1.193~76.786, P=0.033)、有早饱(95%CI: 1.259~82.652, P=0.030)是胃癌化疗患者营养不良的独立危险因素。ROC曲线下面积为0.757(95%CI: 0.680~0.833)。校准曲线斜率接近1, 且Hosmer-Lemeshow拟合优度检验良好(χ2=5.834, P=0.442)。
    结论  性别男、化疗期间未肠外营养支持、有低蛋白血症、有早饱是胃癌化疗患者营养不良的独立危险因素,基于此构建预测列线图模型具有良好的区分度与一致性。

     

    Abstract:
    Objective  To analyze the risk factors of malnutrition in patients with gastric cancer undergoing chemotherapy and construct a nomogram prediction model.
    Methods  A total of 152 patients who received complete chemotherapy were selected as study subjects. After complete chemotherapy, the patients were divided into well-nourished group (n=46) and undernourished group (n=106) according to the nutritional evaluation results. Logistic regression analysis was used to screen the influencing factors of malnutrition in patients with gastric cancer undergoing chemotherapy. A nomogram model was constructed to predict the risk of malnutrition in patients with gastric cancer undergoing chemotherapy. Receiver operating characteristic (ROC) curve and calibration curve were used to verify the differentiation and consistency of the nomogram model.
    Results  Among 152 patients with gastric cancer treated with chemotherapy, 106 were malnourished, the incidence rate was 69.74%. Male (95%CI, 1.232 to 6.292, P=0.014), no parenteral nutrition support during chemotherapy (95%CI, 1.528 to 7.781, P=0.003), hypoproteinemia (95%CI, 1.193 to 76.786, P=0.033), early satiety (95%CI, 1.259 to 82.652, P=0.030) were independent risk factors for malnutrition in patients with gastric cancer undergoing chemotherapy. The area under ROC curve was 0.757 (95%CI, 0.680 to 0.833). The slope of calibration curve was close to 1, and the Hosmer-Lemeshow goodness of fit test was good (χ2=5.834, P=0.442).
    Conclusion  Male, lack of parenteral nutrition support during chemotherapy, hypoproteinemia and early satiety are independent risk factors for malnutrition inpatients with gastric cancer undergoing chemotherapy. The prediction nomogram model built on this basis has good differentiation and consistency.

     

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