阴道上皮内瘤变3级风险的临床预测模型

A clinical risk prediction model for vaginal intraepithelial neoplasia grade 3

摘要

目的 探究影响阴道上皮内瘤病变3级(VaIN3)发生的危险因素并构建评估VaIN3风险的预测模型。方法 选取2019年1月1日至2024年9月30日在我院妇科通过阴道镜引导下活检确诊为阴道上皮内瘤变(VaIN)的患者共1 107例,其中阴道低级别鳞状上皮内病变(VaIN1)共824例,阴道上皮内瘤病变2级(VaIN2)共222例,VaIN3共61例。比较VaIN3与VaIN1/2组患者的临床特征,采用Logistic回归分析筛选独立危险因素,并基于此构建列线图预测模型。模型的区分度、校准度及临床实用性分别采用受试者工作特征(ROC)曲线、校准曲线与临床决策曲线(DCA)进行评价。结果 Logistic回归分析显示,年龄＞65岁(OR=6.004,95%CI:1.406~25.627)、存在临床症状(OR=3.344,95%CI:1.622~6.694)、细胞学结果为高级别鳞状上皮内病变(OR=7.446,95%CI:2.322~23.875)以及因宫颈癌行子宫切除术(OR=4.460,95%CI:2.051~9.697)是VaIN3的独立危险因素(均P＜0.05)。基于此构建的预测模型表现出良好的预测效能,ROC曲线下面积(AUC)为0.817(95%CI:0.759~0.876),Hosmer-Lemeshow检验提示模型拟合良好(χ²=12.177,P=0.143)。校准曲线显示预测概率与实际概率一致性较高,DCA表明模型在5%~50%的阈值概率范围内具有临床净获益。结论 本研究所构建的临床预测模型可用于评估VaIN患者确诊为VaIN3的风险,模型预测效能较好,具有临床诊断及早期干预的参考价值。

Abstract

Objective To explore the risk factors influencing the occurrence of vaginal intraepithelial neoplasia grade 3 (VaIN3) and to develop a predictive model for assessing the risk of VaIN3. Methods A total of 1 107 patients diagnosed with vaginal intraepithelial neoplasia (VaIN) by colposcopy-guided biopsy at the Department of Gynecology of our hospital from January 1,2019,to September 30,2024,were selected,including 824 cases of low-grade squamous intraepithelial lesions of the vagina (VaIN1),222 cases of VaIN2,and 61 cases of VaIN3.The clinical characteristics of patients with VaIN3 were compared to those with VaIN1/2.Logistic regression analysis was used to identify independent risk factors,based on which a nomogram prediction model was constructed.The model's discrimination,calibration,and clinical utility were evaluated using receiver operating characteristic (ROC) curves,calibration curves,and decision curve analysis (DCA),respectively. Results Logistic regression analysis showed that age ＞65 years (OR=6.004,95%CI:1.406-25.627),presence of clinical symptoms (OR=3.344,95%CI:1.622-6.694),cytology results of HSIL (OR=7.446,95%CI:2.322-23.875),and hysterectomy due to cervical cancer (OR=4.460,95%CI:2.051-9.697) were independent risk factors for VaIN3 (all P＜0.05).The predictive model based on these factors showed good predictive performance,with an area under the ROC curve (AUC) of 0.817 (95%CI:0.759-0.876).The Hosmer-Lemeshow test indicated good model fit (χ ²=12.177,P=0.143).The calibration curve showed high consistency between predicted and actual probabilities,and DCA suggested that the model provides clinical net benefit within a threshold probability range of 5%-50%. Conclusion The clinical prediction model developed in this study can be used to assess the risk of VaIN patients being diagnosed with VaIN3.The model has good predictive performance and provides reference value for clinical diagnosis and early intervention.

关键词

阴道上皮内瘤变 / 危险因素 / 预测模型 / 列线图

Key words

vaginal intraepithelial neoplasia / risk factor / prediction model / nomogram

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基金资助

陕西省自然科学基础研究资助项目(2021JM-282)