结直肠癌根治术后发生严重并发症的危险因素分析

Analysis of Risk Factors for Severe Complications After Radical Resection of Colorectal Cancer

目的:探讨结直肠癌根治术后早期严重并发症的发生情况及相关危险因素。方法:回顾性分析2020年1月至2023年3月我院收治的316例行结直肠癌根治术患者的临床资料,观察严重并发症发生情况、分析危险因素并评价预测指标效能。采用单因素和多因素分析以确定结直肠癌根治术后发生严重并发症的临床因素,绘制受试者工作特征(ROC)曲线,以曲线下面积(AUC)判定和比较诊断标准的准确性,约登指数确定最佳截断值。结果:316例中,术后发生严重并发症患者23例(7.28%),其中Ⅲa并发症13例,Ⅲb级并发症5例,Ⅳa级3例,Ⅳb级1例,Ⅴ级1例。单因素分析显示术后C反应蛋白与白蛋白比值、C反应蛋白、白蛋白及预后营养指数是结直肠癌术后发生严重并发症的相关因素(t=11.76,9.64,4.06,2.85,P<0.05)。多因素分析显示,术后C反应蛋白与白蛋白比值是影响结直肠癌根治术后发生严重并发症的独立危险因素(比值比=0.214,95%可信区间为0.07-0.657,P=0.007);ROC曲线显示术后C反应蛋白与白蛋白比值对结直肠癌术后发生严重并发症的预测准确性略高于C反应蛋白,其AUC为0.935,95%可信区间为0.889-0.98(P<0.05),灵敏度为0.913,特异度为0.843,最佳截断值为3.735,约登指数为0.756;术后C反应蛋白AUC为0.928,95%可信区间为0.877-0.978(P<0.05),灵敏度为0.87,特异度为0.819,最佳截断值为127.53,约登指数为0.689。结论:术后C反应蛋白与白蛋白比值是结直肠癌根治术后发生严重并发症的独立危险因素。

Objective To investigate the occurrence of early severe complications and related risk factors after radical resection of colorectal cancer.Methods The clinical data of 316patients undergoing radical resection of colorectal cancer in our hospital from January 2020to March 2023were retrospectively ana-lyzed to observe the occurrence of severe complications,analyze risk factors,and evaluate the efficacy of predictive indicators.Univariate and multivariate analyses were used to determine the clinical factors of se-vere complications after radical resection of colorectal cancer.Receiver operating characteristic(ROC)curves were plotted,the area under the curve(AUC)was used to determine and compare the accuracy of diagnostic criteria,and the optimal cut-off value was determined by Jorden index.Results Among 316 cases,23cases(7.28%)had severe complications,including 13cases ofⅢa complications,5cases ofⅢb complications,3cases ofⅣa complications,1case ofⅣb complication,and 1case ofⅤcomplication.Uni-variate analysis showed that the ratio of C-reactive protein to albumin,C-reactive protein,albumin and prognostic nutrition index were correlated with severe complications after colorectal cancer operation(t=11.76,9.64,4.06,2.85,P<0.05).Multivariate analysis showed that the ratio of C-reactive protein to albu-min was an independent risk factor for severe complications after radical resection of colorectal cancer(odds ratio=0.214,95%,confidence interval 0.07-0.657,P=0.007).ROC curve showed that the ratio of postoperative C-reactive protein to albumin was slightly more accurate than that of C-reactive protein in predicting the occurrence of postoperative severe complications of colorectal cancer,with AUC of 0.935,95%confidence interval of 0.889to 0.98(P <0.05),sensitivity of 0.913,specificity of 0.843,and optimalcut-off value of 3.735.The Jorden index was 0.756.After operation,the AUC of C-reactive protein was 0.928,the 95%confidence interval was 0.877to 0.978 (P <0.05).The sensitivity was 0.87,the specificitywas 0.819,the optimal cut-off value was 127.53,and the Yoden index was 0.689. Conclusion The ratio ofC-reactive protein to albumin is an independent risk factor for severe complications after radical resection ofcolorectal cancer.