腹膜后肿瘤患者术后并发症发生情况及预测模型构建

Current status and predictive model construction of postoperative complications in patients with retroperitoneal tumor

目的分析腹膜后肿瘤患者术后并发症的发生情况及危险因素,并建立预测并发症发生的列线图模型。方法回顾性收集2019年6月至2022年5月期间四川大学华西医院血管外科符合本研究条件的腹膜后肿瘤患者,采用单因素和多因素logistic回归分析影响腹膜后肿瘤患者术后并发症发生的风险因素,基于风险因素建立预测术后并发症发生的列线图模型并对此模型进行验证。结果本研究共纳入205例患者,其中有70例(34.1%)患者术后发生了并发症,经多因素logistic回归分析结果显示,术前血清白蛋白<35 g/L[OR=2.355,95%CI(1.256,4.416),P=0.008]、肿瘤为肉瘤[OR=2.498,95%CI(1.219,5.120),P=0.012]及手术切除脏器[OR=2.008,95%CI(1.042,3.868),P=0.037]增加腹膜后肿瘤患者术后发生并发症的概率,基于这些危险因素建立的列线图模型预测术后发生并发症的受试者操作特征曲线下的面积为0.704[95%CI(0.626,0.781),P<0.001],Bootstrap法对列线图模型进行内部验证具有较好的区分度[一致性指数为0.704,95%CI(0.628,0.779)],列线图模型的校准曲线显示预测值与实际值基本一致,Hosmer-Lemeshow拟合优度检验模型拟合度良好(χ2=3.407,P=0.906)。结论从本研究结果看,腹膜后肿瘤患者的肿瘤类型为肉瘤、术前白蛋白低于35 g/L及手术中切除脏器与其术后并发症发生有关,根据这些因素构建的列线图模型对术后并发症发生有较好的预测价值。

Objective To analyze the current status and risk factors of postoperative complications in patients with retroperitoneal tumor(RPT)and to establish a nomogram for predicting the occurrence of postoperative complications.Methods The clinicopathologic data of patients with RPT who met the inclusion criteria in the West China Hospital of Sichuan University from June 2019 to May 2022 were retrospectively collected.The risk factors of postoperative complications were analyzed by using univariate and multivariate analyses,and the nomogram was constructed based on the risk factors and validated.Results A total of 205 patients were collected in this study,70(34.1%)of whom had postoperative complications.The multivariate analysis results of logistic regression showed that the preoperative serum albumin<35 g/L[OR=2.355,95%CI(1.256,4.416),P=0.008],tumor sarcoma[OR=2.498,95%CI(1.219,5.120),P=0.012],and visceral resection[OR=2.008,95%CI(1.042,3.868),P=0.037]increased the probability of postoperative complications for the patients with RPT.The area under the receiver operating characteristic curve of the nomogram based on the risk factors in predicting the occurrence of postoperative complications was 0.704[95%CI(0.626,0.781),P<0.001].The consistency index of the nomogram by internal verification was 0.704[95%CI(0.628,0.779)].The calibration curve of the nomogram showed that the predicted value was basically consistent with the actual value,the Hosmer-Lemeshow goodness-of-fit test model had a good goodness-of-fit(χ2=3.407,P=0.906).Conclusions From the results of this study,the tumor sarcoma,lower preoperative serum albumin,and visceral resection are associated with postoperative complications for patients with RPT.The nomogram based on risk factors has a good predictive value for postoperative complications.