| Objective : To establish and verify a nomogram model for predicting benign and malignant gallbladder polyps.Methods : A retrospective study was conducted to collect the clinical and pathological data of patients who underwent cholecystectomy with gallbladder polyps in Dalian Friendship Hospital from June 2002 to July 2021 and the First Affiliated Hospital of Dalian Medical University from December 2015 to October 2021,including age,gender,size of gallbladder polyps,number of polyps,whether combined with gallstones,and thickness of gallbladder wall.The receiver operating characteristic curve(ROC)was used to determine the cut-off value of age and size for distinguishing non-neoplastic polyps from neoplastic polyps.Logistic univariate regression analysis was used to determine the risk factors for predicting benign and malignant gallbladder polyps.Logistic multivariate regression analysis was used to determine the independent risk factors for predicting benign and malignant gallbladder polyps.R 4.1.2 software was used to construct a nomogram model for predicting the risk of benign and malignant gallbladder polyps with independent risk factors.The area under the ROC curve(AUC)was used to evaluate the model discrimination,and the Hosmer-Lemeshow test was used to evaluate the model calibration.The Bootstrap method(self-sampling method)was used to verify the model internally,and the patient data of the First Affiliated Hospital of Dalian Medical University was used for external verification.Results : A total of 445 patients were included,including 306 patients in Dalian Friendship Hospital(modeling set)and 139 patients in the First Affiliated Hospital of Dalian Medical University(external validation set).(1)The cutoff value of age determined by ROC curve was 54.5 years old,AUC = 0.738(95 % CI :0.673-0.804),sensitivity was 46.9 %,and specificity was 79.1 %.The cutoff value of polyp size was 13.9 mm,AUC = 0.678(95 % CI : 0.611-0.745),sensitivity was51.9 %,and specificity was 87.5 %.In order to meet the clinical practice,the two are taken as integers,namely 55 years old and 14 mm.(2)A total of 306 patients in Dalian Friendship Hospital were used as the modeling set,including 85 patients(27.8 %)aged≥ 55 years old and 221 patients(72.2 %)aged < 55 years old,119 males(38.9 %)and187 females(61.1 %).Polyp size : ≥ 14 mm in 65 cases(21.2 %),< 14 mm in 241cases(78.8 %);there were 73 cases(23.9 %)with gallstones and 233 cases(76.1 %)without gallstones.There were 94 cases(30.7 %)of single polyps and 212 cases(69.3 %)of multiple polyps.There were 83 cases(27.1 %)with gallbladder wall thickening and 223 cases(72.9 %)with normal gallbladder wall thickness.There were225 cases(73.5 %)of non-neoplastic polyps,including 218 cases(71.2 %)of cholesterol polyps,3 cases(1%)of hyperplastic polyps,2 cases(0.7 %)of inflammatory polyps,1 case(0.3 %)of metaplastic polyps and 1 case(0.3%)of fibrous polyps.There were 81 cases(26.5 %)of neoplastic polyps,including 71 cases(23.2 %)of adenomatous polyps and 10 cases(3.2 %)of gallbladder cancer.139 patients from the First Affiliated Hospital of Dalian Medical University were used as the validation set.(3)Univariate Logistic regression analysis showed that gender,age,gallbladder stones,polyp number,polyp size ≥ 14 mm,gallbladder wall thickening(>3mm)were risk factors for neoplastic gallbladder polyps.(4)The nomogram model for predicting benign and malignant gallbladder polyps was established and verified by R software.The area under the ROC curve of the model was AUC = 0.851(95 % CI : 0.800-0.902),which had good discrimination.The Hosmer-Lemeshow test(also known as the goodness of fit test)results P = 0.591(> 0.05),the model has good calibration.The predicted probability of the calibration curve of the model was in good agreement with the actual probability.The area under the ROC curve obtained by external verification was AUC = 0.861(95 % CI : 0.788-0.935).The calibration curve of external verification was in good agreement,and the model had good external ductility.Based on the constructed nomogram model,an online web page calculator(https://wchenxu.shinyapps.io/gallbladder_polyps/),was further created to make the application of the model more convenient.Conc Iusion : The nomogram prediction model based on sex,age,gallbladder stones,polyp number,polyp size and gallbladder wall thickening can effectively predict the benign and malignant gallbladder polyps.According to the prediction results,different strategies are adopted for different risk groups to achieve individualized diagnosis and treatment. |
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