食管癌术后发生颈部吻合口漏的列线图预测模型

Nomogram prediction model of cervical anastomotic leakage after esophageal cancer surgery

目的回顾性分析食管癌术后颈部吻合口漏的危险因素,建立预测食管癌术后患者颈部吻合口漏发生的列线图预测模型。方法回顾性分析2010年1月至2015年5月期间在中国医学科学院肿瘤医院行食管癌根治术患者(702例)的临床病理资料,颈部吻合口漏的危险因素分析采用logistic回归模型,依据影响因素构建列线图。采用内部验证法评价验证列线图的预测效能。结果全组702例患者,训练组492例,验证组210例。492例患者中,食管癌术后颈部吻合口漏发生率为16.1%(79/492)。多因素分析显示,降主动脉钙化(OR=2.12,95%CI:1.14~3.94,P=0.018)、腹腔动脉钙化(OR=2.29,95%CI:1.13~4.64,P=0.022)、外周血管病(OR=5.50,95%CI:1.64~18.40,P=0.006)、术后呼吸机辅助呼吸(OR=5.33,95%CI:1.83~15.56,P=0.002)、胸腔积液或脓胸(OR=3.08,95%CI:1.11~8.55,P=0.031)、切口脂肪液化及感染(OR=3.49,95%CI:1.68~7.27,P=0.001)为食管癌术后发生颈部吻合口漏的独立危险因素。依据食管癌术后吻合口漏的独立危险因素建立的列线图预测模型显示,内部训练组和外部验证组一致性指数分别为0.73和0.74(P<0.001),提示预测模型具有较好的预测效能。结论列线图预测模型可以直观的预测患者术后颈部吻合口漏的发生率,且预测准确度较高,有助于为患者颈部吻合口漏的预防和患者的个体化治疗提供临床依据。

Objective To retrospectively analyze the risk factors of anastomotic leakage in the neck after esophageal cancer and establish a nomogram prediction model that can accurately predict the occurrence of anastomotic leakage in the neck of the patient.Methods The study retrospectively analyzed 702 patients who underwent radical esophageal cancer surgery between January 2010 and May 2015 at Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College.A multivariate logistic regression model was used to determine the risk factors for neck anastomotic leak,and a nomogram model was constructed,internal validation methods were used to evaluate and verify the predictive effectiveness of the nomogram.Results There were 702 patients in the whole group,492 in the training group and 210 in the validation group.The incidence of postoperative cervical anastomotic leak was 16.1%(79/492)in 492 patients with esophageal cancer in the training group.Multifactorial analysis revealed calcification of the descending aorta(OR=2.12,95%CI:1.14,3.94,P=0.018),calcification of the celiac artery(OR=2.29,95%CI:1.13,4.64,P=0.022),peripheral vascular disease(OR=5.50,95%CI:1.64,18.40,P=0.006),postoperative ventilator-assisted breathing(OR=5.33,95%CI:1.83,15.56,P=0.002),pleural effusion or septic chest(OR=3.08,95%CI:1.11,8.55,P=0.031),incisional fat liquefaction and infection(OR=3.49,95%CI:1.68,7.27,P=0.001)were independent risk factors for the development of cervical anastomotic leak after esophageal cancer surgery.The results of the nomogram prediction model showed that the consistency indices of the training and external validation groups were 0.73 and 0.74,respectively(P<0.001),suggesting that the prediction model has good predictive efficacy.Conclusion The nomogram prediction model can intuitively predict the incidence of postoperative cervical anastomotic leakage in patients with high prediction accuracy,which can help provide a clinical basis for preventing cervical anastomotic leak and individualized treatment of patients.