PDF(Pubmed)
Abstract：
BACKGROUND: For patients with rectal cancer, the utilization of temporary ileostomy (TI) has proven effective in minimizing the occurrence of severe complications post-surgery, such as anastomotic leaks; however, some patients are unable to reverse in time or even develop a permanent stoma (PS). We aimed to determine the preoperative predictors associated with TS failure and develop and validate appropriate predictive models to improve patients\' quality of life.
METHODS: This research included 403 patients with rectal cancer who underwent temporary ileostomies between January 2017 and December 2021. All patients were randomly divided into either the developmental (70%) or validation (30%) group. The independent risk factors for PS were determined using univariate and multivariate logistic regression analyses. Subsequently, a nomogram was constructed, and the prediction probability was estimated by calculating the area under the curve (AUC) using receiver operating characteristic (ROC) analysis. A calibration plot was used to evaluate the nomogram calibration.
RESULTS: Of the 403 enrolled patients, 282 were randomized into the developmental group, 121 into the validation group, and 58 (14.39%) had a PS. The development group consisted of 282 patients, of whom 39 (13.81%) had a PS. The validation group consisted of 121 patients, of whom, 19 (15.70%) had a PS; 37 related factors were analyzed in the study. Multivariate logistic regression analysis demonstrated significant associations between the occurrence of PS and various factors in this patient cohort, including tumor location (OR = 6.631, P = 0.005), tumor markers (OR = 2.309, P = 0.035), American Society of Anesthesiologists (ASA) score (OR = 4.784, P = 0.004), T4 stage (OR = 2.880, P = 0.036), lymph node metastasis (OR = 4.566, P = 0.001), and distant metastasis (OR = 4.478, P = 0.036). Furthermore, a preoperative nomogram was constructed based on these data and subsequently validated in an independent validation group.
CONCLUSIONS: We identified six independent preoperative risk factors associated with PS following rectal cancer resection and developed a validated nomogram with an area under the ROC curve of 0.7758, which can assist surgeons in formulating better surgical options, such as colostomy, for patients at high risk of PS.
METHODS: This research included 403 patients with rectal cancer who underwent temporary ileostomies between January 2017 and December 2021. All patients were randomly divided into either the developmental (70%) or validation (30%) group. The independent risk factors for PS were determined using univariate and multivariate logistic regression analyses. Subsequently, a nomogram was constructed, and the prediction probability was estimated by calculating the area under the curve (AUC) using receiver operating characteristic (ROC) analysis. A calibration plot was used to evaluate the nomogram calibration.
RESULTS: Of the 403 enrolled patients, 282 were randomized into the developmental group, 121 into the validation group, and 58 (14.39%) had a PS. The development group consisted of 282 patients, of whom 39 (13.81%) had a PS. The validation group consisted of 121 patients, of whom, 19 (15.70%) had a PS; 37 related factors were analyzed in the study. Multivariate logistic regression analysis demonstrated significant associations between the occurrence of PS and various factors in this patient cohort, including tumor location (OR = 6.631, P = 0.005), tumor markers (OR = 2.309, P = 0.035), American Society of Anesthesiologists (ASA) score (OR = 4.784, P = 0.004), T4 stage (OR = 2.880, P = 0.036), lymph node metastasis (OR = 4.566, P = 0.001), and distant metastasis (OR = 4.478, P = 0.036). Furthermore, a preoperative nomogram was constructed based on these data and subsequently validated in an independent validation group.
CONCLUSIONS: We identified six independent preoperative risk factors associated with PS following rectal cancer resection and developed a validated nomogram with an area under the ROC curve of 0.7758, which can assist surgeons in formulating better surgical options, such as colostomy, for patients at high risk of PS.
摘要：
背景：对于直肠癌患者，使用临时回肠造口术（TI）已被证明可有效减少术后严重并发症的发生，如吻合口漏；然而，一些患者无法及时逆转，甚至无法形成永久性造口（PS）。我们旨在确定与TS失败相关的术前预测因子，并开发和验证适当的预测模型以改善患者的生活质量。
方法：本研究纳入了403例直肠癌患者，他们在2017年1月至2021年12月期间接受了临时回肠造口术。将所有患者随机分为发育组(70%)或验证组(30%)。使用单变量和多变量逻辑回归分析确定PS的独立危险因素。随后，构造了一个列线图，并且通过使用受试者工作特征（ROC）分析计算曲线下面积（AUC）来估计预测概率。使用校准图来评估列线图校准。
结果：在403名患者中，282人随机进入发育组，121进入验证组，58例（14.39%）有PS。发展组包括282名患者，其中39人（13.81%）有PS。验证组由121名患者组成，谁,19例(15.70%)有PS；研究中分析了37个相关因素。多因素logistic回归分析显示，在该患者队列中，PS的发生与各种因素之间存在显着关联。包括肿瘤部位(OR=6.631,P=0.005),肿瘤标志物(OR=2.309,P=0.035),美国麻醉医师协会(ASA)评分(OR=4.784,P=0.004),T4阶段（OR=2.880，P=0.036），淋巴结转移(OR=4.566,P=0.001),远处转移(OR=4.478,P=0.036)。此外，基于这些数据构建了术前列线图,随后在一个独立的验证组中进行了验证.
结论：我们确定了与直肠癌切除术后PS相关的六个独立的术前危险因素，并开发了一个经过验证的列线图，ROC曲线下面积为0.7758，这可以帮助外科医生制定更好的手术方案。比如结肠造口术,对于PS高危患者。
方法：本研究纳入了403例直肠癌患者，他们在2017年1月至2021年12月期间接受了临时回肠造口术。将所有患者随机分为发育组(70%)或验证组(30%)。使用单变量和多变量逻辑回归分析确定PS的独立危险因素。随后，构造了一个列线图，并且通过使用受试者工作特征（ROC）分析计算曲线下面积（AUC）来估计预测概率。使用校准图来评估列线图校准。
结果：在403名患者中，282人随机进入发育组，121进入验证组，58例（14.39%）有PS。发展组包括282名患者，其中39人（13.81%）有PS。验证组由121名患者组成，谁,19例(15.70%)有PS；研究中分析了37个相关因素。多因素logistic回归分析显示，在该患者队列中，PS的发生与各种因素之间存在显着关联。包括肿瘤部位(OR=6.631,P=0.005),肿瘤标志物(OR=2.309,P=0.035),美国麻醉医师协会(ASA)评分(OR=4.784,P=0.004),T4阶段（OR=2.880，P=0.036），淋巴结转移(OR=4.566,P=0.001),远处转移(OR=4.478,P=0.036)。此外，基于这些数据构建了术前列线图,随后在一个独立的验证组中进行了验证.
结论：我们确定了与直肠癌切除术后PS相关的六个独立的术前危险因素，并开发了一个经过验证的列线图，ROC曲线下面积为0.7758，这可以帮助外科医生制定更好的手术方案。比如结肠造口术,对于PS高危患者。
