Multivariate analysis of prognosis of patients with malignant bowel obstruction

doi:10.16139/j.1007-9610.2022.04.013

Abstract

Abstract:

Objective To analyze the risk factors for prognosis of patients with malignant bowel obstruction (MBO) using multiple factors, and establish the nomogram model for predicting the survival of patients with MBO. Methods The clinical data of 203 patients with MBO from June 2013 to June 2019 who were followed up in our hospital were analyzed retrospectively. Results A total of 143 (70.4%) patients have been followed up. It was shown with univariate analysis that indexes of gender, age, platelet, C-reactive protein, and total protein levels, comorbidities, the treatment with somatostatin, enteral nutrition, and parenteral nutrition, length of hospital were not related to the survival of patients with MBO. There were some factors including late TNM stage of tumor (P<0.001), tumor metastasis (P<0.001), anemia (P=0.001), lower albumin (P<0.001), higher white blood cell(P=0.023), non-surgical treatment(P=0.013), low quality of life score (P<0.001) and poor liver function [including high alanine aminotransferase (P=0.023), high aspartate aminotransferase (P=0.005)] which related with poorer prognosis in patients with MBO. Multivariate analysis showed that tumor stage (P=0.003) and albumin level(P=0.001) were independent risk factors affecting the prognosis of MBO. Nomogram was constructed using 4 indexes including late TNM stage, tumor metastasis, lower hemoglobin and lower albumin. It was indicated that the results of internal prognosis were better for the prediction of survival of 3 to 12 months of 40 cases. Conclusions The study on poor prognosis of patients with MBO combined with nomogram showed that both late stage of tumor and malnutrition were main factors.

Key words: Malignant bowel obstruction, Prognostic factor, Surgical treatment, Nomogram model

CLC Number:

R574.2

CHENG Wei, HUANG Yuhua, WANG Jian, LI Yousheng. Multivariate analysis of prognosis of patients with malignant bowel obstruction[J]. Journal of Surgery Concepts & Practice, 2022, 27(04): 340-345.

Figures/Tables 5

References 24

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指标	病例数	危险比	95%CI	P值
性别	143	0.727	0.469~1.126	0.153
年龄	143	1.003	0.989~1.017	0.679
TNM分期	127	3.768	2.346~6.025	<0.001
原发或继发转移	143	3.506	2.230~5.514	<0.001
白细胞	143	1.050	1.090~1.012	0.023
红细胞	143	0.584	0.436~0.783	<0.001
血小板	143	0.999	0.997~1.001	0.168
血红蛋白	143	0.985	0.976~0.994	0.001
CRP	57	1.003	0.998~1.010	0.235
ALT	143	1.006	1.001~1.010	0.023
AST	143	1.002	1.001~1.003	0.005
总蛋白	143	0.984	0.961~1.007	0.175
白蛋白	143	0.924	0.891~0.958	<0.001
前白蛋白	138	0	0.001~0.002	<0.001
合并慢性病数量	143	1.133	0.860~1.492	0.376
生长抑素	143	0.961	0.594~1.553	0.870
肠内营养	143	0.810	0.439~1.496	0.501
肠外营养	143	0.715	0.440~1.161	0.175
住院时间	143	0.999	0.983~1.014	0.879
是否手术	143	0.522	0.312~0.870	0.013
生活质量评分 QOL	143	0.860	0.883~0.887	<0.001
ZPS	143	8.672	5.440~13.826	<0.001
KPS	143	0.916	0.899~0.934	<0.001

变量	回归系数	标准误	危险比	95%CI	P值
TNM分期	0.838	0.281	2.312	1.331~4.015	0.003
原发或继发转移	0.544	0.350	1.723	0.867~3.423	0.120
血红蛋白	-0.005	0.006	0.995	0.985~1.006	0.395
白蛋白	-0.076	0.023	0.927	0.886~0.970	0.001
ALT	0.002	0.006	1.002	0.989~1.015	0.762
AST	0.001	0.002	1.001	0.996~1.005	0.795
是否手术	-0.090	0.284	0.914	0.524~1.594	0.752