I期子宫内膜癌淋巴脉管间隙浸润的高危因素分析及预测模型的构建

Analysis of High Risk Factors of Lymphatic Vascular Space Infiltration in Stage I Endometrial Carcinoma and Construction of Predictive Model

摘要: 目的：探讨I期子宫内膜癌患者发生淋巴脉管间隙浸润(LVSI)的相关风险因素，同时构建I期子宫内膜癌发生LVSI的预测模型，用于术前评估LVSI的风险。方法：回顾性分析2019年1月至2022年12月就诊于山东大学齐鲁医院并行全面分期手术治疗的425例I期子宫内膜癌患者的临床资料，使用Logistic回归分析确定I期子宫内膜癌发生LVSI的独立危险因素，并以此作为预测因子使用R语言软件构建I期子宫内膜癌LVSI的风险预测模型，后使用ROC (Receiver Operating Characteristics)曲线下面积AUC (Area Under the ROC)、校准曲线和决策曲线分析DCA (Decision Curve Analysis)来评估该预测模型的预测性能、校准度和临床收益。结果：425例I期子宫内膜癌患者中，LVSI阳性者118例(27.7%)。单因素分析显示年龄、合并高血压、绝经、CA125水平、病理类型、肌层浸润深度、组织学分级与I期子宫内膜癌发生淋巴血管间隙浸润显著相关(P < 0.05)。多因素分析显示肌层浸润深度(OR = 6.216, 95% CI: 3.300~11.709, P < 0.001)，病理类型(OR = 3.816, 95% CI: 1.122~12.985, P = 0.032 < 0.05)，组织学分级(OR = 4.032, 95% CI: 1.924~8.450, P < 0.001)，CA125水平(OR = 2.762, 95% CI: 1.503~5.073, P < 0.001)是I期子宫内膜癌发生淋巴血管间隙浸润的独立危险因素。以此构建的列线图预测模型有良好的预测效能(AUC = 0.812)、符合度(平均绝对误差为0.017)和较好的临床收益。结论：术前CA125 ≥ 35 U/ml、病理分型为非子宫内膜样癌、组织学分级为G3和肌层浸润 ≥ 1/2是EC患者发生LVSI的独立危险因素；基于此建立的I期子宫内膜癌发生LVSI的风险预测模型具有良好的预测效能，可用于术前评估I期子宫内膜癌患者发生LVSI的风险。

Abstract: Objective: To investigate the risk factors for lymphovascular space invasion (LVSI) in patients with stage I endometrial carcinoma and create a predictive model for evaluating the risk of LVSI in stage I endometrial carcinoma before operation. Methods: The clinical data of 425 patients with stage I endometrial cancer who underwent comprehensive staging surgery in Qilu Hospital of Shandong University from January 2019 to December 2022 were retrospectively analyzed. Logistic regression analysis was used to determine the independent risk factors for LVSI in stage I endometrial cancer. Using these factors as predictors, a risk prediction model of LVSI in stage I endometrial cancer was constructed using R language, and then the ROC curve, the decision curve analysis and calibration curve were used to evaluate the predictive performance and conformity of the prediction model. Results: Among 425 patients with stage I endometrial cancer, 118 (27.7%) were LVSI positive. Univariate analysis showed that age, hypertension, menopause, CA125 level, pathological type, depth of myometrial invasion and histological grade were significantly correlated with LVI in stage I endometrial cancer (P < 0.05). Multivariate analysis showed that the depth of myometrial invasion (OR = 6.216, 95% CI: 3.300~11.709, P < 0.001), pathological type (OR = 3.816, 95% CI: 1.122~12.985, P = 0.032 < 0.05), histological grade (OR = 4.032, 95% CI: 1.924~8.450, P < 0.001), CA125 level (OR = 2.762, 95% CI: 1.503~5.073, P < 0.001) were independent risk factors for LVI in stage I endometrial cancer. The nomogram prediction model constructed with those predictors had good prediction efficiency (AUC = 0.812), conformity (mean absolute error = 0.017) and clear clinical benefit. Conclusions: CA125 ≥ 35 U/ml, non-endometrioid carcinoma, histological grade G3 and myometrial invasion ≥ 1/2 are independent risk factors for LVSI in EC patients. The risk prediction model of LVSI in patients with stage I endometrial cancer has a good predictive efficiency, which can be used to evaluate the risk of LVSI in patients with early endometrial cancer before surgery.