胰十二指肠切除术后达到教科书式结局的影响因素分析及列线图模型构建

Analysis of influencing factors of textbook outcome after pancreaticoduodenectomy and construction of nomogram model

目的:分析胰腺导管腺癌患者胰十二指肠切除术(PD)后达到教科书式结局(TO)的影响因素,并构建列线图模型探讨其对TO的预测价值。方法:回顾性分析2019年1月至2022年12月在河南大学人民医院接受PD治疗的205例胰腺导管腺癌患者的临床资料,其中男性88例,女性117例,年龄(61.3±9.8)岁。依据患者术后是否达到TO分为两组:TO组( n=113)和非TO组( n=92)。收集患者的年龄、性别、术中出血量、手术时间、输血量、胰腺CT值、肿瘤分化程度等临床资料。logistic回归分析筛选PD术后达到TO的影响因素并构建列线图模型。使用受试者工作特征(ROC)曲线、校准图和决策曲线分析评估列线图模型的性能。 结果:多因素logistic回归分析结果表明,肿瘤分化程度越高(高分化比中分化: OR=7.20,95% CI:1.20~43.28;高分化比低分化: OR=16.55,95% CI:2.01~136.11)、CT值>38.45 Hu( OR=0.29,95% CI:0.13~0.65)、输血量≤350 ml( OR=8.05,95% CI:2.94~22.01)和手术时间≤407.5 min( OR=10.88,95% CI:3.90~30.41)的胰腺导管腺癌患者,PD术后越容易达到TO(均 P<0.05)。基于上述影响因素构建PD术后预测TO的列线图模型,该列线图模型的一致性指数为0.863(95% CI:0.816~0.911),ROC曲线的灵敏度和特异度分别为0.804和0.752,校准图显示校准曲线与理想曲线贴合良好,决策曲线显示该模型具有明显的正向净效益。 结论:肿瘤分化程度、CT值、输血量、手术时间是胰腺导管腺癌患者PD术后达成TO的独立影响因素,以此构建的列线图模型对TO的预测性能良好。

Objective To analyze the influencing factors of achieving textbook outcome(TO)after pancreaticoduodenectomy(PD)in patients with pancreatic ductal adenocarcinoma,and to construct a nomograph model to explore its predictive value in TO.Methods The clinical data of 205 patients with pancreatic ductal adenocarcinoma treated by PD in Henan University People's Hospital from January 2019 to December 2022 were analyzed retrospectively,including 88 males and 117 females with the age of(61.3±9.8)years old.Patients were divided into two groups based on whether they achieved TO after surgery:TO group(n=113)and non-TO group(n=92).Clinical data such as age,gender,intraoperative blood loss,operation time,blood transfusion volume,pancreatic CT value,and tumor differentiation degree were collected.Logistic regression analysis screened the influencing factors of PD postoperative TO and built a nomogram model.The performance of the nomogram model was evaluated using receiver operating characteristic(ROC)curve,calibration diagram,and decision curve analysis.Results Multivariate logistic regression analysis showed that the higher the degree of tumor differentiation was in patients with pancreatic ductal adenocarcinoma(high differentiation to medium differentiation:OR=7.20,95%CI:1.20-43.28;high differentiation to low differentiation:OR=16.55,95%CI:2.01-136.11),CT value>38.45 Hu(OR=0.29,95%CI:0.13-0.65),blood transfusion volume≤350 ml(OR=8.05,95%CI:2.94-22.01)and operative time≤407.5 min(OR=10.88,95%CI:3.90-30.41),the easier it was to achieve TO after PD(all P<0.05).Based on the above influencing factors,a nomogram model of the postoperative effect of PD on TO was established,and the consistency index of this column graph model was 0.863(95%CI:0.816-0.911).The sensitivity and specificity of ROC curve were 0.804 and 0.752,respectively.The calibration diagram showed that the calibration curve fits well with the ideal curve,and the decision curve showed that the model had obvious positive net benefit.Conclusion The degree of tumor differentiation,CT value,blood transfusion volume,and operation time are independent influencing factors for the achievement of TO after PD in patients with pancreatic ductal adenocarcinoma,and the nomogram model constructed based on which has good predictive performance for TO.