解放军医学杂志2024，Vol.49Issue(4)：416-425,10.DOI:10.11855/j.issn.0577-7402.2209.2023.0529
结肠癌根治术后严重并发症危险因素分析及动态列线图预测模型构建
Risk factors for comprehensive complication index after radical resection of colon cancer and establishment of its dynamic nomogram prediction model
摘要
Abstract
Objective To investigate the independent risk factors of comprehensive complication index(CCI)≥26.2 after radical resection of colon cancer,and use these factors to establish and verify a dynamic web-based nomogram model.Methods The clinical data of colon cancer patients who underwent radical resection in the Affiliated Hospital of Jiangnan University from November 2020 to April 2022 were retrospectively collected,and divided into main cohort(November 2020 to October 2021,n=438)and validation cohort(November 2021 to April 2022,n=196).CCI scores of all patients were obtained based on CCI calculator(http://www.assessurgery.com).Univariate and multivariate logistic regression analysis were performed to identify the risk factors for CCI≥26.2,and a nomogram model was constructed.Receiver operator characteristic curve(ROC),C index and calibration curve were used to evaluate the differentiation and consistency of predictive nomogram model,and the decision curve analysis was conducted to assess the clinical benefits of the model.Internal validation of the model is performed in the validation cohort.Results A total of 438 patients were identified in present study,of which 63 cases(14.4%)had CCI≥26.2.Multivariate logistic regression analysis revealed that age≥60 years(OR=2.662,95%CI 1.341-5.285,P=0.005),low third lumbar spine skeletal muscle mass index(L3MI;OR=4.572,95%CI 2.435-8.583,P<0.001),NRS2002≥3(OR=4.281,95%CI 2.304-7.952,P<0.001),and preoperative bowel obstruction(OR=3.785,95%CI 1.971-7.268,P<0.001)were significant independent risk factors for postoperative CCI≥26.2.Based on these results,a static and web-based dynamic nomogram was established(https://jndxfsyywcwksyf.shinyapps.io/DynNomCCI/).The C-index and area under the curve(AUC)of the nomogram were 0.742 and 0.787,respectively.The calibration curve indicated a good consistency between the predicted probability and the actual probability.In the validation cohort,the nomogram also presented good discrimination(C-index=0.722,AUC=0.795)and predictive consistency.The decision curve analysis indicated the clinical benefit and application value of the nomogram prediction model.Conclusion This easy-to-use dynamic nomogram based on 4 independent risk factors can conveniently and reliably predict the probability of CCI≥26.2 after radical resection of colon cancer,which helps optimize the preoperative evaluation system,formulate precise individualized treatment strategies,and enhance recovery after surgery.关键词
结肠癌/综合并发症指数/骨骼肌指数/列线图模型Key words
colon cancer/comprehensive complication index/skeletal muscle mass index/nomogram model分类
医药卫生引用本文复制引用
史益凡,沈晓明,杨增辉,夏李,许炳华,鲍传庆..结肠癌根治术后严重并发症危险因素分析及动态列线图预测模型构建[J].解放军医学杂志,2024,49(4):416-425,10.基金项目
This work was supported by the Wuxi Municipal Health Commission Youth Scientific Research Project(Q202049) 无锡市卫生健康委员会青年基金项目(Q202049) （Q202049）
