直肠癌前切除术术后吻合口漏危险因素分析及列线图预测模型构建

Related risk factors and nomogram for predicting of anastomotic leakage following sphincter-preserving surgery for rectal cancer

目的探讨直肠癌前切除术术后吻合口漏发生的危险因素,并构建列线图模型预测直肠癌术后吻合口漏的发生风险。方法采用病例对照研究方法,回顾性收集收治的行直肠癌前切除手术患者的临床病理资料,采用单因素分析和多因素Logistic回归分析筛选直肠癌前切除术术后吻合口漏发生的独立危险因素。基于这些独立危险因素建立列线图风险预测模型,应用Bootstrap抽样法验证模型的符合度,通过构建受试者工作特征曲线(ROC)评价模型区分度。结果男性(OR=2.847,95%CI:1.197~6.771)、BMI≥24 kg/m^2(OR=3.790,95%CI:1.812~7.927)、肿瘤M1分期(OR=3.176,95%CI:1.122~8.989)和肿瘤距肛缘距离≤7 cm(OR=2.992,95%CI:1.407~6.362)是直肠癌前切除术术后吻合口漏发生的独立危险因素。基于筛选出的4项独立危险因素,建立预测术后吻合口漏发生风险的列线图模型。列线图模型的ROC曲线下面积(AUC)为0.773(95%CI:0.712~0.844),经Bootstrap自抽样进行内部验证后,模型的C-index值为0.755。校正曲线显示预测吻合口漏发生率与实际吻合口漏发生率的相关性良好。结论男性、BMI≥24 kg/m^2、肿瘤M1分期和肿瘤距肛缘距离≤7 cm是直肠癌前切除术术后吻合口漏发生的独立危险因素。基于上述危险因素构建的列线图模型能较好地预测术后吻合口漏的发生概率。

Objective To identify risk factors for anastomotic leakage and to create a nomogram for precise prediction of anastomotic leakage after anterior resection for rectal cancer.Methods A case-control study was conducted to retrospectively analyze the clinicopathological data of 326 consecutive patients who underwent sphincter-preserving surgery for rectal cancer.Univariate and multivariable logistic regression analysis were used to determine independent risk factors associated with postoperative anastomotic leakage.A nomogram was constructed based on the selected independent risk factors to predict anastomotic leakage.The accuracy and predictability of the model were evaluated by using a bootstrapped-concordance index and calibration plots.Results Univariate and multivariate analysis identified the following variables as independent risk factors for anastomotic leakage:gender(male)(OR=2.847,95%CI:1.197~6.771),BMI(≥24 kg/m^2)(OR=3.790,95%CI:1.812~7.927),M stage(M1)(OR=3.176,95%CI:1.122~8.989)and distance of tumor to anal verge(≤7 cm)(OR=2.992,95%CI:1.407~6.362).We created a nomogram with high discriminative ability(concordance index,0.755)validate by the Bootstrap internal verification method.The area under the curve value,which evaluated the predictive performance of external validation,was 0.773(95%CI:0.712~0.844).The validation of the model showed that the predicted values and the observed values were basically consistent,indicating that the nomogram prediction model had a good predictive ability.Conclution Male,BMI≥24 kg/m^2,M1 stage and distance from anal verge to tumor≤7 cm were independently associated with anastomotic leakage formation.The nomogram prediction model is helpful to predict the probability of AL after sphincter-preserving surgery.