双能量计算机断层扫描影像组学列线图对气腔播散阳性肺腺癌患者术后复发风险的预测价值
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R734.2

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北京医学奖励基金会项目(YXJL-2025-0483-0293);


Predicting postoperative recurrence risk in pulmonary adenocarcinoma patients with spread through air spaces using dual-energy computed tomography radiomics nomogram
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    摘要:

    目的:探讨双能量计算机断层扫描(CT)影像组学列线图对气腔播散(STAS)阳性肺腺癌患者术后复发风险的预测价值。方法:选取150例STAS阳性肺腺癌患者为研究对象,依据术后1年内结局不同分为复发组(n=47)和未复发组(n=103)。比较两组患者术前双能量CT图像上提取常规混合能量CT值、碘基图碘浓度、能谱曲线斜率、有效原子序数及影像组学评分;LASSO回归法对变量进行筛选,运用多因素Logistic回归分析明确影响研究结局的独立预测因素,基于筛选出的独立预测因素绘制列线图构建预测模型;ROC曲线分析预测模型对STAS阳性肺腺癌患者术后复发风险的预测价值。结果:复发组患者肿瘤大小、常规混合能量CT值、碘基图碘浓度、能谱曲线斜率、有效原子序数和影像组学评分高于未复发组(P<0.05);病理分级为高级别、接受亚肺叶切除的患者比例低于未复发组(P<0.05)。多因素回归分析结果显示,肿瘤大小、常规混合能量CT值、碘基图碘浓度、能谱曲线斜率和影像组学评分均为术后1年内复发的独立影响因素(P<0.05)。列线图预测术后复发的ROC曲线下面积(AUC)为0.891(95%CI:0.824~0.959),校准曲线表明,模型预测的概率与实际情况表现出良好一致性。结论:基于双能量CT影像组学的列线图模型对STAS阳性肺腺癌患者术后1年复发风险具有较好的预测价值,可为术后风险分层提供参考。

    Abstract:

    Objective: To explore the predictive value of dual-energy computed tomography (CT) radiomics nomogram for postoperative recurrence risk in patients with STAS-positive lung adenocarcinoma due to intracavitary dissemination. Methods: A total of 150 patients with STAS-positive lung adenocarcinoma were selected as the research subjects and divided into a recurrence group (n = 47) and a non-recurrence group (n = 103) based on different postoperative outcomes within 1 year. Clinical and pathological data were collected. Preoperative dual-energy CT imaging features, including conventional mixed-energy CT values, iodine concentration on iodine maps, spectral curve slope, effective atomic number, and radiomics scores, were extracted. The Least Absolute Shrinkage and Selection Operator (LASSO) regression method was employed for variable selection. Multivariate Logistic regression analysis was performed to identify independent predictors associated with the study outcome. A nomogram was constructed based on the selected independent predictors to develop the predictive model. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of the model for postoperative recurrence risk in STAS-positive lung adenocarcinoma patients. Results: The tumor size, conventional mixed-energy CT value, iodine concentration on the iodine basis map, slope of the energy spectrum curve, effective atomic number, and radiomics score of the recurrent group were higher than those of the non-recurrent group (P < 0.05). The proportion of patients with high-grade pathological grading who underwent sublobectomy was lower than that of the non-recurrent group (P < 0.05). Multivariate regression analysis demonstrated that tumor size, conventional mixed-energy CT value, iodine concentration, spectral curve slope, and radiomics score were all independent influencing factors for postoperative recurrence within one year (P < 0.05). The area under the ROC curve (AUC) of the nomogram for predicting postoperative recurrence was 0.891 (95% CI: 0.824~0.959). The calibration curve indicated good agreement between the predicted probabilities of the model and the actual observations. Conclusion: The nomogram model based on dual-energy CT radiomics exhibits a favorable predictive value for the 1-year postoperative recurrence risk in patients with STAS-positive lung adenocarcinoma, providing a reference for postoperative risk stratification.

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张继军;邱晓丽;李荣俊;.双能量计算机断层扫描影像组学列线图对气腔播散阳性肺腺癌患者术后复发风险的预测价值[J].川北医学院学报,2026,41(10):1225-1229.

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  • 在线发布日期: 2026-10-26
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