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

doi:10.16139/j.1007-9610.2024.03.09

Abstract

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

CLC Number:

R735.2

Gong Tingting, Qian Aihua, Chen Xi. Construction of a Nomogram model for personalized prediction of the risk of delayed postoperative bleeding after endoscopic submucosal dissection for early gastric cancer[J]. Journal of Surgery Concepts & Practice, 2024, 29(03): 236-242.

Figures/Tables 4

Tab 1

Comparison of clinical data between the two groups of patients[n(%)]

Clinical characteristics		DPPB Group（n=23）	Non-DPPB Group（n=211）	χ² value	P value
Gender	Male	14（60.9）	120（56.9）	0.135	0.713
	Female	9（39.1）	91（43.1）
Age（years）	≥60	13（56.5）	114（54.1）	0.052	0.820
	<60	10（43.5）	97（45.9）
BMI（kg/m²）	≥24	9（39.1）	78（36.9）	0.042	0.838
	<24	14（60.9）	133（63.1）
High blood pressure	Yes	8（34.8）	51（24.2）	1.239	0.266
	No	15（65.2）	160（75.8）
Diabetes	Yes	7（30.4）	43（20.4）	1.248	0.264
	No	16（69.6）	168（79.6）
Coronary heart disease	Yes	9（39.1）	47（22.3）	3.237	0.072
	No	14（60.9）	164（77.7）
Smoking history	Yes	12（52.2）	91（43.1）	0.689	0.407
	No	11（47.8）	120（56.9）
Alcohol intake history	Yes	8（34.8）	82（38.9）	0.146	0.703
	No	15（65.2）	129（61.1）
Use of antithrombotic drugs	Yes	6（26.1）	17（8.1）	7.607	0.006
	No	17（73.9）	194（91.9）
Lesion area	Upper 1/3	7（30.4）	74（35.1）	0.245	0.885
	Middle 1/3	4（17.4）	31（14.7）
	Lower 1/3	12（52.2）	106（50.2）
Morphology of lesions	0-Ⅰp/0-Ⅰs	1（4.4）	34（16.1）	2.364	0.307
	0-Ⅱa-Ⅱc	21（91.3）	166（78.7）
	0-Ⅲ	1（4.3）	11（5.2）
Number of biopsies（times）	≥3	11（47.8）	27（12.8）	18.710	0.000
	<3	12（52.2）	184（87.2）
Consolidated ulcer	Yes	10（43.5）	43（20.4）	6.316	0.012
	No	13（56.5）	168（79.6）
Maximum diameter of lesion	≥3 cm	15（65.2）	68（32.2）	9.861	0.002
	<3 cm	8（34.8）	143（67.8）
Infiltration depth	T1a	11（47.8）	173（81.9）	14.407	0.000
	T1b	12（52.2）	38（18.1）
Vascular invasion	No	20（86.9）	195（92.4）	0.829	0.363
	Yes	3（13.1）	16（7.6）
Curative resection	Yes	21（91.3）	195（92.4）	0.036	0.849
	No	2（8.7）	16（7.6）
Surgical time (h)	≥1	14（60.9）	109（51.7）	0.706	0.401
	<1	9（39.1）	102（48.3）
Intraoperative bleeding	ERB-c	8（34.8）	17（8.1）	15.524	0.000
	ERB-0	15（65.2）	194（91.9）

Tab 1

Tab 2

Fig 1

Fig 2

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Factors	Description of assignment	B	Standard error	Wald	P value	OR	95% confidence interval
Factors	Description of assignment	B	Standard error	Wald	P value	OR	Lower limit	Upper limit
Number of biopsies (1)	“<3”=0，“≥3”=1	1.963	0.538	13.328	0.000	7.120	2.482	20.424
Maximum diameter of lesion (1)	“<3 cm”=0，“≥3 cm”=1	1.533	0.536	8.176	0.004	4.631	1.620	13.244
Infiltration depth (1)	“T1a”=0，“T1b”=1	1.353	0.511	7.013	0.008	3.870	1.421	10.536
Intraoperative bleeding (1)	“No”=0，“Yes”=1	1.287	0.581	4.908	0.027	3.620	1.160	11.300
Constant		-4.254	0.582	53.418	0.000	0.014