目的 探讨非小细胞肺癌(NSCLC)患者营养状况恶化的危险因素,构建列线图预测模型并验证其预测价值。方法 采用便利抽样法选取2019年6月至2025年6月南通大学附属肿瘤医院312例肺癌患者,按7∶3分为建模组(212例)和验证组(100例)。以是否发生营养状况恶化为因变量,对建模组进行单因素分析筛选变量,再经多因素二元Logistic回归构建预测营养恶化的列线图模型,并予验证组验证。结果 建模组212例NSCLC患者中75例发生营养状况恶化(35.38%)。多因素Logistic回归分析结果显示,年龄(OR=1.982)、共病指数(OR=1.640)、原有消化系统疾病(OR=1.694)、自评营养摄入差(OR=1.507)、肿瘤坏死因子-α(TNF-α)(OR=2.059)及白介素-6(IL-6)(OR=2.342)成为NSCLC患者营养状况恶化的危险因素(P＜0.05),体质指数(BMI)18.5~24.0 kg/m2(OR=0.787)/BMI＞24.0 kg/m2(OR=0.739)成为NSCLC患者营养状况恶化的保护性因素(P＜0.05)。列线图预测模型,logit(P)=2.538+0.684(年龄)+0.495(共病指数)+0.527K(原有消化系统疾病)+(-0.239)K(BMI为18.5~24.0 kg/m2)+(-0.239)K(BMI>24.0 kg/m2)+0.410K(自评营养摄入)+0.722(TNF-α)+0.851(IL-6),K是指示函数,条件为真时取1,否则取0。受试者操作特性(ROC)曲线分析结果显示,建模组和验证组曲线下面积(AUC)分别为0.82(95%CI=0.78~0.86)和0.78(95%CI=0.72~0.83)。校准曲线与参考曲线相接近,决策曲线分析(DCA)显示该模型决策能够使患者获益。结论 NSCLC患者营养状况恶化的发生与患者的年龄、共病指数、原有消化系统疾病、BMI、自评营养摄入、TNF-α及IL-6有关,基于上述指标构建列线图预测模型,可较好地预测NSCLC患者营养状况恶化的发生,可为临床营养状况恶化的早期预防提供依据。
Abstract
Objective To explore the risk factors for the deterioration of nutritional status in patients with non-small cell lung cancer(NSCLC), construct a nomogram prediction model and verify its predictive value. Method Convenience sampling was used to select 312 lung cancer patients admitted to the Affiliated Cancer Hospital of Nantong University from June 2019 to June 2025. The patients were divided into a modeling group (212 cases) and a validation group (100 cases) at a 7:3 ratio. With the occurrence of nutritional deterioration as the dependent variable, univariate analysis was performed on the modeling group to screen for statistically significant variables, which were then included in a multivariate binary Logistic regression to develop a nomogram model for predicting nutritional deterioration, and the model was validated using the validation group. Result In the modeling group, 212 patients with NSCLC were obtained, and 75 of them experienced deterioration of nutritional status (35.38%). Multivariate results age (OR=1.982), comorbidity index (OR=1.640), pre-existing digestive system diseases (OR=1.694), poor self-assessed nutritional intake (OR=1.507), TNF-α (OR=2.059), and IL-6 (OR=2.342) became risk factors for the deterioration of nutritional status in patients with non-small cell lung cancer (P < 0.05). Body mass index(BMI)of 18.5-24.0 kg/m2 (OR=0.787)/BMI > 24.0 kg/m2 (OR=0.739) became a protective factor for the deterioration of nutritional status in patients with NSCLC (P < 0.05). Nomogram prediction model logit (P)=2.538+0.684 (age) +0.495 (comorbidity index) +0.527K (pre-existing digestive system diseases) + (-0.239) K (BMI between 18.5 and 24.0 kg/m2) + (-0.239) K (BMI>24.0 kg/m2) +0.410K (self-assessed nutritional intake) +0.722 (TNF-α) +0.851 (IL-6). The analysis results of the receiver operating characteristic(ROC) curve showed that the AUC of the modeling group and the validation group was 0.82 (95%CI was 0.78-0.86) and 0.78, respectively, and the (95%CI was 0.72-0.83) . The calibration curve is close to the reference curve, and the decision analysis curve shows that the model's decisions can benefit patients. Conclusion The occurrence of nutritional deterioration in patients with NSCLC is related to the patients' age, comorbidity index, pre-existing digestive system diseases, body mass index, self-rated nutritional intake, TNF-α and IL-6. Based on the above indicators, a nomogram prediction model is constructed, which can better predict the occurrence of nutritional deterioration in patients with NSCLC. It can provide a basis for early prevention of deterioration in clinical nutritional status.
关键词
非小细胞肺癌 /
靶向治疗 /
营养状况恶化 /
风险预测 /
列线图
Key words
Non-small cell lung cancer /
Targeted therapy /
Nutritional deterioration /
Risk prediction /
Nomogram
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