收稿日期: 2024-11-25
网络出版日期: 2025-03-20
The predictive value of the systemic inflammation response index for non⁃curative resection after endoscopic submucosal dissection for early colorectal cancer
Received date: 2024-11-25
Online published: 2025-03-20
目的 探讨全身炎症反应指数（systemic inflammation response index， SIRI）对内镜黏膜下剥离术（endoscopic submucosal dissection， ESD）治疗早期结直肠癌（colorectal cancer， CRC）时发生非治愈性切除的预测价值，并构建列线图预测模型。 方法 回顾性收集2016年1月至2024年8月期间收住院且行ESD治疗的235例早期CRC患者的相关资料，绘制ROC曲线分析SIRI等炎性指标对ESD术后非治愈性切除的预测价值，应用logistic回归分析非治愈性切除的独立危险因素，基于所得危险因素构建预测模型，并对模型进行内部验证。 结果 入组患者中非治愈性切除的发生率为26.38%（62/235），炎性指标SIRI、全身免疫炎症指数（SII）对早期CRC患者RSD术后的非治愈性切除有一定的预测价值，其中SIRI（AUC = 0.704）的预测价值更高，年龄、家族史、癌胚抗原（CEA）、SIRI、SII是影响非治愈性切除的独立危险因素（P < 0.05）；基于logistic回归分析结果，选取年龄、家族史、CEA、SIRI构建列线图预测模型，C-index为0.741（0.675 ~ 0.806），应用Bootstrap法检验预测模型，决策曲线提示模型的预测价值良好。 结论 SIRI相对于SII在预测早期CRC患者ESD术后的非治愈性切除中具有更高的价值，年龄、家族史、CEA、SIRI、SII是影响ESD术后非治愈性切除的独立危险因素，基于上述危险因素中年龄、家族史、CEA、SIRI构建的列线图预测模型能有效预测ESD术后非治愈性切除的发生。
朱吉玥 , 张波 , 李亚茹 , 黄留业 . 全身炎症反应指数对早期结直肠癌内镜黏膜下剥离术后非治愈性切除的预测价值[J]. 实用医学杂志, 2025 , 41(5) : 716 -723 . DOI: 10.3969/j.issn.1006-5725.2025.05.015
Objective To evaluate the predictive value of the Systemic Inflammation Response Index （SIRI） for non?curative resection during endoscopic submucosal dissection （ESD） treatment of early?stage colorectal cancer （CRC）， and to develop a nomogram?based prediction model. Methods Retrospective data were collected from 235 patients diagnosed with early?stage CRC who underwent ESD at our hospital between January 2016 and August 2024. Receiver operating characteristic （ROC） curves were constructed to evaluate the predictive performance of inflammatory markers， such as the SIRI， for non?curative resection following ESD. Logistic regression analysis was conducted to identify independent risk factors associated with non?curative resection， and a prediction model was developed based on these factors. The model was internally validated. Results The incidence of non?curative resection in the study population was 26.38% （62 out of 235 cases）. Inflammatory markers， specifically SIRI and SII， demonstrated predictive value for non?curative resection following ESD in patients with early?stage CRC， with SIRI exhibiting a higher predictive accuracy （AUC = 0.704）. Logistic regression analysis identified age， family history， CEA， SIRI， and SII as independent risk factors for non?curative resection （all P < 0.05）. Based on these findings， a nomogram prediction model incorporating age， family history， CEA， and SIRI was developed， achieving a C?index of 0.741 （95% CI： 0.675 ~ 0.806）. The model's performance was validated using the Bootstrap method， and the decision curve analysis indicated satisfactory predictive accuracy. Conclusions SIRI demonstrates superior predictive value compared to SII for non?curative resection following ESD in patients with early?stage CRC. Independent risk factors for non?curative resection after ESD include age， family history， CEA levels， SIRI， and SII. A nomogram prediction model constructed using these risk factors?specifically age， family history， CEA levels， and SIRI?can effectively predict the likelihood of non?curative resection after ESD.
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