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中华消化病与影像杂志(电子版) ›› 2021, Vol. 11 ›› Issue (04) : 158 -163. doi: 10.3877/cma.j.issn.2095-2015.2021.04.004

临床研究

结直肠癌患者术后肠梗阻发生风险列线图预测模型的构建及评估
李明东1, 谢红强2, 陶涛1,(), 朱萧3   
  1. 1. 255000 淄博市中心医院西院消化科
    2. 255000 淄博市中心医院西院胃肠外科
    3. 523000 广东东莞,广东省医学分子诊断重点实验室
  • 收稿日期:2021-04-26 出版日期:2021-08-01
  • 通信作者: 陶涛

Construction and evaluation of nomogram prediction model for postoperative intestinal obstruction in patients with colorectal cancer

Mingdong Li1, Hongqiang Xie2, Tao Tao1,(), Xiao Zhu3   

  1. 1. Department of Gastroenterology, West Hospital of Zibo Central Hospital, Zibo 255000, China
    2. Department of Gastrointestinal Surgery, West Hospital of Zibo Central Hospital, Zibo 255000, China
    3. Guangdong Province Key Laboratory of Medical Molecular Diagnosis, Dongguan 523000, China
  • Received:2021-04-26 Published:2021-08-01
  • Corresponding author: Tao Tao
引用本文:

李明东, 谢红强, 陶涛, 朱萧. 结直肠癌患者术后肠梗阻发生风险列线图预测模型的构建及评估[J/OL]. 中华消化病与影像杂志(电子版), 2021, 11(04): 158-163.

Mingdong Li, Hongqiang Xie, Tao Tao, Xiao Zhu. Construction and evaluation of nomogram prediction model for postoperative intestinal obstruction in patients with colorectal cancer[J/OL]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2021, 11(04): 158-163.

目的

分析结直肠癌患者术后肠梗阻发生的危险因素,构建列线图预测模型并进行评估。

方法

回顾性分析2018年6月至2020年8月淄博市中心医院西院收治的经手术病理确诊的283例结直肠癌患者,所有患者均行结直肠癌根治术。其中31例患者术后1个月发生肠梗阻。比较肠梗阻与非肠梗阻患者一般临床资料差异。采用多因素logistics回归分析筛选结直肠癌患者术后肠梗阻发生的危险因素,并基于筛选出的危险因素建立术后肠梗阻发生风险的列线图预测模型,使用受试者操作特征(ROC)曲线评估模型的区分度并进行一致性检验。

结果

283例结直肠癌患者术后肠梗阻发生率为11.0%(31/283),其中机械性肠梗阻15例,麻痹性肠梗阻9例,炎症性肠梗阻7例。Logistic回归分析结果显示,肿瘤TNM Ⅲ期、中转开腹、右半结肠切除术、手术时间、既往大肠肿瘤切除史是结直肠癌患者术后肠梗阻发生的独立危险因素(P<0.05);将独立危险因素引入R软件(R3.6.3)构建列线图模型,曲线下面积为0.919(95%CI 0.862-0.975),列线图校准曲线斜率接近1。Hosmer-Lemeshow拟合优度检验=8.576,P=0.379。

结论

基于结直肠癌患者术后肠梗阻发生的危险因素如肿瘤TNM分期、手术类型、手术方式、手术时间、既往大肠肿瘤切除史建立的列线图预测模型具有良好的区分度与一致性,可为结直肠癌术后肠梗阻的预防提供一定指导。

Objective

To analyze the risk factors of postoperative intestinal obstruction in patients with colorectal cancer and construct a nomogram prediction model.

Methods

The clinical data of 283 patients with colorectal cancer diagnosed by surgery and pathology admitted to West Hospital of Zibo Central Hospital from June 2018 to August 2020 were retrospectively analyzed. All patients underwent radical resection of colorectal cancer. Thirty-one patients developed ileus one month after surgery. The general clinical data of patients with intestinal obstruction and those without intestinal obstruction were compared. Multivariate logistic regression model was used to screen out the risk factors of postoperative intestinal obstruction in patients with colorectal cancer. Based on the screened risk factors, a nomogram prediction model for the risk of postoperative intestinal obstruction was established, and receiver operating characteristic (ROC) curve was used to evaluate the discrimination of the model and the consistency was tested.

Results

The incidence of postoperative intestinal obstruction in 283 patients with colorectal cancer was 11.0% (31/283), including 15 cases of mechanical intestinal obstruction, 9 cases of paralytic intestinal obstruction and 7 cases of inflammatory intestinal obstruction. Logistic regression analysis showed that TNM stage Ⅲ, conversion to laparotomy, right hemicolectomy, operation time and previous colorectal tumor resection history were independent risk factors for postoperative intestinal obstruction in patients with colorectal cancer (P<0.05). The independent risk factors were introduced into R software (R3.6.3) to construct nomogram model, the area under the curve was 0.919 (95% CI: 0.862-0.975), and the slope of nomogram calibration curve was close to 1. Hosmer-Lemeshow goodness-of-fit test showed that =8.576, P=0.379.

Conclusion

Based on the risk factors of postoperative intestinal obstruction in patients with colorectal cancer, such as tumor TNM stage, operation type, operation method, operation time and previous colorectal tumor resection history, the established nomogram prediction model has good discrimination and consistency, and it can provide certain guidance value for the prevention of postoperative intestinal obstruction of colorectal cancer.

表1 肠梗阻与非肠梗阻患者一般临床资料比较
因素 肠梗阻组(n=31) 非肠梗阻组(n=252) 检验值 P
年龄(岁,±s 56.8±5.1 54.8±4.4 t=2.430 0.016
性别(例,男性/女性) 14/17 148/104 χ2=2.077 0.150
饮酒史[例(%)]     χ2=0.372 0.542
  8(25.8) 53(21.0)    
  23(74.2) 199(79.0)    
吸烟史[例(%)]     χ2=0.819 0.365
  9(29.0) 55(21.8)    
  22(71.0) 197(78.2)    
肿瘤部位[例(%)]     χ2=0.218 0.641
  直肠 14(45.2) 125(49.6)    
  结肠 17(54.8) 127(50.4)    
肿瘤分化程度[例(%)]     χ2=4.831 0.089
  高分化 3(9.7) 70(27.8)    
  中分化 15(48.4) 103(40.9)    
  低分化 13(41.9) 79(31.4)    
肿瘤直径[例(%)]     χ2=0.692 0.406
  ≤4 cm 7(22.6) 75(29.8)    
  >4 cm 24(77.4) 177(70.2)    
肿瘤TNM分期[例(%)]     χ2=7.807 0.020
  Ⅰ期 5(16.1) 81(32.1)    
  Ⅱ期 10(32.3) 94(37.3)    
  Ⅲ期 16(51.6) 77(30.6)    
手术类型[例(%)]     χ2=17.386 <0.001
  腹腔镜手术 9(29.0) 108(42.9)    
  开腹手术 14(45.2) 131(52.0)    
  中转开腹 8(25.8) 13(5.2)    
手术方式[例(%)]     χ2=6.289 0.043
  右半结肠切除术 13(41.9) 62(24.6)    
  左半结肠切除术 8(25.8) 51(20.2)    
  其他 10(32.3) 139(55.2)    
手术时间(min,±s 188±26 152±20 t=8.765 <0.001
既往大肠肿瘤切除史[例(%)]   χ2=13.476 <0.001
  13(41.9) 38(15.1)    
  18(58.1) 214(84.9)    
术前白蛋白水平(g/L,±s 45.4±6.7 47.5±7.1 t=1.595 0.112
术中造瘘[例(%)]     χ2=3.612 0.057
  15(48.4) 79(31.4)    
  16(51.3) 173(68.6)    
表2 结直肠癌患者术后肠梗阻发生危险因素的多因素logistic回归分析结果
图1 预测结直肠癌患者术后肠梗阻发生风险的列线图模型
图2 列线图模型预测术后肠梗阻的受试者操作特征曲线
图3 列线图的校准曲线
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