老年喉癌患者术后心肺并发症危险因素分析及预测模型构建  

Risk factors analysis and prediction model construction of postoperative cardiopulmonary complications in elderly patients with laryngeal cancer

作　　者：王卫卫[1] 程慧娟[2] WANG Wei-wei;CHENG Hui-juan(Department of Laryngeology,Head and Neck Surgery,Henan Provincial People's Hospital,Zhengzhou 450052,China;Department of Laryngeology,Head and Neck Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]河南省人民医院耳鼻咽喉头颈外科,郑州450003 [2]郑州大学第一附属医院咽喉头颈外科,郑州450052

出　　处：《医药论坛杂志》2025年第1期29-33,共5页Journal of Medical Forum

基　　金：河南省医学科技攻关计划项目(LHGJ20240005)。

摘　　要：目的分析老年喉癌患者术后出现心肺并发症的危险因素并构建列线图预测模型。方法回顾性分析2018年1月至2023年6月在河南省人民医院行喉癌切除术的老年患者的临床资料,以术后出现心肺并发症为结局变量,采用单因素及logistic回归分析探讨老年喉癌患者术后合并心肺并发症的独立危险因素。应用R语言建立列线图预测模型,并采用Bootstrap方法及临床决策曲线验证该模型的预测效能。结果共纳入259例老年喉癌患者,其中66例患者术后出现心肺并发症。发生组与未发生组患者在年龄、吸烟史、淋巴结转移、临床分期、肿瘤部位、手术方式、气管切开、颈淋巴结清扫、手术时间等方面差异有统计学意义(P<0.05)。吸烟、临床分期、手术方式、手术时间是老年喉癌患者术后出现心肺并发症的独立危险因素(P<0.05)。受试者工作特征(receiver operator characteristic curve,ROC)曲线显示构建的列线图对预测老年喉癌术后出现心肺并发症区分度较好[曲线下面积(area under curve,AUC)=0.852,95%CI=0.784~0.920],Bootstrap方法对列线图进行验证,校准曲线平均绝对误差为0.021,表明校准曲线与理想曲线贴合度良好。决策曲线显示老年喉癌术后心肺并发症的发生阈值居于0.07~0.98时模型适用性最优。结论老年喉患者术后出现心肺并发症的独立危险因素为吸烟、临床分期、手术方式、手术时间,根据以上危险因素构建的列线图模型对老年喉癌术后出现心肺并发症有较好的预测价值,有助于老年喉癌患者术后心肺并发症的监测,临床应用价值较高。Objective To analyze the risk factors of cardiopulmonary complications in elderly laryngeal patients after surgery and to construct a nomogram prediction model.Methods A retrospective analysis was performed cancer for the clinical data of elderly patients who underwent laryngeal cancer resection in the Henan Provincial People's Hospital from January 2018 to June 2023,and univariate and logistic regression analysis were used to explore the independent risk factors for postoperative cardiopulmonary complications in elderly patients with laryngeal cancer.The nomogram prediction model was established by using R programming language,and the prediction performance of the model was verified by using the Bootstrap method and clinical decision curve.Results A total of 259 elderly patients with laryngeal cancer were included,and 66 of them developed cardiopulmonary complications after surgery.There were differences between the occurrence group and the non-occurrence group in terms of age,smoking history,lymph node metastasis,clinical stage,tumor location,surgical method,tracheostomy,cervical lymph node dissection and operation time and the difference were statistically significant(P<0.05).Smoking,clinical stage,surgical method,and operation time were independent risk factors for cardiopulmonary complications in elderly patients with laryngeal cancer after surgery(P<0.05).The receiver operator characteristic curve(ROC)showed that the constructed nomogram had a good discrimination in predicting cardiopulmonary complications after surgery for elderly laryngeal cancer[area under curve(AUC)=0.852,95%CI=0.784~0.920],the Bootstrap method verifies the nomogram,and the average absolute error of the calibration curve was 0.021,indicating that the calibration curve fits well with the ideal curve.The decision curve showed that the applicability of the model was the best when the threshold for the occurrence of cardiopulmonary complications after laryngeal cancer surgery in the elderly was 0.07~0.98.Conclusion The independent risk fact

关 键 词：喉癌 心肺并发症 危险因素 预测模型 

分 类 号：R739.65[医药卫生—肿瘤]