老年直肠癌保肛术后出现低位前切除综合征风险预测模型的建立

Establishment of a risk prediction model for low anterior resection syndrome in elderly patients with rectal cancer after anus-preserving surgery

目的探讨老年直肠癌保肛术后出现低位前切除综合征(LOW ANTERIOR RESECTION SYNDROM,LARS)的危险因素并建立预测模型。方法回顾性收集2017年1月至2019年12月某院收治的老年直肠癌患者274例,依据患者是否出现LARS分为观察组104例和对照组170例,对两组患者的各项临床数据进行比较,筛选发生LARS相关危险因素,建立风险预测模型并验证预测效能。结果多因素LOGISTIC回归分析显示,肿瘤位置、术前放疗、吻合口位置、术后恢复时间和坐骨棘间径是老年直肠癌保肛手术患者术后出现LARS的独立危险因素(P<0.05)。构建联合预测因子模型为:F=X1+0.663X2+1.232X3+0.775X4+0.503X5。经采用受试者工作特征(ROC)曲线显示,联合预测指标的曲线下面积、敏感度、特异度均优于单一危险因素指标。结论低位直肠癌、术前接受放疗、吻合口距肛缘近、术后恢复时间短和坐骨棘间径小的老年直肠癌保肛手术患者术后易出现LARS;同时,以与LARS有关的多因素作为风险预测模型,效能明显优于单一因素。

OBJECTIVE To investigate the risk factors of low anterior resection syndrome(LARS)in elderly patients with rectal cancer after anus-preserving surgery and to establish a prediction model.METHODS 274 elderly patients with rectal cancer admitted to a hospital from January 2017 to December 2019 were collected retrospectively.According to the presence or absence of LARS,the patients were divided into observation group(104 patients)and control group(170 patients).Various clinical data of the two groups were compared,LARS related risk factors were screened,risk prediction model was established and prediction efficacy was verified.RESULTS Multivariate Logistic Regression analysis showed that tumor location,preoperative radiotherapy,anastomotic site,postoperative recovery time and ischial spine diameter were independent risk factors for LARS after anus-preserving surgery in elderly patients with rectal cancer(P<0.05).The joint predictor model was constructed as follows:F=X1+0.663X2+1.232X3+0.775X4+0.503X5.Receiver Operating Characteristic(ROC)curve showed the area under the curve,sensitivity and specificity of the combined predictors were all better than those of the single risk factor.CONCLUSION Elderly patients with low rectal cancer,preoperative radiotherapy,anastomotic site close to the anal edge,short postoperative recovery time and small ischial spine diameter are prone to LARS after anus-preserving surgery.At the same time,multi-factors related to LARS are taken as the risk prediction model,and the efficiency is obviously superior to a single factor.