背景:胆囊腺瘤是胆囊癌的癌前病变。然而,在手术前将其与胆囊的胆固醇息肉区分开来是具有挑战性的。因此,我们旨在全面探讨导致胆囊腺瘤形成的各种危险因素,以促进临床医生的知情诊断和治疗。
方法:我们对2015年1月至2022年12月在青岛大学附属医院行胆囊切除术的患者进行了回顾性分析。术后病理检查后,患者被分为胆固醇息肉组和腺瘤组.我们分析了它们的基线特征,超声成像变量,和使用logistic的生化数据,套索,和逐步回归。随后,我们构建了基于独立危险因素的术前预测模型。
结果:模型组520例胆囊息肉和288例胆囊腺瘤的回归分析显示,年龄,胆囊壁厚,息肉大小,回声,花梗,腺苷脱氨酶(ADA)水平是胆囊腺瘤的独立预测因子,均P<0.05。使用这些指标,我们建立了一个回归方程:Logistic(P)=-5.615+0.018*年龄-4.64*胆囊壁厚度+1.811*息肉大小+2.855*息肉回声+0.97*计算+0.092*ADA。所得曲线下面积(AUC)值为0.894(95%CI:0.872-0.917,P<0.01),灵敏度为89.20%,特异性为79.40%,腺瘤检测的总体准确率为84.41%。
结论:年龄,息肉大小,胆囊壁厚,息肉回声,花梗,和ADA水平是胆囊腺瘤的独立危险因素。
BACKGROUND: Gallbladder adenoma represents a precancerous lesion of gallbladder cancer. However, distinguishing it from cholesteryl polyps of the gallbladder before surgery is challenging. Thus, we aimed to comprehensively explore various risk factors contributing to the formation of gallbladder adenoma to facilitate an informed diagnosis and treatment by clinicians.
METHODS: We conducted a retrospective analysis of patients who had undergone cholecystectomy at the Affiliated Hospital of Qingdao University between January 2015 and December 2022. Following postoperative pathological examination, patients were categorized into cholesterol polyp and adenoma groups. We analyzed their baseline characteristics, ultrasound imaging variables, and biochemical data using logistic, lasso, and stepwise regression. Subsequently, we constructed a preoperative prediction model based on the independent risk factors.
RESULTS: Regression analysis of 520 gallbladder polyps and 288 gallbladder adenomas in the model group revealed that age, gallbladder wall thickness, polyp size, echogenicity, pedunculation, and adenosine deaminase (ADA) levels were independent predictors of gallbladder adenoma, all with P < 0.05. Using these indicators, we established a regression equation: Logistic (P) = -5.615 + 0.018 ∗ age - 4.64 ∗ gallbladder wall thickness + 1.811 ∗ polyp size + 2.855 ∗ polyp echo + 0.97∗ pedunculation + 0.092 ∗ ADA. The resulting area under the curve (AUC) value was 0.894 (95 % CI: 0.872-0.917, P < 0.01), with a sensitivity of 89.20 %, specificity of 79.40 %, and overall accuracy of 84.41 % for adenoma detection.
CONCLUSIONS: Age, polyp size, gallbladder wall thickness, polyp echogenicity, pedunculation, and ADA levels emerge as independent risk factors for gallbladder adenoma.