基于基线资料构建眼眶肿瘤手术术后预后模型的价值

The value of constructing a postoperative prognostic model for orbital tumors based on baseline data

目的分析影响眼眶肿瘤摘除手术后预后的相关因素。方法前瞻性系列病例研究。选择2020年1月至2022年1月到我院进行手术切除治疗的眼眶肿瘤患者109例(109只眼)。所有患者均进行眼眶肿瘤摘除手术,患者术后进行6个月随访,对患者术后并发症情况进行记录,对患者的一般资料进行收集。依据患者是否存在死亡、复发、呼吸衰竭、视力损伤、休克、脑血管意外、心跳骤停以及失明等情况则判定患者预后不良,依据患者预后情况将患者分为预后不良组和预后良好组。结果在109例患者中有16例患者出现并发症,患者并发症发生率为14.68%,其中发生率最高的眼球运动障碍,其发生率为13.76,球后出血、瞳孔散大、视力障碍、上睑下垂的发生率分别为9.17%、7.33%、5.50%、4.59%。在109例患者中,其中有94例患者预后良好,15例患者预后不良,预后良好率为86.24%。经过单因素分析,预后良好组和预后不良组患者的病程(P=0.103)和性别(P=0.785)相似,预后不良组患者的肿瘤累及深部(P=0.001)、肿瘤分化为低分化(P=0.007)、存在合并症(P=0.001)、肿瘤边界模糊(P=0.001)、传统开眶恶性肿瘤(P=0.001)、肌锥内肿瘤(P=0.032)、手术时间≥3 h(P=0.002)、年龄>75岁(P=0.008)例数高于预后良好组。将单因素分析中存在统计学意义因素纳入Logistic多因素分析,分析结果显示,患者肿瘤累及深部(P=0.000)、肿瘤分化为低分化(P=0.001)、存在并发症(P=0.001)、肿瘤边界模糊(P=0.000)、传统开眶方式(P=0.000)、恶性肿瘤(P=0.000)、肌锥内肿瘤(P=0.000)、手术时间≥3 h(P=0.000)和年龄≥75岁(P=0.028)是患者预后不良的独立危险因素。将Logistic多因素分析中危险因素最下β值赋值1,其它变量β值除以最小值后四舍五入取整数,其中肿瘤性质和开眶方式为4分,肿瘤累及深部和肿瘤边界为3分,肿瘤分化、合并症为2分,肿瘤部位、手术时间和年龄为1分。总分在0~21分之间。依据该模型对所有患者进行评分,分析其对患者预后预测价值,预测发现评分越高,患者预后不良的发生率越高,其中评分1~3患者无预后不良发生,19~21分患者预后不良发生率为100%。绘制危险评估模型对眼眶摘除术后预后不良发生的ROC曲线,以危险评分为自变量,术后预后情况为因变量。分析结果显示ROC曲线下面积为0.849(95%CI为0.773⁃0.936),其中13.23分为最佳临界值,此时其预测特异度和敏感度分别为72.3%和75.6%。结论患者肿瘤累及深部、肿瘤分化为低分化、存在并发症、肿瘤边界模糊、传统开眶方式、恶性肿瘤、肌锥内肿瘤、手术时间≥3 h和年龄≥75岁是患者预后不良的独立危险因素,联合以上因素构建预后模型对患者预后有积极意义,临床中对该预测模型进行关注并进行积极干预,可有效改善患者预后。

Objective To analyze the prognostic factors of orbital tumor resection.Methods A prospective case series study.109 patients with orbital tumor were selected for surgical resection in our hospitalwere selected from January 2020 to January 2022.All patients underwent orbital tumor removal surgery,and patients were followed up for 6 months after surgery.Postoperative complications were recorded and general data of patients were collected.According to whether the patients had death,recurrence,respiratory failure,visual impairment,shock,cerebrovascular accident,cardiac arrest and blindness,the patients were determined to have a poor prognosis.According to the prognosis of the patients,the patients were divided into a poor prognosis group and a good prognosis group.Results Among the 109 patients,16 patients had complications,with a complication rate of 14.68%,among which the highest incidence of eye movement disorders was 13.76%,and the incidence of postbulbar hemorrhage,dilated pupil,visual impairment and ptosis were 9.17%,7.33%,5.50%and 4.59%,respectively.Among the 109 patients,94 had good prognosis and 15 had bad prognosis.The good prognosis rate was 86.24%.Through univariate analysis,the course of disease and gender of patients in the good prognosis group and the poor prognosis group were similar(P>0.05).The number of cases in the poor prognosis group was higher than that in the good prognosis group(P<0.05),including deep tumor involvement,low tumor differentiation,complications,blurred tumor boundaries,traditional orbital open malignant tumor,intramuscular tumor,operation time≥3 h,age>75 years.Statistically significant factors in univariate analysis were incorporated into logistic multivariate analysis,and the analysis results showed that,the independent risk factors for poor prognosis were deep tumor involvement,poorly differentiated tumor differentiation,complications,blurred tumor boundaries,traditional orbital opening,malignant tumor,intramuscular tumor,operation time≥3 h and age≥75 years(P<0.05).The lowestβvalue of risk factors in logistic multivariate analysis was assigned 1,and theβvalue of other variables was divided by the minimum value and rounded to an integer.Among them,tumor nature and orbital opening method were 4 points,tumor involvement and tumor boundary were 3 points,tumor differentiation and complications were 2 points,and tumor site,operation time and age were 1 point.The total score is between 0 and 21.According to this model,all patients were scored and its predictive value for patients'prognosis was analyzed.It was found that the higher the score was,the higher the incidence of poor prognosis was.Among them,the incidence of poor prognosis was 100%in patients with scores 1~3 and 19~21.The receiver operating characteristic(ROC)curve of the risk assessment model for the occurrence of poor prognosis after orbital extraction was drawn,with the risk score as the independent variable and the postoperative prognosis as the dependent variable.Analysis results showed that the area under ROC curve was 0.849(95%CI:0.773 to 0.936),and 13.23 was the optimal critical value,at which the prediction specificity and sensitivity were 80.3%and 85.6%,respectively.Conclusions Deep tumor involvement,poorly differentiated tumor differentiation,complications,blurred tumor boundaries,traditional orbital opening,malignant tumor,intramuscular tumor,operation time≥3 h,and age≥75 years are independent risk factors for poor prognosis of patients.The combination of the above factors to construct a prognostic model has positive significance for the prognosis of patients.Clinical attention and active intervention to the prediction model can effectively improve the prognosis of patients.