【摘要】：目的:通過分析臨床因素與難治性SCLC的關系,建立難治性SCLC的預測模型。方法:1.研究因素:回顧性分析2008年4月-2014年9月年期間,就診于吉林大學第一醫(yī)院腫瘤中心的329例小細胞肺癌患者。根據一線化療結束后到疾病進展的時間將患者分為敏感性SCLC組和難治性SCLC組,納入的329例患者,敏感性SCLC組有239例,難治性SCLC組有90。研究因素包括年齡、性別、吸煙指數、臨床分期、上腔靜脈綜合征、化療方案、化療療周期及2療程化療療效等。2.建立預測模型:通過應用logistic回歸進行單因素及多因素回歸分析確定影響難治性SCLC的獨立危險因素,對獨立危險因素進行l(wèi)ogistic多因素分析時產生一個新的聯合預測變量PRE-1并建立回歸方程,用受試者工作特性曲線(ROC)對新預測變量的預測能力進行分析,獲得曲線下面積,根據約登指數(敏感性+特異性-1)找出最佳診斷界點。以P0.05為差異有統(tǒng)計學意義。結果:1.單因素logistic回歸分析主要是確定各項因素對難治性SCLC的相關性。有統(tǒng)計學意義的因素主要有性別、吸煙指數、上腔靜脈綜合征、臨床分期、化療方案和胸部放療。進一步多因素logistic回歸分析顯示,吸煙指數400支*年、有上腔靜脈綜合征、廣泛期、與EP方案相比EC方案和無胸部放療是難治性SCLC的獨立危險因素。2.預測模型ROC曲線下面積(AUC)為0.721,95%可信區(qū)間為0.657-0.784,取約登指數最大值所對應的分界點為診斷點,即PRE_1為0.306,其靈敏度為61.1%,特異度為79.9%。結論:1.吸煙指數400、有上腔靜脈綜合征、廣泛期、與EP方案相比EC方案和無胸部放療是難治性SCLC的獨立危險因素。2.根據獨立危險因素建立的難治性SCLC的預測模型,具有較高的靈敏度、特異度,可輔助臨床醫(yī)生對一線治療后的SCLC進行預測難治性SCLC。
[Abstract]:Objective: to establish a predictive model of refractory SCLC by analyzing the relationship between clinical factors and refractory SCLC. Method 1: 1. Study factors: a retrospective analysis of 329 patients with small cell lung cancer (SCLC) from April 2008 to September 2014 was conducted in the Cancer Center of the first Hospital of Jilin University. The patients were divided into sensitive SCLC group and refractory SCLC group according to the time from the end of first-line chemotherapy to the progression of the disease. There were 239 cases in the sensitive SCLC group and 90 cases in the refractory SCLC group. The factors included age, sex, smoking index, clinical stage, superior vena cava syndrome, chemotherapy regimen, chemotherapy cycle and 2 courses of chemotherapy. The prediction model was established: the independent risk factors affecting refractory SCLC were determined by single factor and multivariate regression analysis with logistic regression. A new joint predictive variable (PRE-1) was generated by logistic multivariate analysis of independent risk factors and a regression equation was established. The predictive ability of the new predictive variable was analyzed by using the operating characteristic curve (ROC) of the subjects, and the area under the curve was obtained. According to the Yorden index (sensitivity specificity-1) to find out the best diagnostic threshold point. P0.05 as the difference was statistically significant. The result is 1: 1. Single factor logistic regression analysis was mainly to determine the correlation between the factors and refractory SCLC. Statistically significant factors were gender, smoking index, superior vena cava syndrome, clinical staging, chemotherapy and chest radiotherapy. Further multivariate logistic regression analysis showed that smoking index was 400 years, had superior vena cava syndrome, extensive stage, EC regimen and non-chest radiotherapy were independent risk factors of refractory SCLC compared with EP regimen. The area (AUC) under the ROC curve of the prediction model was 0.721% 95% confidence interval 0.657-0.784. The dividing point corresponding to the maximum value of the Jorden index was taken as the diagnostic point, that is, the PRE_1 was 0.306, the sensitivity was 61.1% and the specificity was 79.9%. Conclusion 1. Smoking index was 400, had superior vena cava syndrome, extensive stage, EC regimen and non-chest radiotherapy were independent risk factors of refractory SCLC compared with EP regimen. The predictive model of refractory SCLC based on independent risk factors has high sensitivity and specificity and can assist clinicians in predicting refractory SCLC after first-line treatment.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R734.2

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