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

doi:10.3969/j.issn.1006-5725.2025.05.015

Abstract

Abstract:

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.

Key words: systemic inflammation response index, early colorectal cancer, endoscopic submucosal dissection, non-curative resection

CLC Number:

R574

Jiyue ZHU,Bo ZHANG,Yaru LI,Liuye. HUANG. The predictive value of the systemic inflammation response index for non⁃curative resection after endoscopic submucosal dissection for early colorectal cancer[J]. The Journal of Practical Medicine, 2025, 41(5): 716-723.

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References 24

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项目	AUC	敏感度	特异度	最佳截断值	约登指数
SIRI	0.704	0.903	0.462	0.671	0.365
SII	0.676	0.726	0.618	438.187	0.344
PLR	0.563	0.823	0.301	106.789	0.124

项目	治愈性切除组（n = 173）	非治愈性切除组（n = 62）	χ²值	P值
性别/例			0.002	0.960
男	111	40
女	62	22
年龄			7.146	0.008
< 71.5岁	149	44
≥ 71.5岁	24	18
家族史/［例（%）］	24（13.9）	27（43.5）	23.655	< 0.001
糖尿病史/［例（%）］	28（16.2）	9（14.5）	0.096	0.757
吸烟史/［例（%）］	53（30.6）	15（24.2）	0.921	0.337
饮酒史/［例（%）］	48（27.7）	18（29.0）	0.037	0.847
病灶长径			1.624	0.203
< 2.55 cm	129	41
≥ 2.55 cm	44	21
病灶部位			3.908	0.689
升结肠	14	8
肝曲	4	1
横结肠	6	2
脾曲	1	1
降结肠	2	0
乙状结肠	54	14
直肠	92	36
分化程度			22.105	＜0.001
高	101	23
高-中	18	9
中	54	24
中-低	0	2
黏液腺癌	0	4
浸润深度			127.345	＜0.001
黏膜层	129	15
< 1 000 μm	44	9
> 1 000 μm	0	34
SM^*	0	4
内镜下分型			0.786	0.675
隆起型	122	40
平坦型	17	7
侧向发育型	34	15
抬举征阳性/［例（%）］	170（98.3）	57（91.9）	5.562	0.018
表面溃疡/［例（%）］	172（0.6）	60（3.2）	2.539	0.111

项目	治愈性切除组（n = 173）	非治愈性切除组（n = 62）	χ²值	P值
SII			21.709	< 0.001
< 438.187 × 10⁹/L	107	17
≥ 438.187 × 10⁹/L	66	45
SIRI			26.300	< 0.001
< 0.671 × 10⁹/L	80	6
≥ 0.671 × 10⁹/L	93	56
Hb			0.940	0.332
< 128.8 g/L	41	11
≥ 128.5 g/L	132	51
TP			2.826	0.093
> 68.62 g/L	77	20
≤ 68.62 g/L	96	42
ALB			0.121	0.728
> 42.84 g/L	40	13
≤ 42.84 g/L	133	49
A∶G			1.768	0.184
> 1.125	170	59
≤ 1.125	3	3
CEA			19.179	< 0.001
< 1.655 ng/mL	89	12
≥ 1.655 ng/mL	84	50
AFP			3.737	0.053
< 1.545 ng/mL	20	2
≥ 1.545 ng/mL	153	60
CA19-9			3.020	0.082
< 8.87 U/mL	103	29
< 8.87 U/mL	70	33

项目	B	P值	OR	95%CI
年龄	0.958	0.029	2.608	1.104 ~ 6.159
抬举征阳性	1.540	0.119	4.665	0.674 ~ 32.278
家族史	1.302	0.001	3.678	1.678 ~ 8.060
SIRI	1.349	0.011	3.853	1.369 ~ 10.843
SII	0.814	0.045	2.257	1.018 ~ 5.005
CEA	1.456	< 0.001	4.290	1.956 ~ 9.410

项目	分段1	分段2
年龄	< 71.5岁（0分）	≥ 71.5岁（50.0分）
家族病史	No（0分）	Yes（70.0分）
CEA	< 1.655（0分）	≥ 1.655（72.5分）
SIRI	< 0.671（0分）	≥ 0.671（100分）
总分

The predictive value of the systemic inflammation response index for non⁃curative resection after endoscopic submucosal dissection for early colorectal cancer

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