预测前列腺癌根治术后并发症风险列线图的建立

Construction of a nomogram predicting the risk of peri-operative complications after open radical prostatectomy

目的采用标准化的评分系统分析前列腺癌根治术围手术期并发症的危险因素及构建预测模型。方法选取2007年6月至2011年6月行前列腺癌根治术的患者240例，年龄50～82岁，平均70岁。术前均经活检病理诊断为前列腺癌。Gleason评分：〈7分95例，≥7分145例。临床分期：T1期1例（0．4％），T2a期5例（2．1％），T2b期7例（2．9％），T2a期162例（67．5％），T3a期26例（10．8％），T3b期39例（16．3％）。患者围手术期（术后30d内）并发症情况依据Clavien—Dindo标准按严重程度分级，II度以上并发症归为有临床意义的并发症，其中直肠损伤4例（1．6％），伤口感染5例（2．0％），深静脉血栓3例（1．2％），尿漏12例（5．O％），淋巴瘘11例（4．5％），心肌梗死14例（5．8％），二次手术4例（1．6％）。采用倒退法多元Logistic回归筛选危险因素，建立预测围手术期II度及以上并发症的列线图。结果围手术期并发症的预测因子中，体质指数（bodymassin—dex，BMI）是独立的预后因素（OR值为0．804，P〈0．05）。通过变量筛选最终的模型包括BMI、N分期、术中出血〉200ml。模型的内部验证显示分辨度C—index为0．633，符合度平均绝对差为0．028。最终根据多因素分析结果绘制了便于临床应用的列线图。结论基于标准化的并发症评估数据，我们建立了预测前列腺癌围手术期临床显著并发症的列线图，该列线图在内部验证中显示了良好的效力，有助于前列腺癌个体化的手术治疗。

Objective To construct and evaluate a nomogram for predicting the risk of peri-operative complications after radical retro-pubic prostatectomy （RRP） with standard classification criteria. Methods The peri-operative complications and clinieopathological data of 240 patients （50 -82 years old） who had undergone RRP for prostate cancer from June 2006 to June 2011 were retrospectively collected. GI- eason score： 95 cases 〈 7; 145 patients ≥7; Clinical staging： cT1 is 1 case （0. 4%）, T2a 5 cases （2.1%）, T2b 7 cases （2. 9%）, T2a 162 cases （67. 5%）, T3a 26 cases （10. 8%）, T3b 39 cases （16. 3% ）. The peri-operative complications （in 30 days after surgery） were classified by Clavien-Dindo Classification system （ the occurrence rates are as follows： rectum injury 1.6% , wound infection 2.0% , deep venous thrombosis 1.2% , urinary leak 5.0% , lymphocele 4.5% , myocardial infarction 5.8% , second look operation 1. 6% ）, and a logistic regression model was used to construct the nomogram. Results BMI, N staging and Blood loss more than 200ml during surgery were independent prognostic factors of RRP morbidity in multivariate logistic regression. The nomogram predicting the risk of peri-operative complications showed relative good concordance index （0. 633 ） and good calibration. Conclusions Based on the clinicopathological factors, a nomogram to predict the probability of peri-operative complications in patients undergone RRP was constructed. This statistical tool may be beneficial in judging operation risk and help consulting with patient before or after surgery.