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。
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.