Nomogram to predict prolonged postoperative ileus after gastrectomy in gastric cancer
Nomogram to predict prolonged postoperative ileus after gastrectomy in gastric cancer
复制标题
列线图预测胃癌胃切除术后肠梗阻延长
DOI：
10.3748/wjg.v25.i38.5838
复制
发表时间：
2019-10-14
影响因子：
4.3
通讯作者：
Chen, Lin
中科院分区：
文献类型：
--
作者：
Liang, Wen-Quan;Zhang, Ke-Cheng;Chen, Lin
背景：术后延长性肠梗阻（PPOI）是胃癌切除术后常见的并发症之一。关于胃切除术后PPOI的预测因素的证据有限，很少使用nomogram预测模型来估计PPOI的风险。我们假设预测nomogram可用于胃癌患者PPOI的临床风险评估。目的探讨PPOI的危险因素，建立临床风险评估的nomogram。方法2016年6月至2017年3月，从前瞻性和观察性注册数据库中获取162例胃切除术患者的数据。获得符合标准的患者的临床资料。采用单变量和多变量logistic回归模型检测各变量与PPOI之间的关系。建立了PPOI的态图，并通过自举重采样进行了验证。利用标定曲线检测模型概率曲线与理想曲线的同心度。我们的模型的临床有效性是用净收益曲线来评估的。结果本研究分析了162例行胃切除术的胃癌患者PPOI的14个潜在变量。胃切除术患者PPOI发生率为19.75%。年龄大于60岁、开放手术、晚期（III-IV）和术后使用阿片类镇痛药是PPOI的独立危险因素。我们开发了一个简单易用的胃切除术后PPOI预测图。该nomogram（曲线下面积，AUC） = 0.836, sensitivity = 84.4%, specificity = 75.4%，具有较好的诊断效果。通过500次重复的自举进一步验证了该nomogram。自举模型的AUC为0.832 （95%CI: 0.741 ~ 0.924）。该模型在决策曲线分析中具有良好的拟合和校正效果，具有良好的净效益。结论建立了胃癌PPOI的预测图。这种新的形态图可能作为胃癌患者PPOI的重要早期预警信号。
BACKGROUND Prolonged postoperative ileus (PPOI) is one of the common complications in gastric cancer patients who underwent gastrectomy. Evidence on the predictors of PPOI after gastrectomy is limited and few prediction models of nomogram are used to estimate the risk of PPOI. We hypothesized that a predictive nomogram can be used for clinical risk estimation of PPOI in gastric cancer patients. AIM To investigate the risk factors for PPOI and establish a nomogram for clinical risk estimation. METHODS Between June 2016 and March 2017, the data of 162 patients with gastrectomy were obtained from a prospective and observational registry database. Clinical data of patients who fulfilled the criteria were obtained. Univariate and multivariable logistic regression models were performed to detect the relationship between variables and PPOI. A nomogram for PPOI was developed and verified by bootstrap resampling. The calibration curve was employed to detect the concentricity between the model probability curve and ideal curve. The clinical usefulness of our model was evaluated using the net benefit curve. RESULTS This study analyzed 14 potential variables of PPOI in 162 gastric cancer patients who underwent gastrectomy. The incidence of PPOI was 19.75% in patients with gastrectomy. Age older than 60 years, open surgery, advanced stage (III–IV), and postoperative use of opioid analgesic were independent risk factors for PPOI. We developed a simple and easy-to-use prediction nomogram of PPOI after gastrectomy. This nomogram had an excellent diagnostic performance [area under the curve (AUC) = 0.836, sensitivity = 84.4%, and specificity = 75.4%]. This nomogram was further validated by bootstrapping for 500 repetitions. The AUC of the bootstrap model was 0.832 (95%CI: 0.741–0.924). This model showed a good fitting and calibration and positive net benefits in decision curve analysis. CONCLUSION We have developed a prediction nomogram of PPOI for gastric cancer. This novel nomogram might serve as an essential early warning sign of PPOI in gastric cancer patients.