青少年恶性骨肿瘤患者癌症复发恐惧预测模型的构建与验证OA
Construction and validation of the prediction model for fear of cancer recurrence in adolescent patients with malignant bone tumors
目的 探讨青少年恶性骨肿瘤患者癌症复发恐惧(FCR)的影响因素,建立预测模型预测患者FCR发生风险并对模型进行验证.方法 选取2019年5月至2024年12月在该院接受治疗的470例青少年恶性骨肿瘤患者作为研究对象.将患者按照7∶3的比例分为训练集(329例)与测试集(141例),将训练集患者根据是否发生FCR分为FCR组与非FCR组.采用logistic回归分析筛选独立危险因素并构建预测模型预测青少年恶性骨肿瘤患者发生FCR风险;通过受试者工作特征(ROC)曲线和校准曲线评估预测模型的区分度和精准度;采用决策曲线分析评估列线图预测模型的临床实用性.结果 与非FCR组比较,FCR组患者年龄、Ⅲ～Ⅳ期比例、病程>3年比例、消极应对方式评分均升高,差异均有统计学意义(P<0.05);家庭人均月收入3 000～5 000元、>5 000元比例及家庭韧性指数(FHI)评分、简易应对方式量表(SCSQ)中积极应对方式评分均降低,差异均有统计学意义(P<0.05).所构建预测模型内部验证[H-L拟合优度检验χ2=5.579,P=0.694;校准曲线与理想曲线基本重合,ROC曲线的曲线下面积(AUC)为0.835(95%CI 0.771～0.899)]、外部验证[H-L拟合优度检验χ2=14.037,P=0.081;校准曲线与理想曲线基本重合;ROC曲线的 AUC为0.787(95%CI 0.714～0.861)]显示模型拟合度、精准度与区分度均良好.结论 以年龄、疾病分期、家庭人均月收入、FHI评分、SCSQ(积极应对方式、消极应对方式)因素构建的预测模型有较高的精准度和区分度,对个体化预测青少年恶性骨肿瘤患者FCR发生风险有重要指导作用.
Objective To explore the influencing factors of fear of cancer recurrence(FCR)in adoles-cent patients with malignant bone tumors,and to establish and validate a prediction model for assessing the risk of FCR.Methods A total of 470 adolescent patients with malignant bone tumors treated at the hospital from May 2019 to December 2024 were enrolled.The patients were divided into a training set(329 cases)and a test set(141 cases)at a ratio of 7∶3.Patients in the training set were categorized into an FCR group and a non-FCR group based on the presence of FCR.Logistic regression analysis was used to identify independent risk factors and construct a prediction model to estimate the risk of FCR.The discrimination and calibration of the model were evaluated using receiver operating characteristic(ROC)curves and calibration curves.Decision curve analysis was employed to assess the clinical utility of the nomogram-based prediction model.Results Compared with the non-FCR group,the FCR group exhibited significantly higher age,higher proportions of stage Ⅲ-Ⅳdisease and disease duration>3 years,higher Family Hardiness Index(FHI)scores,and higher negative cop-ing style scores on the Simplified Coping Style Questionnaire(SCSQ),whereas positive coping style scores on the SCSQ and monthly per capita household income were lower,the differences were statistically significant(P<0.05).Internal validation[Hosmer-Lemeshow(H-L)goodness-of-fit test χ2=5.579,P=0.694,with the calibration curve closely fitting the ideal curve,and an area under the ROC curve(AUC)of 0.835(95%CI 0.771-0.899)],and external validation[H-L test χ2=14.037,P=0.081,a calibration curve closely coinci-ding with the ideal curve,and an AUC of 0.787(95%CI 0.714-0.861)]of the prediction model all demon-strated good goodness-of-fit,accuracy,and discrimination.Conclusion The prediction model constructed based on age,disease stage,monthly per capita household income,FHI score,and SCSQ scores(positive and negative coping styles)exhibits high accuracy and discrimination,and provides important guidance for individ-ualized prediction of the risk of FCR in adolescent patients with malignant bone tumors.
赵俊;刘新;韩金钱
郑州大学附属肿瘤医院/河南省肿瘤医院骨科,河南 郑州 450000郑州大学附属肿瘤医院/河南省肿瘤医院骨科,河南 郑州 450000郑州大学附属肿瘤医院/河南省肿瘤医院骨科,河南 郑州 450000
医药卫生
恶性骨肿瘤癌症复发恐惧预测模型危险因素
Malignant bone tumorFear of cancer recurrencePrediction modelRisk factors
《现代医药卫生》 2026 (6)
1208-1214,7
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