基于基线数据和三维超声构建子宫内膜癌术后复发/转移预测模型及实证

doi:10.3969/j.issn.1006-6233.2025.04.020

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摘要 目的: 基于基线数据和三维超声构建子宫内膜癌(Endometrial carcinoma,EMC)术后复发/转移预测模型及实证。方法: 选取2020年1月至2022年6月山西省临汾市人民医院收治的289例行手术治疗的EMC患者,根据术后2年内是否发生复发/转移分为复发组、未复发组。统计并比较两组临床资料、三维超声资料,采用Lasso-Logistic回归方程分析EMC术后复发/转移的影响因素,构建列线图预测模型,并进行验证。结果: 术后2年,289例EMC患者中71例患者发生复发/转移,复发率为24.57%(71/289);复发组肿瘤直径、FIGO分期、病理分级、肌层浸润≥1/2、淋巴脉管内癌栓患者占比、VFI高于未复发组,术后放疗患者占比、RI低于未复发组(P<0.05);经Lasso-Logistic回归方程显示,FIGO分期、病理分级、肌层浸润、术后放疗、淋巴脉管内癌栓、RI、VFI为术后复发/转移的独立相关影响因素(P<0.05);基于上述影响因素构建的列线图预测模型C-index为0.815;校准曲线、ROC曲线显示该模型敏感度、准确性较高,具有良好的预测价值。结论: EMC患者术后2年复发率较高,其术后复发/转移的独立相关影响因素为FIGO分期、病理分级、肌层浸润、术后放疗、淋巴脉管内癌栓、RI、VFI,基于此构建的列线图模型敏感性、准确性较高,可精准识别早期潜在的高风险人群,便于个性化防治措施。

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关键词 ：子宫内膜癌, 三维超声, 复发/转移, 内部验证, 外部验证

Abstract：Objective: To construct a predictive model and empirical validation for postoperative recurrence/metastasis of endometrial carcinoma (EMC) based on baseline data and three-dimensional ultrasound. Methods: A total of 289 patients with EMC who underwent surgical treatment at Linfen People's Hospital,Shanxi Province from January 2020 to June 2022 were selected and divided into a recurrence group and a non-recurrence group according to whether recurrence/metastasis occurred within 2 years after surgery.The clinical data and three-dimensional ultrasound data of the two groups were statistically compared.The Lasso-Logistic regression equation was used to analyze the influencing factors of recurrence/metastasis after EMC,and a nomogram prediction model was constructed and validated. Results: Two years after surgery,71 out of 289 EMC patients had recurrence/metastasis,with a recurrence rate of 24.57% (71/289).The recurrence group had a higher proportion of patients with tumor diameter,FIGO stage,pathological grade,muscle invasion ≥1/2,lymphatic vascular cancer thrombus,and VFI than the non-recurrence group,and a lower proportion of patients with postoperative radiotherapy and RI than the non-recurrence group (P<0.05).The Lasso-Logistic regression equation showed that FIGO stage,pathological grade,muscle invasion,postoperative radiotherapy,lymphatic and vascular cancer thrombus,RI,and VFI were independent factors associated with postoperative recurrence/metastasis (P<0.05).The C-index of the Nomogram prediction model constructed based on the above influencing factors was 0.815.The calibration curve and ROC curve showed that the model had high sensitivity and accuracy,and had good predictive value. Conclusion: The recurrence rate of EMC patients is high two years after surgery,and the independent factors associated with postoperative recurrence/metastasis are FIGO stage,pathological grade,muscle invasion,postoperative radiotherapy,lymphovascular invasion,RI,and VFI.The nomogram model constructed based on these factors has high sensitivity and accuracy,and can accurately identify potential high-risk populations in the early stage for personalized prevention and treatment measures.

Key words： Endometrial marcinoma Three-dimensional ultrasound Recurrence/Metastasis Internal validation External validation

基金资助:山西省科学技术研究与开发项目,(编号:202001D1132001)

通讯作者: 贾蓉

引用本文:

黄娟, 高剑英, 张娇, 姚秋菊, 贾蓉. 基于基线数据和三维超声构建子宫内膜癌术后复发/转移预测模型及实证[J]. 河北医学, 2025, 31(4): 648-655.
HUANG Juan, GAO Jianying, ZHANG Jiao, et al. Construction of a Predictive Model for Postoperative Recurrence/Metastasis of Endometrial Carcinoma Based on Baseline Data and Three-Dimensional Ultrasound Along with Empirical Validation. HeBei Med, 2025, 31(4): 648-655.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2025.04.020 或 http://www.hbyxzzs.cn/CN/Y2025/V31/I4/648

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