2024 年第 8 期 第 19 卷

低级别子宫内膜样癌患者淋巴脉管间隙浸润的危险因素分析及列线图预测模型构建

Risk factors analysis of lymphovascular space invasion in patients with low-grade endometrial carcinoma and construction of a nomogram prediction model

作者：郝敏1韩伟2郑晓丹3马楠1蒋沫怡1朱夏琴1王志启1

英文作者：Hao Min1 Han Wei2 Zheng Xiaodan3 Ma Nan1 Jiang Moyi1 Zhu Xiaqin1 Wang Zhiqi1

单位：1首都医科大学附属北京友谊医院妇产科，北京100050；2北京协和医学院基础医学院中国医学科学院基础医学研究所，北京100730；3首都医科大学附属北京友谊医院病理科，北京100050

英文单位：1Department of Obstetrics and Gynecology Beijing Friendship Hospital Capital Medical University Beijing 100050 China; 2Institute of Basic Medicine Chinese Academy of Medical Sciences School of Basic Medicine Peking Union Medical College Beijing 100730 China; 3Department of Pathology Beijing Friendship Hospital Capital Medical University Beijing 100050 China

关键词：低级别子宫内膜样癌；淋巴脉管间隙浸润；列线图

英文关键词：Low-gradeendometrialcarcinoma;Lymphovascularspaceinvasion;Nomogram

• 摘要：

• 目的 分析低级别子宫内膜样癌患者淋巴脉管间隙浸润（LVSI）的危险因素，构建列线图预测模型并评价其效能。方法 收集2015年 1月至2023年5月在首都医科大学附属北京友谊医院妇科进行初始治疗的167例低级别子宫内膜样癌患者的临床资料进行回顾性分析。根据脉管浸润情况将患者分为无脉管浸润组（143例）和脉管浸润组（24例）。运用Logistic回归分析法确定低级别子宫内膜样癌LVSI的危险因素。建立预测低级别子宫内膜样癌LVSI风险的列线图模型，使用一致性系数和校准曲线评估该模型的预测性能和符合度。结果 采用多因素Logistic回归模型（逐步选择法）分析低级别子宫内膜样癌患者LVSI的独立危险因素，结果显示，阴道出血时间长、甘油三酯≥1.7 mmol/L，糖类抗原125≥35 kU/L，国际妇产科联盟临床分期Ⅱ期及以上是低级别子宫内膜样癌患者LVSI的独立危险因素(比值比=1.000、1.070、1.820、7.700，均P＜0.05)。利用以上多因素Logistic回归分析筛选出的独立危险因素建立预测低级别子宫内膜样癌LVSI风险的列线图模型，经校准验证，预测风险接近于实际风险，一致性指数为0.843。结论 临床高分期、血清高甘油三酯、高糖类抗原125和术前阴道出血时间长是低级别子宫内膜样癌患者LVSI的危险因素，利用这些指标构建的列线图模型可用于术前评估该类患者LVSI风险。

• Objective To analyze the risk factors for lymphovascular space invasion(LVSI) in patients with low-grade endometrial carcinoma, construct a nomogram prediction model, and evaluate its effectiveness. Methods  The clinical data of 167 patients with low-grade endometrial carcinoma who underwent initial treatment in the Department of Gynecology, Beijing Friendship Hospital, Capital Medical University from January 2015 to May 2023 were retrospectively analyzed. The patients were divided into non-vascular invasion group (143 cases) and vascular invasion group (24 cases) according to vascular invasion. Logistic regression analysis was used to determine the risk factors of LVSI in low-grade endometrial carcinoma. A nomogram model for predicting the risk of LVSI in low-grade endometrial carcinoma was established, and the consistency coefficient and calibration curve were used to evaluate the predictive performance and conformity of the model. Results  Multivariate Logistic regression model (stepwise selection method) was used to analyze the independent risk factors of LVSI in patients with low-grade endometrial carcinoma. The results showed that long vaginal bleeding time, triglycerides≥1.7 mmol/L, carbohydrate antigen 125≥35 kU/L, International Federation of Gynecology and Obstetrics clinical stage Ⅱ and above were independent risk factors for LVSI in patients with low-grade endometrial carcinoma(odds ratios=1.000, 1.070, 1.820, 7.700, all P<0.05). The independent risk factors screened by multivariate Logistic regression analysis were used to establish a nomogram model for predicting the risk of LVSI in low-grade endometrial carcinoma. After calibration and verification, the predicted risk was close to the actual risk, and the concordance index was 0.843. Conclusion  Clinical high staging, serum high triglycerides, high carbohydrate antigen 125, and long preoperative vaginal bleeding time are risk factors for LVSI in patients with low-grade endometrial carcinoma. The nomogram model based on these indicators can be used to evaluate the risk of LVSI in these patients before surgery.