复发性鼻咽癌患者鼻内镜手术围术期输血的危险因素及预测模型的建立

Risk factors and nomogram prediction model establishment of perioperative blood transfusion in patients with recurrent nasopharyngeal carcinoma undergoing nasal endoscopic surgery

目的 筛选复发性鼻咽癌患者鼻内镜手术围术期输血的危险因素,建立列线图预测模型。方法 回顾性分析2021年1月至2023年5月行鼻内镜手术的262例复发性鼻咽癌患者的临床资料,根据围术期是否输血分为两组:未输血组和输血组。通过单因素和多因素Logistic回归分析筛选围术期输血的危险因素,构建列线图预测模型,绘制受试者工作特征(ROC)曲线并计算曲线下面积(AUC)。结果 有46例(17.6%)患者在鼻内镜手术围术期输血。多因素Logistic回归分析显示,术前Hb浓度70~<100 g/L(OR=6.178,95%CI 2.271~16.805,P<0.001)、术前白蛋白浓度25~<35 g/L(OR=2.126,95%CI 1.021~4.424,P=0.044)、手术分型Ⅲ或Ⅳ型(OR=4.725,95%CI 1.634~13.584,P=0.004)是复发性鼻咽癌患者鼻内镜手术围术期输血的独立危险因素。列线图模型的AUC为0.769(95%CI 0.701~0.838),敏感性为67.6%,特异性为76.1%。结论 复发性鼻咽癌患者鼻内镜手术围术期输血的独立危险因素是术前Hb浓度70~<100 g/L、术前白蛋白浓度25~<35 g/L、手术分型Ⅲ或Ⅳ型,基于以上危险因素建立的列线图模型对围术期输血有良好的预测能力。

Objective To explore the risk factors of perioperative blood transfusion in patients with recurrent nasopharyngeal carcinoma undergoing nasal endoscopic surgery,and construct a nomogram prediction model.Methods A retrospective analysis was conducted on the clinical data of 262 patients who underwent the nasal endoscopic surgery from January 2021 to May 2023.The patients were divided into two groups according to perioperative blood transfusion or not:non-transfusion group and transfusion group.Univariate and multivariate logistic regression were conducted to identify independentrisk factors of perioperative blood transfusion,and a nomogram prediction model was developed.The receiver operating characteristic(ROC) curve was drawn,and the area under the curve(AUC) was calculated.Results The incidence of blood transfusion in patients with recurrent nasopharyngeal carcinoma undergoing nasal endoscopic surgery was 46(17.6%).Multivariate logistic regression analysis revealed that preoperative hemoglobin level 70 to <100 g/L(OR = 6.178,95% CI 2.271-16.805,P < 0.001),preoperative albumin level 25 to <35 g/L(OR = 2.126,95% CI 1.021-4.424,P = 0.044),and classification of surgery grade Ⅲ or Ⅳ(OR = 4.725,95% CI 1.634-13.584,P = 0.004) were independent risk factors for predicting perioperative blood transfusion in patients with recurrent nasopharyngeal carcinoma undergoing nasal endoscopic surgery.The AUC of the nomogram model was 0.769(95% CI 0.701-0.838),the sensitivity was 67.6%,and the specificity was 76.1%.Conclusion Preoperative hemoglobin level 70 to <100 g/L,preoperative albumin level 25 to <35 g/L,and classification of surgery grade Ⅲ or Ⅳ are independent risk factors of perioperative blood transfusion in patients with recurrent nasopharyngeal carcinoma undergoing nasal endoscopic surgery.The nomogram model established based on the above risk factors has good predictive ability for perioperative blood transfusion.