摘要
目的识别结直肠癌(CRC)患者术后发生肠梗阻(POI)的临床危险因素,并构建列线图预测模型以评估其发生风险。方法选取贵州中医药大学第一附属医院2020年1月至2024年1月收治的285例确诊为结直肠癌并行根治术的患者为研究对象,系统性采集入组病例的临床信息。分组标准为是否发生POI,相应形成POI组与非POI组。纳入POI的潜在预测变量进行单因素及多因素Logistic回归分析,以识别独立危险因素。整合这些显著因子构建临床预测模型,模型的区分能力与校准性能分别通过受试者工作特征(ROC)曲线下面积(AUC)和校准图进行验证。结果285例CRC患者POI发生率为11.6%(33/285),肠梗阻组患者手术时间长于非肠梗阻组,术前白蛋白水平低于非肠梗阻组,女性占比少于非肠梗阻组,肿瘤分期在Ⅲ~Ⅳ期患者多于非肠梗阻组,术后有造瘘的比例多于非肠梗阻组(P<0.05)。多因素Logistic回归显示,男性、肿瘤分期为Ⅲ~Ⅳ期、术中造瘘、术前白蛋白水平是POI发生的独立危险因素(P<0.05)。由前述独立预测因子建立的CRC患者POI列线图模型,经ROC曲线验证具有良好区分度(AUC=0.857,95%CI:0.792~0.922)。校准曲线中Hosmer-Lemeshow拟合优度检验(P=0.9232)进一步支持该模型预测概率与观测结局间具有较高的一致性。结论男性、肿瘤分期为Ⅲ~Ⅳ期、术中造瘘、术前白蛋白水平与POI的发生密切相关,基于上述危险因素建立的列线图具有中等可预测性,可为临床医生评估POI风险提供参考。
Objective To identify clinical risk factors for postoperative intestinal obstruction(POI)in patients with colorectal cancer(CRC)and construct a nomogram prediction model to assess the risk of occurrence.Methods A total of 285 patients diagnosed with colorectal cancer and undergoing radical surgery at the First Affiliated Hospital of Guizhou University of Chinese Medicine from January 2020 to January 2024 were selected as the study subjects.Clinical information of the enrolled cases was systematically collected.The grouping criteria are based on whether POI occurs,resulting in the formation of POI and non-POI groups.Potential predictive variables for POI were analyzed using univariate and multivariate logistic regression to identify independent risk factors.These significant factors were integrated to construct a clinical predictive model,whose discriminatory ability and calibration performance were validated using the area under the receiver operating characteristic(ROC)curve(AUC)and calibration plots,respectively.Results The incidence of POI in 285 CRC patients was 11.6%(33/285).The operative time of patients in the ileus group was longer than that in the non-ileus group,the preoperative albumin level was lower than that in the non-ileus group,the proportion of females was less than that in the non-ileus group,the number of patients with tumor stageⅢandⅣwas more than that in the non-ileus group,and the proportion of postoperative fistula was higher than that of non-ileal obstruction group(P<0.05).Multivariate Logistic regression showed that male gender,tumor stageⅢ-Ⅳ,intraoperative fistula,and preoperative albumin level were independent risk factors for the occurrence of POI(P<0.05).The POI nomogram model for CRC patients established using the aforementioned independent predictors was validated using a ROC curve and demonstrated good discriminatory ability(AUC=0.857,95%CI:0.792-0.922).The Hosmer-Lemeshow goodness-of-fit test in the calibration curve(P=0.9232)further supports the high consistency between the predicted probabilities of the model and the observed outcomes.Conclusion Male gender,tumor stageⅢ-Ⅳ,intraoperative fistula,and preoperative albumin level are closely related to the occurrence of POI.The nomogram established based on the above risk factors has moderate predictability and can provide certain reference value for clinicians to assess the risk of POI.
作者
李漫漫
肖天保
陈江
曹一波
曾炼
常靖雯
杨桃
Li Manman;Xiao Tianbao;Chen Jiang;Cao Yibo;Zeng Lian;Chang Jingwen;Yang Tao(Guizhou University of Traditional Chinese Medicine,Guiyang Guizhou 550025,China;Department of Proctology,First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine,Guiyang Guizhou 550001,China)
出处
《合肥医科大学学报》
2025年第12期1255-1262,共8页
Journal of Zunyi Medical University
基金
国家自然科学基金资助项目(NO:82260936)
国家中医药管理局高水平中医药重点学科建设项目(NO:zyyzdxk-2023188)
贵州省科技计划项目[NO:黔科合基础-ZK(2024)一般399]。
关键词
结直肠癌
术后肠梗阻
危险因素
列线图
colorectal cancer
postoperative ileus
risk factors
nomograms
