腹腔镜辅助下右半结肠癌根治术后复发转移危险因素及风险列线图模型的建立

Risk factors of recurrence and metastasis after laparoscopic resection of right colon cancer and establishment of risk nomogram model

目的探讨腹腔镜辅助下右半结肠癌根治术后复发转移危险因素及风险列线图模型的建立。方法选取164例行腹腔镜辅助下右半结肠癌根治术患者作为研究对象,采取电话、门诊等方式进行术后随访,根据随访期间是否发生复发转移分为复发转移组(n=39)和无复发转移组(n=125),收集2组患者性别、年龄、体质量指数(BMI)、输血、梗阻、手术时间、肿瘤最大直径、淋巴结转移、大体分型、组织类型、分化程度、浸润深度、Tumor Node Metastasis(TNM)分期、术后癌胚抗原(CEA)、术后镇痛、术后辅助化疗及术后住院时间等临床资料,采用χ^(2)检验对肿瘤术后复发转移的影响因素进行单因素分析,采用多因素Logistic回归分析确定独立危险因素并建立相关列线图预测模型。结果单因素分析结果显示,2组患者的梗阻、肿瘤直径、淋巴结转移、分化程度、TNM分期及术后CEA等临床资料差异有统计学意义(P<0.05);多因素Logistic回归分析结果显示梗阻、肿瘤直径≥10 cm、淋巴结转移、低级分化、TNM分期≥Ⅲ期及术后CEA≥5.0μg/L是腹腔镜辅助下右半结肠癌根治术后复发转移的独立危险因素(P<0.05),基于这6项危险因素建立列线图模型结果显示预测值同实测值基本一致且曲线下面积(AUC)高达0.879(95%CI为0.849~0.909)。结论腹腔镜辅助下右半结肠癌根治术后复发转移的危险因素较多,基于危险因素建立的列线图模型具有良好的精准性和区分度。

Objective To explore the risk factors and the establishment of nomogram model of recurrence and metastasis after laparoscopic resection of right colon cancer.Methods One hundred and sixty-four patients with right colon cancer undergoing laparoscopic assisted right hemicolectomy were selected as the research objects.All patients were followed up by telephone and outpatient service.According to the recurrence and metastasis during the follow-up period,they were divided into recurrence and metastasis group(n=39)and non recurrence and metastasis group(n=125).The clinical data of gender,age,body mass index(BMI),blood transfusion,obstruction,operation time,maximum tumor diameter,lymph node metastasis,gross classification,tissue type,differentiation degree,depth of invasion,TumorNode Metastasis(TNM)stage,postoperative carcinoembryonic antigen(CEA),postoperative analgesia,postoperative adjuvant chemotherapy and postoperative hospital stay were collected,Chi square test was used to analyze the influencing factors of postoperative recurrence and metastasis.Multivariate Logistic regression analysis was used to determine the independent risk factors and establish the related nomogram prediction model.Results Univariate analysis showed that there were significant differences in the clinical data of obstruction,tumor diameter,lymph node metastasis,differentiation degree,TNM stage,and postoperative CEA between the two groups(P<0.05);multivariate logistic regression analysis showed that obstruction,tumor diameter≥10 cm,lymph node metastasis,low-grade differentiation,TNM stage≥Ⅲ,and postoperative CEA≥5.0μg/L was an independent risk factor for recurrence and metastasis of right colon cancer after laparoscopic assisted radical resection(P<0.05).Based on the above six risk factors,a nomogram model was established.The results showed that the predicted value was basically consistent with the measured value,and area under curve(AUC)index was as high as 0.879(95%CI was 0.849-0.909).Conclusion There are many risk factors for recurrence and metastasis after laparoscopic-assisted radical resection of right colon cancer.The nomogram model based on risk factors has good accuracy and discrimination.