中晚期口腔癌组织瓣移植术区感染发生的危险因素及Nomogram预测模型构建  

Risk factors and Nomogram prediction model for surgical site infection after radical surgery with tissue flap transplantation in patients with primary moderate-advanced oral cancer

作　　者：马腾 李德龙[2] 冯芝恩[2] MA Teng;LI De-long;FENG Zhi-en(Department of Stomatology,Beijing Huairou Hospital,Beijing 101400,China)

机构地区：[1]北京怀柔医院口腔科,101400 [2]首都医科大学口腔医学院口腔颌面-头颈肿瘤科

出　　处：《北京口腔医学》2024年第4期257-260,共4页Beijing Journal of Stomatology

基　　金：国家自然科学基金(82072984);北京市科技新星计划交叉合作课题(20230484404);北京市属医院科研培育计划(PX2024056);首都医科大学附属北京口腔医院创新基金临床研究专项(23-09-19)。

摘　　要：目的分析中晚期口腔癌患者手术同期组织瓣移植术区感染危险因素,并构建列线图Nomogram预测模型。方法收集2015年3月至2020年3月,首都医科大学附属北京口腔医院住院接受游离组织瓣移植手术的中晚期口腔癌患者,建立研究队列,收集患者基线和临床资料。观察术区感染发生率,以多因素Logistic回归分析术区感染的主要危险因素,并基于回归分析结果,建立Nomogram预测模型,以模型一致性指数和ROC曲线的曲线下面积(area under curve,AUC)验证模型的预测区分度;绘制校准曲线并进行Hosmer-Lemeshow验证模型的概率一致性;通过决策曲线分析(decision curve analysis,DCA)验证预测模型的临床效益。结果所有纳入研究患者中83例(23.1%)发生术区感染。Logistic回归分析证实,糖尿病、肿瘤部位(非上颌区域)、T4b分期、手术时间≥8 h及气管切开术是术区感染发生的独立危险因素。构建的Nomogram预测模型,经内部验证,C指数为0.682,Hosmer-Lemeshow拟合优度检验P=0.974,证实模型具有较好的区分度和模型概率一致性。临床决策曲线显示,在0.1-0.55阈值范围内,模型能够提供临床净收益。结论本研究通过临床分析,获得中晚期口腔癌患者接受同期游离组织瓣移植术后术区感染的主要危险因素,并构建了Nomogram预测模型,模型具有较好的临床效能。Objective To analysis the risk factors of surgical site infection(SSI)after radical surgery with tissue flap transplantation in patients with primary moderate-advanced oral cancer,and to establish a risk prediction model by nomogram.Methods Patients firstly diagnosed with primary moderate-advanced oral squamous cell carcinoma in Beijing Stomatological Hospital,Capital Medical University from March 2015 to March 2020 were enrolled.The baseline data,intraoperative data,information of SSI were collected.Multivariate Logistic regression analysis was used to determine the risk factors for SSI,and a nomogram model was established.ROC curves,Calibration curves,Hosmer-Lemeshow test,and Decision Curve Analysis(DCA)were used to evaluate the discrimination,calibration,and the clinical value of the nomogram model.Results A total of 360 patients were enrolled in this study.83(23.1%)of the patients suffered from SSI.History of diabetes,tumor location,T4b stage,operation time≥8.0h and tracheostomy were determined as independent risk factors for SSI by multivariate logistic regression analysis.The C-index of the model was 0.682,the P value of Hosmer Lemeshow test was 0.974.Decision curve confirmed net benefit for patients of this model in the analysis.Conclusions The risk factors of surgical site infection after radical surgery with tissue flap transplantation in patients with primary moderate-advanced oral cancer were determined in this study.The nomogram model was established and showed a reliable ability in predicting the occurrence of SSI and guiding value in clinical work.

关 键 词：中晚期口腔癌 组织瓣移植 术区感染 风险预测模型 列线图 

分 类 号：R739.8[医药卫生—肿瘤]