食管癌术后颈部吻合口漏列线图风险预测模型的建立和应用  

Establishment and application of a nomogram model for predicting the risk of cervical anastomotic leakage after esophagectomy of esophageal cancer

作　　者：王青 陈丽丽 刘郁鹏 WANG Qing;CHEN Lili;LIU Yupeng(Department of Thoracic Surgery,Affiliated Cancer Hospital of Nantong University,Nantong Cancer Hospital,Nantong,Jiangsu 226000,China)

机构地区：[1]南通大学附属肿瘤医院(南通市肿瘤医院)胸外科,江苏南通226000

出　　处：《临床外科杂志》2024年第7期716-720,共5页Journal of Clinical Surgery

基　　金：南通大学临床医学专项项目(2022LY020)。

摘　　要：目的探讨食管癌术后颈部吻合口漏发生的危险因素,建立并验证列线图风险预测模型。方法2019年1月~2022年12月行食管癌根治术的食管癌病人623例,按7∶3的比例随机分为建模集组(428例)和验证集组(195例)。根据是否发生颈部吻合口漏将建模集组病人分为两组,比较两组病人基线临床资料,通过多因素Logistic回归分析颈部吻合口漏发生的危险因素,应用R软件建立列线图风险预测模型并验证其准确性,进行内部验证和外部验证。结果建模集组428例食管癌病人术后颈部吻合口漏发生率为8.18%(35/428)。吻合口漏组高血压、糖尿病、新辅助治疗、肿瘤位于上段食管、术后白蛋白≤30 g/L、术后低氧血症的病人比例均明显高于非吻合口漏组,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,新辅助治疗、肿瘤位于上段食管、术后白蛋白≤30 g/L、术后低氧血症是食管癌术后颈部吻合口漏发生的独立危险因素(P<0.05)。建模集和验证集的C-index分别为0.873(95%CI:0.781~0.965)和0.887(95%CI:0.744~0.972),两组的校正曲线与标准曲线拟合良好,两组的受试者工作特征曲线(ROC)分析显示,曲线下面积(AUC)分别为0.811(95%CI 0.738~0.865)和0.825(95%CI 0.720~0.913),显示出较好的预测精准度。结论基于新辅助治疗、肿瘤位于上段食管、术后白蛋白≤30 g/L、术后低氧血症建立的列线图模型,对食管癌术后颈部吻合口漏发生预测的准确性良好。Objective To investigate the risk factors for cervical anastomotic leakage after esophagectomy of esophageal cancer,and to establish a predictive nomogram model and verify its predictive ability.Methods A total of 623 patients diagnosed with esophageal cancer and treated with esophagectomy in the affiliated cancer hospital of Nantong university from January 2019 to December 2022 were selected and randomly divided into the modeling set group(n=428)and the validation set group(n=195)in a ratio of 7∶3.The patients in the modeling set group were divided into 2 groups based on the incidences of cervical anastomotic leakage.The baseline clinical data of 2 groups were collected and compared,and the risk factors of cervical anastomotic leakage were analyzed by multivariate Logistic regression.The nomogram model was constructed by R software and its accuracy was verified.The internal and external validation were conducted.Results Among the 428 patients with esophageal cancer in the modeling group,8.18%(35/428)had cervical anastomotic leakage after esophagectomy.The proportion of patients with hypertension,diabetes,neoadjuvant therapy,upper esophageal tumor,postoperative albumin≤30 g/L and postoperative hypoxemia in the anastomotic leakage group were significantly higher than those in the non-anastomotic leakage group(P<0.05).Multivariate Logistic regression analysis showed that neoadjuvant therapy,upper esophageal tumor,postoperative albumin≤30 g/L and postoperative hypoxemia were independent risk factors for cervical anastomotic leakage after esophagectomy of esophageal cancer(P<0.05).The C-index of the modeling set and validation set were 0.873(95%CI:0.781-0.965)and 0.887(95%CI:0.744-0.972),respectively.The calibration curves of 2 groups fitted well with the standard curve.The receiver operating characteristic curve(ROC)analysis of 2 groups showed that the area under the curve(AUC)was 0.811(95%CI:0.738-0.865)and 0.825(95%CI:0.720-0.913),,respectively,showing good prediction accuracy.Conclusion Establishing a nomog

关 键 词：食管癌 颈部吻合口漏 危险因素 列线图 

分 类 号：R735.1[医药卫生—肿瘤]