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中华临床医师杂志(电子版) ›› 2024, Vol. 18 ›› Issue (08) : 717 -723. doi: 10.3877/cma.j.issn.1674-0785.2024.08.003

医护一体化

肝癌微波消融术后中重度疼痛风险预测列线图模型构建及验证
韦巧玲1, 黄妍1,(), 赵昌1, 宋庆峰1, 陈祖毅1, 黄莹1, 蒙嫦1, 黄靖1   
  1. 1.530021 广西南宁,广西医科大学附属肿瘤医院介入科
  • 收稿日期:2024-06-06 出版日期:2024-08-15
  • 通信作者: 黄妍
  • 基金资助:
    广西科技计划项目广西科技基地和人才专项(桂科AD20238096)广西壮族自治区卫生健康委员会自筹经费科研课题(Z-A20220733)2023年广西医科大学重点教材建设立项项目(Gxmuzdjc2318)广西壮族自治区中医药管理局自筹经费科研课题(GXZYA20230330)

Construction and verification of moderate to severe pain risk prediction model after microwave ablation of liver cancer

Qiaoling Wei1, Yan Huang1,(), Chang Zhao1, Qingfeng Song1, Zuyi Chen1, Ying Huang1, Chang Meng1, Jing Huang1   

  1. 1.Interventional Department, Guangxi Medical University Cancer Hospital,Nanning 530021, China
  • Received:2024-06-06 Published:2024-08-15
  • Corresponding author: Yan Huang
引用本文:

韦巧玲, 黄妍, 赵昌, 宋庆峰, 陈祖毅, 黄莹, 蒙嫦, 黄靖. 肝癌微波消融术后中重度疼痛风险预测列线图模型构建及验证[J]. 中华临床医师杂志(电子版), 2024, 18(08): 717-723.

Qiaoling Wei, Yan Huang, Chang Zhao, Qingfeng Song, Zuyi Chen, Ying Huang, Chang Meng, Jing Huang. Construction and verification of moderate to severe pain risk prediction model after microwave ablation of liver cancer[J]. Chinese Journal of Clinicians(Electronic Edition), 2024, 18(08): 717-723.

目的

用数据驱动方法进行特征筛选并建立肝癌微波消融术后中重度疼痛风险预测模型。

方法

选取2018 年1 月至2023 年12 月在广西某三甲医院住院的239 例局麻下行肝癌微波消融术患者为研究对象,根据术后疼痛评分(VAS)分为轻微疼痛组和中重度疼痛组,采用 LASSO 模型进行肝癌微波消融术后疼痛的特征筛选并构建预测模型,通过bootstrap重抽样法对预测模型内部验证。

结果

239 例患者中有126 例患者术后出现中重度疼痛,中重度疼痛的发生率为52.72%,基于数据驱动下特征筛选结果,将年龄、性别、是否肝硬化、原发病、Child-Pugh 分级、既往手术、病灶直径、病灶数量、离肝包膜距离、消融时间、疼痛灾难化、焦虑、抑郁纳为肝癌微波消融术后患者发生中重度疼痛的预测因子。Bootstrap 法内部验证显示平均ROC 曲线下面积(area under the curve,AUC)为0.978、C-Index 为0.978,AUC 为0.882、模型特异度为0.941、敏感度为0.792,基于以上结果构建术后中重度疼痛的列线图。

结论

验证结果表明模型校准度和区分度较好,基于该模型的肝癌微波消融术后中重度疼痛列线图具有良好的预测效能和临床应用价值。

Objective

To use data-driven method for feature screening and establish a moderate to severe pain risk prediction model after microwave ablation of liver cancer.

Methods

A total of 239 patients undergoing microwave ablation of hepatoma under local anesthesia who were hospitalized in the Department of Interventional Oncology Affiliated to Guangxi Medical University from January 2018 to December 2023 were selected as the study objects, and were divided into mild pain group and moderate to severe pain group according to postoperative pain scale (VAS).LASSO model was used to screen the characteristics of pain after microwave ablation of liver cancer, and a prediction model was constructed.The prediction model was internally verified by bootstrap resampling method.

Results

126 of the 239 patients had moderate to severe pain after surgery, and the incidence of moderate to severe pain was 52.72%.Based on the data driven feature screening results, Age, sex, cirrhosis, primary disease, Child-Pugh grade, previous surgery,lesion diameter, number of lesions, distance from liver envelope, ablation time, pain disaster, anxiety and depression were included as predictors of moderate to severe pain after microwave ablation of liver cancer.Internal verification by Bootstrap method showed that the average areaunder ROC curve (AUC) was 0.978,C-Index was 0.978, AUC was 0.882, model specificity was 0.941,and sensitivity was 0.792.Based on the above results, the nomogram of moderate and severe postoperative pain was constructed.

Conclusion

The verification results show that the calibration and differentiation of the model are good,and the moderate and severe pain nomogram based on this model has good predictive efficacy and clinical application value.

表1 2 组疼痛水平的患者基线特征比较[n(%)]
特征 病例数(n=239) 无或轻微疼痛组(n=113) 中重度疼痛组(n=126) P
年龄 0.004
>60岁 109(45.6) 63(55.8) 46(36.5)
≤60岁 130(54.4) 50(44.2) 80(63.5)
性别 0.299
81(33.9) 34(30.1) 47(37.3)
158(66.1) 79(69.9) 79(62.7)
肝硬化 0.283
173(72.4) 86(76.1) 87(69.0)
66(27.6) 27(23.9) 39(31.0)
原发病 0.007
其他 41(17.2) 11(9.7) 30(23.8)
肝癌 198(82.8) 102(90.2) 96(76.2)
Child-Pugh分期 0.179
B 134(56.1) 69(61.1) 65(51.6)
A 105(43.9) 44(38.9) 61(48.4)
既往手术 0.872
133(55.6) 64(56.6) 69(54.8)
106(44.3) 49(43.4) 57(45.2)
病灶大小 0.061
>3 cm 120(50.2) 49(43.4) 71(56.3)
≤3 cm 119(49.8) 64(56.6) 55(43.7)
病灶数量 0.170
2~3个 139(58.2) 60(53.1) 79(62.7)
单个 100(41.8) 53(46.9) 47(37.3)
离肝包膜距离 0.008
≥5 mm 145(60.7) 79(69.9) 66(52.4)
<5 mm 94(39.3) 34(30.1) 60(47.6)
消融时间 0.001
≥5 min 90(37.7) 30(26.5) 60(47.6)
<5 min 149(62.3) 83(73.5) 66(52.4)
疼痛灾难化 0.018
67(28.0) 23(20.4) 44(34.9)
172(72.0) 90(79.6) 82(65.1)
焦虑 0.003
88(36.8) 30(26.5) 58(46.0)
151(63.2) 83(73.5) 68(54.0)
抑郁 0.004
47(19.7) 13(11.5) 34(27.0)
192(80.3) 100(88.5) 92(73.0)
图1 肝癌微波消融术后中重度疼痛的列线图预测模型
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