联合中医证型分析喉癌变的影响因素及构建预测模型

Analysis of influencing factors for laryngeal carcinogenesis and construction of a predictive model

摘要

目的 联合中医证型分析喉癌变的影响因素并建立列线图预测模型。方法 回顾性收集首次确诊为早期喉癌、癌前病变的219例患者的临床资料作为病例组，选取同期125例声带息肉患者作为对照组。通过Logistic回归分析筛选喉癌变的独立危险因素，联合独立危险因素构建列线图预测模型，采用受试者工作特征曲线（receiver operating characteristic，ROC）、ROC曲线下面积（the area under the ROC curve，AUC）、一致性指数（the consistency index，C-index）进行评价，模型的校准度通过Hosmer-Lemeshow Test和校准曲线图评价。结果 多因素回归分析显示高龄、男性人群、吸烟、饮酒、证型为气血凝结证、白细胞（white blood cells，WBC）、中性粒细胞/淋巴比值细胞（neutrophil to lymphocyte ratio，NLR）升高为患者罹患喉癌变的独立危险因素，差异有统计学意义（P<0.05），基于上述7个独立危险因素构建列线图模型；ROC曲线评估模型区分度结果显示，联合预测AUC为0.923（95%CI: 0.895~0.952）（P<0.01），灵敏度为83.6%，特异度为87.2%；Hosmer-Lemeshow Test显示，列线图的拟合优度良好（χ²=8.853，P=0.355）；模型的校准曲线显示，模型的区分度良好（平均绝对误差=0.009，C-index=0.923）。结论 高龄、男性人群、吸烟、饮酒、证型为气血凝结证、WBC、NLR是喉癌变的独立危险因素，建立的中西医结合的列线图预测模型能有效预测发生喉癌变的风险，为临床早期防治喉癌变提供一定的参考。

Abstract

Objective To analyze the influencing factors of laryngeal carcinogenesis, incorporating traditional Chinese medicine (TCM) syndrome patterns, and to develop a nomogram prediction model. Methods The clinical data of 219 patients who were first diagnosed with early laryngeal cancer and precancerous lesions in the Department of Otorhinolaryngology of Zhongshan Hospital of Traditional Chinese Medicine from January 2013 to December 2023 were collected retrospectively as the case group, and 125 patients with vocal cord polyps during the same period were selected as the control group. Independent risk factors for laryngeal carcinogenesis were identified using Logistic regression analysis. A nomogram was constructed based on these factors. The model’s discrimination was evaluated using the receiver operating characteristic (ROC) curve, the area under the curve (AUC), and the Concordance Index (C-index). The model’s calibration was assessed using the Hosmer-Lemeshow test and a calibration curve. Results Multivariate regression analysis showed that advanced age, male sex, smoking, alcohol consumption, Qi stagnation and blood stasis syndrome, elevated WBC, and elevated NLR were significant independent risk factors for laryngeal carcinogenesis (all P<0.05). A nomogram was constructed based on these seven factors. The area under the ROC curve (AUC) for the combined model was 0.923(95%CI: 0.895-0.952), with a sensitivity of 83.6% and a specificity of 87.2%. The Hosmer-Lemeshow test indicated good goodness-of-fit for the nomogram (χ²=8.853, P=0.355). The calibration curve demonstrated good agreement (mean absolute error=0.009), and the model showed excellent discrimination (C-index=0.923). Conclusion Advanced age, male sex, smoking, alcohol consumption, Qi stagnation and blood stasis syndrome, elevated WBC, and elevated NLR are independent risk factors for laryngeal carcinogenesis. The established nomogram, which integrates factors from both TCM and Western medicine, can effectively predict the risk of laryngeal carcinogenesis, providing a valuable reference for its early prevention and clinical management.

关键词

喉癌 / 癌前病变 / 喉癌变 / 列线图模型 / 预测

Key words

Laryngeal carcinoma / Precancerous lesion / Laryngeal carcinogenesis / Nomogram model / Prediction

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基金资助

中山市社会公益与基础研究项目(2024B1135)

中山市中医药传承创新发展科研项目(2024B3004)

广东省医学科研基金(A2024627)

中山市科技局社会公益科技项目(2023B1068)

中山市医学科研项目(2023A020348)