胃上部癌全胃切除术后肺部并发症预测模型的构建  

ESTABLISHMENT OF A PREDICTIVE MODEL FOR POSTOPERATIVE PULMONARY COMPLICATIONS AFTER TOTAL GASTRECTOMY FOR UPPER GASTRIC CANCER

作　　者：杨永康 刘尚龙[1] 高源[1] 刘睿清 郑龙波 解文韬 卢云[1] YANG Yongkang;LIU Shanglong;GAO Yuan;LIU Ruiqing;ZHENG Longbo;XIE Wentao;LU Yun(Department of Gastrointestinal Surgery,The Affiliated Hospital of Qingdao University,Qingdao 266555,China)

机构地区：[1]青岛大学附属医院胃肠外科,山东青岛266555

出　　处：《精准医学杂志》2023年第3期232-236,共5页Journal of Precision Medicine

基　　金：山东省重点研发计划(2018GSF118206)。

摘　　要：目的 通过分析胃上部癌全胃切除术后肺部并发症(PPCs)相关危险因素,建立列线图风险预测模型。方法 回顾性分析我院2020年6月1日—2021年9月30日因胃上部癌行全胃切除手术197例患者的临床资料,采用单因素及多因素Logistic回归分析PPCs相关危险因素,并构建PPCs列线图预测模型,采用一致性指数、受试者工作特征曲线、校准曲线评估预测模型效能,采用决策曲线分析(DCA)曲线评估模型的临床获益度。结果 197例患者术后发生肺部并发症71例,发生率为36%;多因素Logistic回归分析显示,年龄、糖尿病、吸烟史、术前血清白蛋白<35 g/L、BMI>26 kg/m2为胃上部癌全胃切除术PPCs发生的独立危险因素。构建的列线图预测模型验证结果,受试者工作特征曲线下面积为0.806,显示模型预测效能良好;校准曲线示预测结果与实际并发症发生率具有良好的一致性;构建的DCA曲线显示明显正向净收益,该预测模型临床获益度良好。结论 通过独立危险因素构建的列线图风险预测模型预测效能良好,为胃上部癌全胃切除患者PPCs的预测提供了依据。Objective To establish a nomogram risk predictive model by analyzing the risk factors for postoperative pulmonary complications(PPCs)after total gastrectomy for upper gastric cancer.Methods A retrospective analysis was performed for the clinical data of 197 patients who underwent total gastrectomy for upper gastric cancer in our hospital from June 1,2020 to September 30,2021.Univariate and multivariate Logistic regression analyses were used to investigate the risk factors for PPCs,and a nomogram predictive model for PPCs was established.Index of concordance,the receiver operating characteristic(ROC)curve,and the calibration curve were used to evaluate the performance of the predictive model,and the DCA curve was used to evaluate the clinical benefit of the model.Results Among the 197 patients included in the analysis,71 experienced PPCs,with an incidence rate of 36%.The multivariate Logistic regression analysis showed that age,diabetes mellitus,smoking history,preoperative serum albumin<35 g/L,and body mass index>26 kg/m 2 were independent risk factors for PPCs after total gastrectomy for upper gastric cancer.The nomogram prediction model established had an area under the ROC curve of 0.806,suggesting that the model had good prediction performance.The calibration curve showed that the predictive model showed good consistency with the actual incidence rate of complications,and the DCA curve showed obvious positive net benefits,indicating that the predictive model had good clinical benefits.Conclusion The nomogram prediction model established based on independent risk factors has good prediction performance and can provide a basis for predicting PPCs in patients undergoing total gastrectomy for upper gastric cancer.

关 键 词：胃肿瘤 胃切除术 手术后并发症 肺疾病 危险因素 列线图 

分 类 号：R735.2[医药卫生—肿瘤] R619.9[医药卫生—临床医学]