国际肿瘤学杂志

国际肿瘤学杂志 ›› 2024, Vol. 51 ›› Issue (4): 193-197.doi: 10.3760/cma.j.cn371439-20231213-00032

• 论著 • 上一篇    下一篇

原发性脑胶质瘤患者术后复发危险因素及预测模型构建

刘萍萍, 何学芳, 张翼, 杨旭, 张珊珊, 季一飞()   

  1. 南充市中心医院（首都医科大学附属北京安贞医院南充医院）神经内科 四川省神经系统疾病临床医学研究中心，南充 637000
  • 收稿日期:2023-12-13 修回日期:2024-03-15 出版日期:2024-04-08 发布日期:2024-05-10
  • 通讯作者: 季一飞，Email：jiyifei_2003@163.com
  • 基金资助:
    国家自然科学基金(81870966);四川省自然科学基金(2022NSFSC0756);南充市社会科学研究“十四五”规划项目(NC21B183)

Risk factors of postoperative recurrence in patients with primary brain glioma and prediction model construction

Liu Pingping, He Xuefang, Zhang Yi, Yang Xu, Zhang Shanshan, Ji Yifei()   

  1. Department of Neurology， Nanchong Central Hospital （Nanchong Hospital， Beijing Anzhen Hospital， Capital Medical University）， Clinical Research Center for Neurological Diseases of Sichuan Province， Nanchong 637000， China
  • Received:2023-12-13 Revised:2024-03-15 Online:2024-04-08 Published:2024-05-10
  • Contact: Ji Yifei， Email：jiyifei_2003@163.com
  • Supported by:
    National Natural Science Foundation of China(81870966);Natural Science Foundation of Sichuan Province of China(2022NSFSC0756);Nanchong Social Science Research "14th Five-Year Plan" Project(NC21B183)

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摘要：

目的 探讨原发性脑胶质瘤患者术后复发危险因素并构建预测模型。方法 回顾性纳入2018年1月至2021年1月于南充市中心医院行根治手术治疗的原发性脑胶质瘤患者98例，根据随访期间有无复发分为复发组（40例）和未复发组（58例）；采用logistic多因素回归分析原发性脑胶质瘤患者术后复发的独立影响因素，并构建logistic预测模型，通过受试者操作特征（ROC）曲线评估各指标的预测效能。结果 复发组和未复发组胶质瘤世界卫生组织（WHO）分级（χ2=12.48，P<0.001）、异柠檬酸脱氢酶（IDH）1/2突变情况（χ2=13.24，P<0.001）、平均血小板体积（MPV）（t=5.34，P<0.001）、MPV/血小板计数（PLT）（t=9.73，P<0.001）的差异均有统计学意义。多因素分析显示，WHO分级Ⅲ~Ⅳ级（OR=8.54，95%CI为1.62~44.99，P=0.011）、IDH1/2野生型（OR=9.08，95%CI为1.68~49.19，P=0.010）、低MPV（OR=0.46，95%CI为0.21~0.99，P=0.048）和低MPV/PLT（OR=0.02，95%CI为0.01~0.03，P<0.001）是原发性脑胶质瘤患者术后复发的独立危险因素。基于上述指标构建的logistic预测模型为logit（P）=11.78+2.15×WHO分级+2.21×IDH1/2突变情况-0.78×MPV-200.70×MPV/PLT（R2=0.785）。ROC曲线分析显示，WHO分级、IDH1/2突变情况、MPV、MPV/PLT及logistic预测模型P值均可用于原发性脑胶质瘤患者术后复发风险预测，曲线下面积分别为0.681、0.684、0.783、0.920、0.964。在各指标的ROC曲线下面积对比中，logistic回归模型P值的预测效能明显高于其他指标（均P<0.05）。结论 原发性脑胶质瘤患者术后复发可能与胶质瘤WHO分级、IDH1/2突变情况及血小板相关实验室指标有关；基于上述指标构建的模型可用于预测原发性脑胶质瘤患者术后复发的风险。

关键词: 神经胶质瘤, 复发, 预后, 血小板

Abstract:

Objective To investigate the risk factors of postoperative recurrence in patients with primary brain glioma and to construct a prediction model. Methods A total of 98 patients with primary brain glioma treated by radical surgery in Nanchong Central Hospital from January 2018 to January 2021 were retrospectively included， and were divided into recurrent group （40 cases） and non-recurrent group （58 cases） according to whether there was recurrence or not during the follow-up period. The independent influencing factors for postoperative recurrence in patients with primary brain glioma were evaluated by multivariate logistic regression. Logistic prediction model of postoperative recurrence risk of patients with primary brain glioma was established， and the predictive efficacy of each index was calculated by receiver operator characteristic （ROC） curve. Results There were statistically significant differences between recurrent group and non-recurrent group in glioma World Health Organization （WHO） grade（χ2=12.48，P<0.001）， isocitrate dehydrogenase （IDH）1/2 mutation （χ2=13.24， P<0.001）， mean platelet volume （MPV）（t=5.34， P<0.001）， and MPV/platelet count （PLT）（t=9.73，P<0.001）. Multivariate analysis showed that WHO grade Ⅲ-Ⅳ （OR=8.54， 95%CI：1.62-44.99， P=0.011）， IDH1/2 wild type （OR=9.08， 95%CI：1.68-49.19， P=0.010）， low MPV （OR=0.46， 95%CI：0.21-0.99， P=0.048） and low MPV/PLT （OR=0.02， 95%CI：0.01-0.03， P<0.001） were independent risk factors for postoperative recurrence in patients with primary brain glioma. The logistic prediction model based on the above indicators was logit（P）=11.78+2.15×WHO grade+2.21×IDH1/2 mutation situation-0.78×MPV-200.70×MPV/PLT （R2=0.785）.The ROC curve analysis results showed that WHO grade， IDH1/2 mutation， MPV， MPV/PLT， and logistic prediction model P-value could all be used to predict the risk of postoperative recurrence in patients with primary brain glioma； The areas under the curve were 0.681， 0.684， 0.783， 0.920 and 0.964， respectively. In the area under ROC curve comparison of each indicator， the predictive performance of the logistic regression model P-value was significantly higher than that of other indicators （all P<0.05）. Conclusion Postoperative recurrence in patients with primary brain glioma may be related to glioma WHO grade， IDH1/2 mutation and platelet related laboratory indexes. The model constructed based on the above indicators can be used to predict the recurrence risk in patients with primary brain glioma after surgery.

Key words: Glioma, Recurrence, Prognosis, Blood platelets