个体化预测胃结直肠癌患者术后下肢静脉栓塞的风险及列线图模型的建立

Establishment of a Personalized Nomogram Model to Predict the Risk of LowerExtremity Venous Embolism in Patients with Gastric Colorectal Cancer After Surgery

目的探讨胃结直肠癌患者(GC)术后下肢静脉栓塞(LDVT)的危险因素及列线图模型的建立。方法选取120例胃结直肠癌患者作为研究对象,根据患者术后是否发生LDVT将患者分为发生组(n=10)和未发生组(n=110),回顾性分析患者的临床资料,分别使用单因素和Logistic回归多因素分析GC患者发生LDVT的独立危险因素,并建立相关列线图预测模型。结果高脂血史、静脉栓塞史、术中存在输血、卧床时间≥10天、静脉穿刺次数≥5次、存在术中感染为GC患者术后是否发生LDVT的独立危险因素(P<0.05),基于筛选出危险因素建立列线图预测模型,并对该模型进行验证。建模集和验证集的C-index指数分别为0.837(95%CI:0.790-0.884)和0.828(95%CI:0.785-0.871),两组的校正曲线均与标准曲线拟合较好,两组ROC曲线下面积(AUC)分别为0.837和0.828,提示模型具有良好的预测精准度。结论GC患者发生LDVT的危险因素较多,本研究基于危险因素建立的列线图模型具有良好的预测能力,有助于医护人员记忆和理解模型的临床意义。

Objective To investigate the risk factors of lower extremity venous embolism(LDVT)after gastric colorectal cancer(GC)surgery and the establishment of the nomogram model.Methods 120 cases of gastric colorectal cancer patients were selected as the research object,according to the patients whether had postoperative LDVT,were divided into LDVT groups(n=10)and non-LDVT group(n=110),the clinical data of patients were retrospectively analyzed;using the single factor and multi-factor logistic regression analysis to study independent risk factors of LDVT in GC,and establish related nomogram prediction model.Results The history of hyperlipidemia,history of venous thrombosis,intraoperative blood transfusion,bed time is greater than or equal to 10 days,venipuncture number greater than or equal to 5 times,the existence of postoperative infection for patients with GC were independent risk factors of LDVT(P<0.05),nomogram prediction model is established based on the selected risk factors,and to validate the model.The c-index index of the modeling set and the validation set were 0.837(95%CI:0.790-0.884)and 0.828(95%CI:0.785-0.871),respectively.The correction curves of the 2 groups were well fitted to the standard curve,and the area under ROC curve(AUC)of the 2 groups was 0.837 and 0.828,respectively,indicating that the model had good prediction accuracy.Conclusion There are many risk factors for LDVT in GC patients,and the trap-line model established in this study based on risk factors has good predictive ability,which is helpful for medical staff to remember and understand the clinical significance of the model.