个体化预测早期食管癌内镜黏膜下剥离术后食管狭窄发生风险的列线图模型构建

Construction of nomogram model for individualized prediction of esophageal stenosis risk after endoscopic submucosal dissection for early esophageal cancer

目的构建个体化预测早期食管癌内镜黏膜下剥离术(ESD)后食管狭窄发生风险的列线图模型。方法选取2016年1月至2019年6月本院消化外科198例经ESD治疗的患者作为研究对象,根据术后是否发生食管狭窄将其分为狭窄组和非狭窄组,分析早期食管癌患者ESD术后食管狭窄的影响因素。采用R4.1.1软件构建预测早期食管癌患者ESD术后食管狭窄发生风险的列线图模型,绘制受试者工作特征(ROC)曲线及校准曲线以评估列线图模型预测早期食管癌患者ESD术后食管狭窄的区分度和一致性。结果ESD治疗的198例早期食管癌患者中,51例发生食管狭窄,发生率为25.76%。单因素分析结果显示,狭窄组和非狭窄组的年龄、手术时间、病变纵径、肌层损伤、病变环周范围和浸润深度比较,差异具有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,病变纵径≥5 cm、肌层损伤、病变环周范围≥3/4周和浸润深度M3/SM1是ESD治疗早期食管癌术后食管狭窄的危险因素(P<0.05)。列线图模型预测早期食管癌患者ESD术后发生食管狭窄的曲线下面积(AUC)为0.838,Hosmer-Lemeshow拟合优度检验提示列线图的预测概率与现况值之间具有较好的一致性(P=0.596)。结论病变纵径≥5 cm、肌层损伤、病变环周范围≥3/4周、浸润深度M3/SM1是早期食管癌患者ESD术后发生食管狭窄的危险因素,本研究构建的列线图模型对早期食管癌患者ESD术后食管狭窄发生风险具有良好的预测能力。

Objective To construct nomogram model for individualized prediction of esophageal stenosis risk after endoscopic submucosal dissection(ESD)for early esophageal cancer.Methods A total of 198 patients treated with ESD in the digestive surgery department of our hospital from January 2016 to June 2019 were selected as the research objects.According to whether esophageal stenosis occurred after operation,the patients were divided into stenosis group and non-stenosis group.The influencing factors of esophageal stenosis after ESD in patients with early esophageal cancer were analyzed.R4.1.1 software was used to construct nomogram model for predicting esophageal stenosis risk after ESD in patients with early esophageal cancer.The receiver operating characteristic(ROC)curve and calibration curve were drawn to evaluate the discrimination and consistency of the nomogram model in predicting esophageal stenosis risk after ESD in patients with early esophageal cancer.Results Among 198 patients with early esophageal cancer treated by ESD,51 cases had esophageal stenosis,with an incidence of 25.76%.Univariate analysis results showed that there were statistically significant differences in age,operation time,lesion longitudinal diameter,muscle layer injury,lesion circumference and infiltration depth between the stenosis group and the non-stenosis group(P<0.05).Multivariate Logistic regression analysis results showed that lesion longitudinal diameter≥5 cm,muscular layer injury,lesion circumference≥3/4 circles and M3/SM1 infiltration depth were risk factors for esophageal stenosis after ESD for early esophageal cancer(P<0.05).The area under the curve(AUC)of the nomogram model for predicting esophageal stenosis risk after ESD in patients with early esophageal cancer was 0.838.Hosmer-Lemeshow goodness-of-fit test showed there was a good consistency between the predicted probability of the nomogram and the current value(P=0.596).Conclusion The lesion longitudinal diameter≥5 cm,muscular layer injury,lesion circumference≥3/4 circles and M3/SM1 infiltration depth are risk factors for esophageal stenosis after ESD in patients with early esophageal cancer.The nomogram model constructed in this study has a good predictive ability for the risk of esophageal stenosis after ESD in patients with early esophageal cancer.