化疗引起的周围神经病变患者生活质量影响因素调查及预测模型构建^*

Investigation of Factors Influencing the Quality of Life in Patients With Chemotherapy-Induced Peripheral Neuropathy and Construction of a Prediction Model

摘要

目的 探讨化疗引起的周围神经病变（chemotherapy-induced peripheral neuropathy, CIPN）患者生活质量的影响因素，并构建风险预测模型。方法 选取2022年1月–2024年12月我院收治的CIPN患者作为研究对象。依据癌症治疗功能评价系统量表（Functional Assessment of Cancer Therapy-General, FACT-G）得分的平均值，将262例患者分为生活质量良好组与不良组。比较两组临床资料，采用二元logistic回归分析生活质量的影响因素，并构建列线图预测模型。通过受试者工作特征（receiver operating characteristic, ROC）曲线、校准曲线、Hosmer-Lemeshow拟合优度检验及决策曲线评估模型预测效能。结果 262例患者FACT-G平均得分为（84.65±13.65）分，其中良好组135例，不良组127例。多因素分析显示，婚姻状况〔比值比（odds ratio, OR）=2.317，95%置信区间（confidence interval, CI）：1.037～5.176〕、肾功能异常（OR=2.635，95%CI：1.197～5.801）、肿瘤TNM分期T2（OR=2.744，95%CI：1.095～6.878）、T3（OR=0.301，95%CI：0.110～0.828）、焦虑（OR=2.763，95%CI：1.260～6.060）、疼痛（OR=4.651，95%CI： 1.998～10.828）、呕吐（OR=3.459，95%CI：1.567～7.637）、失眠（OR=5.215，95%CI：1.789～15.197）、嗜睡（OR=3.870，95%CI：1.387～10.795）是CIPN患者生活质量的独立影响因素（P<0.05）。基于上述因素构建的列线图预测模型在建模组中ROC曲线下面积（area under the curve, AUC）为0.864（95%CI：0.813～0.915），其ROC曲线最佳截断值对应的特异度为0.827（0.752～0.901）、灵敏度为0.741（0.648～0.834）；在验证组中AUC为0.803（95%CI：0.707～0.900），最佳截断值对应的特异度为0.703（0.555～0.850）、灵敏度为0.738（0.605～0.871），提示模型诊断效能良好。理想曲线与校准曲线拟合良好，Hosmer-Lemeshow检验示模型校准度良好。决策曲线显示模型在0.5～1.0范围内具有较高的净收益。结论 婚姻状况、肾功能异常、肿瘤TNM分期、焦虑、疼痛、呕吐、失眠、嗜睡是CIPN患者生活质量较差的独立影响因素；基于这些因素构建的预测模型具有良好的区分度与校准度，可用于临床评估CIPN患者的生活质量。

Abstract

Objective To investigate the factors influencing quality of life in patients with chemotherapy-induced peripheral neuropathy (CIPN) and to construct a risk prediction model. Methods Patients with CIPN admitted to our hospital from January 2022 to December 2024 were selected. Based on the mean score of the Functional Assessment of Cancer Therapy-General (FACT-G) scale, 262 patients were divided into good quality of life group and poor quality of life group. Clinical data were compared between the two groups. Binary logistic regression was used to identify factors influencing quality of life, and a nomogram prediction model was constructed. The predictive performance of the model was evaluated using receiver operating characteristic (ROC) curve, calibration curve, Hosmer-Lemeshow goodness-of-fit test, and decision curve analysis. Results The 262 patients were divided into a good group (135 cases) and a poor group (127 cases) based on the mean FACT-G score of 84.65 ± 13.65. Multivariate analysis showed that marital status (odds ratio [OR] = 2.317, 95% CI: 1.037-5.176), renal dysfunction (OR = 2.635, 95% CI: 1.197-5.801), tumor TNM stage T2 (OR = 2.744, 95% CI: 1.095-6.878), stage T3 (OR = 0.301, 95% CI: 0.110-0.828), anxiety (OR = 2.763, 95% CI: 1.260-6.060), pain (OR = 4.651, 95% CI: 1.998-10.828), vomiting (OR = 3.459, 95% CI: 1.567-7.637), insomnia (OR = 5.215, 95% CI: 1.789-15.197), and somnolence (OR = 3.870, 95% CI: 1.387-10.795) were independent influencing factors for quality of life in CIPN patients (allP < 0.05). The nomogram prediction model was established based on the above factors. In the training cohort, the AUC of the ROC curve was 0.864 (95% CI: 0.813-0.915). The specificity and sensitivity corresponding to the optimal cut-off value were 0.827 (95% CI: 0.752-0.901) and 0.741 (95% CI: 0.648-0.834), respectively. In the validation cohort, the AUC was 0.803 (95% CI: 0.707-0.900), with a specificity of 0.703 (95% CI: 0.555-0.850) and a sensitivity of 0.738 (95% CI: 0.605-0.871) at the optimal cut-off value, suggesting good diagnostic efficacy of the model. The ideal curve aligns well with the calibration curve, and the Hosmer-Lemeshow test indicates that the model is well calibrated. Decision curve analysis demonstrated a high net benefit of the model within the range of 0.5 to 1.0. Conclusion Marital status, renal dysfunction, tumor TNM staging, anxiety, pain, vomiting, insomnia, and somnolence are factors associated with a lower quality of life in patients with CIPN. The prediction model constructed based on these factors exhibits good discrimination and calibration, which can facilitate clinical assessment of quality of life in CIPN patients.

关键词

化疗 / 周围神经病变 / 生活质量 / 预测模型

Key words

Chemotherapy / Peripheral neuropathy / Quality of life / Prediction model

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基金资助

*江苏省社会发展面上项目(BE2019693)