外科理论与实践 ›› 2024, Vol. 29 ›› Issue (03): 236-242.doi: 10.16139/j.1007-9610.2024.03.09

• 论著 • 上一篇    下一篇

个体化预测早期胃癌内镜黏膜下剥离术后迟发性出血风险的列线图模型构建

龚婷婷, 钱爱华, 陈希()   

  1. 上海交通大学医学院附属瑞金医院 消化内科,上海 200025
  • 收稿日期:2024-04-26 出版日期:2024-05-25 发布日期:2024-09-03
  • 通讯作者: 陈希,E-mail:cx11977@rjh.com.cn
  • 基金资助:
    上海市科学技术委员会课题(22ZR1439600)

Construction of a Nomogram model for personalized prediction of the risk of delayed postoperative bleeding after endoscopic submucosal dissection for early gastric cancer

Gong Tingting, Qian Aihua, Chen Xi()   

  1. Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  • Received:2024-04-26 Online:2024-05-25 Published:2024-09-03

摘要:

目的:分析早期胃癌内镜黏膜下剥离术(ESD)术后迟发性出血(DPPB)的影响因素并构建列线图模型。方法:收集2021年4月至2023年4月本院行ESD治疗且病理诊断为早期胃癌的234例病人临床资料,依据有无发生DPPB分组,采用Logistic回归分析筛选影响早期胃癌病人ESD后发生DPPB的危险因素;采用R软件构建预测早期胃癌ESD后发生DPPB风险的列线图模型;通过绘制受试者工作特征(ROC)曲线、校准曲线以及Hosmer-Lemeshow拟合优度检验对列线图模型进行评价。结果:234例行ESD治疗的早期胃癌病人中共23例(9.8%)发生DPPB。多因素Logistic回归分析结果显示,活检次数≥3次(95%CI:2.482~20.424,P=0.000)、病变最大直径≥3 cm(95%CI:1.620~13.244,P=0.004)、浸润深度至黏膜下层(95%CI:1.421~10.536,P=0.008)、术中出血(95%CI: 1.160~11.300,P=0.027)是早期胃癌ESD后发生DPPB的独立危险因素。ROC曲线下面积(AUC)为0.838(95%CI:0.743~0.932)。校准曲线斜率接近1。Hosmer-Lemeshow拟合优度检验,χ2=3.328,P=0.505。结论:活检次数≥3次、病变最大直径≥3 cm、浸润深度至黏膜下层、术中出血是早期胃癌ESD后发生DPPB的独立危险因素,基于这4个独立危险因素构建的列线图模型可有效预测早期胃癌ESD后发生DPPB风险。

关键词: 早期胃癌, 内镜黏膜下剥离术, 术后迟发性出血, 影响因素, 列线图

Abstract:

Objective To analyze the influencing factors of delayed postoperative bleeding (DPPB) after endoscopic submucosal dissection (ESD) for early gastric cancer and construct a Nomogram model. Methods The clinical information of 234 patients who underwent ESD treatment at our hospital and pathologically diagnosed with early gastric cancer from April 2021 to April 2023 were collected. The patients were grouped based on the presence or absence of DPPB. Logistic regression analysis was applied to screen for risk factors affecting DPPB after ESD in early gastric cancer patients. R software was applied to construct a Nomogram model for predicting the risk of DPPB in early gastric cancer patients after ESD. Receiver operator characteristic (ROC) curve, calibration curve, and Hosmer-Lemeshow goodness of fit test were plotted to evaluate the Nomogram model. Results A total of 23 (9.8%) of 234 early gastric cancer patients who underwent ESD treatment developed DPPB. Multivariate Logistic regression analysis showed that the number of biopsies ≥ 3 (95%CI: 2.482-20.424, P=0.000), the maximum diameter of lesions ≥ 3 cm (95%CI: 1.620-13.244, P=0.004), the depth of invasion to submucosa (95%CI: 1.421-10.536, P=0.008), and intraoperative bleeding (95%CI: 1.160-11.300, P=0.027) were independent risk factors for DPPB after ESD in early gastric cancer patients. The area under ROC curve (AUC) was 0.838 (95%CI: 0.743-0.932). The slope of the calibration curve was close to 1. Hosmer-Lemeshow goodness of fit test showed χ2=3.328, P=0.505. Conclusions The number of biopsies ≥ 3, the maximum diameter of lesion ≥ 3 cm, the depth of invasion to submucosa, and intraoperative bleeding are independent risk factors for DPPB after ESD in early gastric cancer patients. The Nomogram model based on these four independent risk factors can effectively predict the risk of DPPB after ESD in early gastric cancer patients.

Key words: Early gastric cancer, Endoscopic submucosal dissection(ESD), Delayed postoperative bleeding(DPPB), Influencing factors, Nomogram

中图分类号: