结直肠癌患者术后肠梗阻发生风险列线图预测模型的构建及评估

Construction and evaluation of nomogram prediction model for postoperative intestinal obstruction in patients with colorectal cancer

目的分析结直肠癌患者术后肠梗阻发生的危险因素,构建列线图预测模型并进行评估。方法回顾性分析2018年6月至2020年8月淄博市中心医院西院收治的经手术病理确诊的283例结直肠癌患者,所有患者均行结直肠癌根治术。其中31例患者术后1个月发生肠梗阻。比较肠梗阻与非肠梗阻患者一般临床资料差异。采用多因素logistics回归分析筛选结直肠癌患者术后肠梗阻发生的危险因素,并基于筛选出的危险因素建立术后肠梗阻发生风险的列线图预测模型,使用受试者操作特征(ROC)曲线评估模型的区分度并进行一致性检验。结果 283例结直肠癌患者术后肠梗阻发生率为11.0%(31/283),其中机械性肠梗阻15例,麻痹性肠梗阻9例,炎症性肠梗阻7例。Logistic回归分析结果显示,肿瘤TNMⅢ期、中转开腹、右半结肠切除术、手术时间、既往大肠肿瘤切除史是结直肠癌患者术后肠梗阻发生的独立危险因素(P<0.05);将独立危险因素引入R软件(R3.6.3)构建列线图模型,曲线下面积为0.919 (95%CI 0.862-0.975),列线图校准曲线斜率接近1。Hosmer Lemeshow拟合优度检验=8.576,P=0.379。结论基于结直肠癌患者术后肠梗阻发生的危险因素如肿瘤TNM分期、手术类型、手术方式、手术时间、既往大肠肿瘤切除史建立的列线图预测模型具有良好的区分度与一致性,可为结直肠癌术后肠梗阻的预防提供一定指导。

Objective To analyze the risk factors of postoperative intestinal obstruction in patients with colorectal cancer and construct a nomogram prediction model. Methods The clinical data of 283 patients with colorectal cancer diagnosed by surgery and pathology admitted to West Hospital of Zibo Central Hospital from June 2018 to August 2020 were retrospectively analyzed. All patients underwent radical resection of colorectal cancer. Thirty-one patients developed ileus one month after surgery. The general clinical data of patients with intestinal obstruction and those without intestinal obstruction were compared. Multivariate logistic regression model was used to screen out the risk factors of postoperative intestinal obstruction in patients with colorectal cancer. Based on the screened risk factors, a nomogram prediction model for the risk of postoperative intestinal obstruction was established, and receiver operating characteristic(ROC) curve was used to evaluate the discrimination of the model and the consistency was tested. Results The incidence of postoperative intestinal obstruction in 283 patients with colorectal cancer was 11.0%(31/283), including 15 cases of mechanical intestinal obstruction, 9 cases of paralytic intestinal obstruction and 7 cases of inflammatory intestinal obstruction. Logistic regression analysis showed that TNM stage Ⅲ, conversion to laparotomy, right hemicolectomy, operation time and previous colorectal tumor resection history were independent risk factors for postoperative intestinal obstruction in patients with colorectal cancer(P<0.05). The independent risk factors were introduced into R software(R3.6.3) to construct nomogram model, the area under the curve was 0.919(95%CI: 0.862-0.975), and the slope of nomogram calibration curve was close to 1. Hosmer-Lemeshow goodness-of-fit test showed that =8.576, P=0.379. Conclusion Based on the risk factors of postoperative intestinal obstruction in patients with colorectal cancer, such as tumor TNM stage, operation type, operation method, operation time and previous colorectal tumor resection history, the established nomogram prediction model has good discrimination and consistency, and it can provide certain guidance value for the prevention of postoperative intestinal obstruction of colorectal cancer.