5因素改良衰弱指数预测食管癌术后严重并发症的价值  

Predictive value of the 5-factor modified frailty index for severe postoperative complications following esophageal cancer surgery

作　　者：袁婷婷 阿迪莱·库热西 米吉提·麦麦提 李丹[1] 扎恩哈尔·塔阿提 闫睿[1] YUAN Tingting;Adilai Kurexi;Mijiti Maimaiti;LI Dan;Zhaenhaer Taati;YAN Rui(Department of Anesthesiology,the Affiliated Cancer Hospital of Xinjiang Medical University,Urumqi 830011,China)

机构地区：[1]新疆医科大学附属肿瘤医院麻醉科,乌鲁木齐830011

出　　处：《浙江医学》2025年第4期403-409,共7页Zhejiang Medical Journal

摘　　要：目的探讨5因素改良衰弱指数(mFI-5)预测食管癌患者术后严重并发症的价值,为食管癌患者围术期管理提供参考依据。方法回顾性分析2019年5月至2022年3月在新疆医科大学附属肿瘤医院接受食管癌根治术的患者346例。收集患者围术期相关临床资料、病史、mFI-5评分等,应用Clavien-Dindo分级系统对术后并发症的程度进行分级,Ⅲ~Ⅴ级为严重并发症。根据mFI-5评分分为衰弱组(mFI-5评分≥2分)与非衰弱组(mFI-5评分<2分)。比较两组患者术后住院时间延长、严重并发症的发生情况,采用单因素及多因素logistic回归分析影响术后结局的独立危险因素;绘制ROC曲线评估mFI-5对食管癌根治术后严重并发症的预测效能。结果衰弱组42例(12.1%),非衰弱组304例(87.9%)。两组患者年龄、体重指数、美国麻醉医师协会(ASA)分级比较差异均有统计学意义(均P<0.05)。衰弱组术后发生严重并发症29例(69.0%),非衰弱组发生111例(36.5%);衰弱组术后住院时间延长22例(52.4%),非衰弱组延长67例(22.0%)。衰弱组患者术后严重并发症的发生率和住院时间延长的发生率均高于非衰弱组,差异均有统计学意义(均P<0.05)。单因素及多因素logistic回归分析发现,mFI-5评分(OR=3.381,95%CI:1.666~6.862,P=0.001)和年龄(OR=1.033,95%CI:1.006~1.061,P=0.017)是术后严重并发症的独立危险因素,mFI-5评分(OR=2.788,95%CI:1.376~5.646,P=0.004)、ASA分级(OR=2.040,95%CI:1.144~3.637,P=0.016)和术前输血(OR=5.393,95%CI:1.155~25.186,P=0.032)是术后住院时间延长的独立危险因素。mFI-5评分预测术后严重并发症的AUC=0.684(95%CI:0.627~0.742,P<0.001),灵敏度为0.729,特异度为0.607。结论mFI-5评分可有效预测食管癌根治术患者术后发生严重并发症,mFI-5评分与食管癌根治术患者的术后严重并发症相关。Objective To investigate the predictive value of the 5-factor modified frailty index(mFI-5)for severe postoperative complications in esophageal cancer patients underwent radical esophagectomy so as to provide evidence for optimizing perioperative management.Methods A retrospective analysis was conducted on 346 patients who underwent radical esophagectomy at the Affiliated Cancer Hospital of Xinjiang Medical University between May 2019 and March 2022.Perioperative clinical data,medical history,and mFI-5 scores were collected.Postoperative complications were classified using the Clavien-Dindo grading system,with grades Ⅲ-Ⅴ defined as severe complications.Patients were stratified into a frailty group(mFI-5≥2)and a non-frailty group(mFI-5<2).Prolonged postoperative hospital stay and severe complications were compared between the two groups.Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for postoperative adverse outcomes.ROC curve analysis was used to evaluate the predictive efficacy of mFI-5 for severe complications after radical esophagectomy.Results The frailty group comprised 42 patients(12.1%),and the non-frailty group included 304 patients(87.9%).Significant differences were observed in age,body mass index,and American Society of Anesthesiologists(ASA)classification between groups(all P<0.05).Severe complications occurred in 29 patients(69.0%)in the frailty group while 111(36.5%)in the non-frailty group;prolonged hospitalization was observed in 22(52.4%)and 67(22.0%)patients in frailty and non-frailty groups,respectively.The incidence of postoperative severe complications and prolonged hospitalization in the frailty group was significantly higher than that of the non-frailty group(all P<0.05).Univariate and multivariate logistic regression analyses identified mFI-5(OR=3.381,95%CI:1.666-6.862,P=0.001)and age(OR=1.033,95%CI:1.006-1.061,P=0.017)as independent risk factors for postoperative severe complications.For prolonged hospitalization,mFI-5(OR

关 键 词：改良衰弱指数 食管癌 严重并发症 

分 类 号：R735.1[医药卫生—肿瘤]