胸腔镜肺癌切除术后合并心肺并发症的危险因素分析及列线图预测模型构建  

Risk factors analysis and nomogram prediction model construction of postoperative cardiopulmonary complications in thoracoscopic lung cancer resection

作　　者：潘永东 朱萍 吕伟[2] PAN Yongdong;ZHU Ping;LYU Wei(Yichun People's Hospital,Jiangxi Yichun 336000,China;Jiangxi University of Traditional Chinese Medicine Hospital,Jiangxi Nanchang 333000,China)

机构地区：[1]宜春市人民医院,江西宜春336000 [2]江西中医药大学附属医院,江西南昌333000

出　　处：《现代肿瘤医学》2024年第4期663-667,共5页Journal of Modern Oncology

基　　金：江西省中医药管理局科技计划(编号:2021B099)。

摘　　要：目的:探讨肺癌患者经胸腔镜切除术后合并心肺并发症的危险因素并构建列线图预测模型。方法:选取2019年10月至2022年9月在我院进行胸腔镜切除术的228例肺癌患者为研究对象,将术后出现心肺并发症的52例患者纳入发生组,未出现心肺并发症的176例患者纳入未发生组。记录两组患者的临床资料,独立样本t检验或χ^(2)检验行单因素分析,探索胸腔镜切除术后合并心肺并发症的相关因素;MedCalc软件对计量指标行ROC曲线分析,探索其对胸腔镜切除术后合并心肺并发症的预测价值;Logistic逐步回归分析探讨胸腔镜切除术后合并心肺并发症的独立危险因素;R语言软件4.0“rms”包构建肺癌患者经胸腔镜切除术后合并心肺并发症的列线图预测模型,校正曲线对列线图预测模型进行内部验证,计算一致性指数(concordance index,C-index),决策曲线对列线图预测模型进行临床预测效能评估。结果:发生组与未发生组患者在年龄、吸烟史、糖尿病史、冠心病史、手术时间、术中出血量、FEV1方面的差异具有统计学意义。年龄、手术时间、术中出血量的AUC分别为0.739、0.785、0.736,最佳截断值分别为55岁、178 min、96 mL。年龄、吸烟史、冠心病史、手术时间、FEV1是肺癌患者经胸腔镜切除术后合并心肺并发症的独立危险因素。内部验证结果指出,列线图预测模型的校正曲线与原始曲线及理想曲线接近,C-index为0.883(95%CI:0.833~0.933),模型拟合度高;列线图预测模型的阈值>0.23,可提供临床净收益,且临床净收益均高于年龄、吸烟史、冠心病史、手术时间、FEV1。结论:本研究基于胸腔镜肺癌切除术后合并心肺并发症的独立危险因素即年龄、吸烟史、冠心病史、手术时间、FEV1构建了列线图预测模型,对心肺并发症的发生具有较好的预测价值,有助于胸腔镜肺癌切除术患者心肺并发症的临床监测,以期降低�Objective:To explore the risk factors of cardiopulmonary complications in lung cancer patients underwent thoracoscopic resection and construct a nomogram prediction model.Methods:228 lung cancer patients who underwent thoracoscopic resection in our hospital from October 2019 to September 2022 were selected as the study subjects.52 patients with postoperative cardiopulmonary complications were included in the occurrence group,and 176 patients without cardiopulmonary complications were included in the non-occurrence group.Record clinical data of two groups of patients.Univariate analysis was performed by independent sample t-test or χ^(2),to explore the related factors of cardiopulmonary complications after thoracoscopic resection.MedCalc software performed ROC curve analysis on measurement indicators to explore its predictive value for cardiopulmonary complications after thoracoscopic resection.Logistic stepwise regression analysis explored independent risk factors for cardiopulmonary complications after thoracoscopic resection.The R language software 4.0"rms"package constructed a nomogram prediction model for lung cancer patients with cardiopulmonary complications after thoracoscopic resection.The calibration curve was used to internally validate the nomogram prediction model,and the concordance index(C-index)was calculated.The decision curve was used to evaluate the clinical predictive efficacy of the nomogram prediction model.Results:There were significant differences in age,smoking history,diabetes history,coronary heart disease history,operation time,intraoperative blood loss and FEV1 between the occurrence group and the non-occurrence group.The AUC for age,surgical time,and intraoperative bleeding was 0.739,0.785,and 0.736,respectively,with the optimal cutoff values of 55 years old,178 minutes,and 96 mL,respectively.Age,smoking history,history of coronary heart disease,surgical time,and FEV1 were independent risk factors for cardiopulmonary complications in lung cancer patients underwent thoracoscopic resec

关 键 词：肺癌 胸腔镜切除术 心肺并发症 危险因素 列线图预测模型 

分 类 号：R734.2[医药卫生—肿瘤]