阴道上皮内瘤变3级风险的临床预测模型

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[中图分类号]R173 [文献标识码]A [文章编号]1673—5293（2026）02—0072-08

Aclinical risk prediction model for vaginal intraepithelial neoplasia grade 3

Chenqing¹，ZHANG Jiayi² ，GAO Li1 ，ZHOU Weihua1，WANG Lisha1，XUE Yan1，ZHU Kexiu1 ，AN Rui （1.Department of Obstetrics and Gynecology，The First Affiliated Hospital of Xi'an Jiaotong University， Shaanxi Xi'an 71OO61，China ;2.Department of Hepatobiliary Surgery，The First Affiliated Hospital of Xi'an Jiaotong University，Shaanxi Xi'an 7loo6l，China）

[Abstract]ObetiveToexploretheriskfactors influencingtheoureneofvagialintraepithelialneoplasiagade3（VaIN）and todevelopapredictive modelforassessing therisk of VaIN3.Methods Atotalof1107patients diagnosed with vaginal intraepithelialneoplasia（VaIN）bycolposcopy-guided biopsyatthe Departmentof Gynecologyofour hospitalfromJanuary1， 2019，to September30，2024，wereselected，including824casesoflow-gradesquamousintraepitheliallesionsofthevagina （VaIN1），222casesof VaIN，and61casesofVaN3.Theclinicalcharacteristicsofpatients with VaIN3werecompared tothose withVaI1/2.Logisticregresionanalysis wasusedtoidentifyindependentriskfactors，basedonwhichanomogramprediction model wasconstructed.Themodel'sdiscrimination，calibration，andclinicalutilitywereevaluatedusingreceiveroperating characteristic（ROC）curves，calibrationcurves，and decisioncurve analysis（DCA），respectively.Results Logisticregresion analysis showed that age >65 years （OR=6. 004，95%CI：1. 406-25. 627） ，presence of clinical symptoms（ OR=3.344，95%CI ： 1.622-6.694），cytology results of HSIL ′OR=7.446，95%CI：2.322-23.875）， and hysterectomy due to cervical cancer （ OR= 4.460，95%CI：2.051%9.697） wereindependent risk factors for VaIN3（all P<0.05 ）.The predictive model based on these factors showed good predictive performance，with an area under the ROC curve（AUC） of 0.817（ 95%CI ：0.759-0.876）.The HosmerLemeshow test indicated good model fit （ χ2=12 .177， P=0 . 143）.The calibration curve showed high consistency between predictedandactualprobabilities，andDCAsuggestedthatthemodelprovidesclinicalnetbenefitwithinathresholdprobability rangeof 5%-50% . Conclusion The clinical prediction model developed in this study canbe used to assessthe risk of VaIN patients beingdiagnosedwithVaIN3.Themodelhasgood predictiveperformanceandprovidesreferencevalueforclinicaldiagnosisand early intervention.

[Key words] vaginal intraepithelial neoplasia;risk factor，; prediction model;nomogram

阴道癌（vaginalcancer，VC）是一种罕见疾病，仅占全球所有女性生殖道恶性肿瘤的 1%～2% ，但其恶性程度高、治疗难度大[1-3]。（剩余10972字）