子宫内膜癌患者术后下肢淋巴水肿风险预测模型的构建及效果验证

doi:10.3761/j.issn.0254-1769.2021.08.009

摘要/Abstract

摘要：

目的了解子宫内膜癌患者术后发生下肢淋巴水肿（lower extremity lymphedema,LEL）的危险因素,构建风险预测模型并检验预测效果。方法采用便利抽样法选取2016年1月—2017年12月武汉市某三级甲等综合医院妇科肿瘤病房符合标准的患者181例,根据是否发生LEL分为LEL组（n=41）和非LEL组（n=140）,对两组资料进行比较,根据Logistic回归分析结果构建风险预测模型。采用受试者操作特征（receiver operating characteristic curve,ROC）曲线下面积检验模型的预测效果。选取2018年1月—2019年1月的78例子宫内膜癌患者对模型预测效果进行验证。结果子宫内膜癌患者术后发生LEL的风险预测模型纳入淋巴清扫（OR=10.683）、病理分期（OR=9.232）、腹腔冲洗液细胞学（OR=19.486）、下肢深静脉血栓（OR=12.008）、术后放疗（OR=4.636）共5个预测因子。模型公式：Z=2.369 × 淋巴清扫+2.223 × 病理分期+2.970 × 腹腔冲洗液细胞学+2.486 × 下肢深静脉血栓+1.534 × 术后放疗-5.518。预测模型的ROC曲线下面积为0.825,灵敏度为0.707,特异度为0.871,Youden指数为0.578。模型验证结果：ROC曲线下面积为0.793,灵敏度为0.875,特异度为0.677,正确率为74.35%,提示其预测效果较好。结论该研究构建的子宫内膜癌患者术后LEL风险预测模型效果良好,可以有效预测LEL的发生,可为护理人员早期对患者采取预防性干预措施提供参考。

关键词: 子宫内膜癌, 下肢淋巴水肿, 危险因素, 预测模型, 肿瘤护理

Abstract:

Objective To identify the risk factors for lower extremity lymphedema（LEL） following surgery for endometrial cancer patients,to build a prediction model and to verify the prediction effect. Methods A total of 181 eligible patients admitted to a gynecological oncology ward from January 2016 to December 2017 were selected by convenience sampling and were divided into a LEL group（n=41） and a non-LEL group（n=140）. Data of the 2 groups was compared to determine the potential risk factors,and Logistic regression analysis was performed to construct the prediction model.The area under the receiver operating characteristic curve（AUC） was used to test the prediction effect of the model.A total of 78 endometrial cancer patients hospitalized in the same ward from January 2018 to January 2019 were selected to verify the model. Results The risk prediction model for postoperative LEL in endometrial cancer patients included 5 predictors of lymph node dissection（OR=10.683）,pathological stage（OR=9.232）,peritoneal wash cytology（OR=19.486）,lower extremity deep vein thrombosis（OR=12.008）,and radiotherapy（OR=4.636）. Model formula：Z=2.369 × lymph node dissection+2.223 × pathological stage+2.970 × peritoneal wash cytology +2.486 × lower extremity deep vein thrombosis +1.534 × radiotherapy -5.518.The AUC of the prediction model was 0.825 with the sensitivity of 0.707,the specificity of 0.871,and the Youden index of 0.578. Validation with 78 cases showed that the AUC was 0.793;the sensitivity was 0.875;the specificity was 0.677.The accuracy rate was 74.35%,indicating satisfactory prediction effects. Conclusion The prediction model for LEL following surgery for endometrial cancer patients has good prediction effects,which might provide references for nursing staff to take preventive interventions as early as possible.

Key words: Endometrial Carcinoma, Lower Extremity Lymphedema, Risk Factors, Prediction Model, Oncologic Nursing Care

吕永利,耿力,万盈璐,杨娇,胡莹,辛小燕,张可可. 子宫内膜癌患者术后下肢淋巴水肿风险预测模型的构建及效果验证[J]. 中华护理杂志, 2021, 56(8): 1174-1179.

LÜ Yongli,GENG Li,WAN Yinglu,YANG Jiao,HU Ying,XIN Xiaoyan,ZHANG Keke. Construction of a risk prediction model for postoperative lower extremity lymphedema after surgery for endometrial cancer and its prediction effect[J]. Chinese Journal of Nursing, 2021, 56(8): 1174-1179.

图/表 3

表1 子宫内膜癌患者术后下肢淋巴水肿的单因素分析[例（百分比,%）]

Table 1 Univariate analysis of postoperative LEL in patients with endometrial cancer[case（percent,%）]

表2 子宫内膜癌患者术后下肢淋巴水肿的的Logistic回归分析结果

Table 2 Logistic regression analysis of LDL risk factors in patients with endometrial cancer after surgery

图1 子宫内膜癌患者术后下肢淋巴水肿风险因素预测模型的ROC曲线

Figure 1 ROC curve of risk factor prediction model for postoperative lowerextremity lymphedema in patients with endometrial cancer

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