个体化预测腹腔镜胃癌根治术后胃瘫综合征发生风险的列线图模型构建-东南大学学报医学版

个体化预测腹腔镜胃癌根治术后胃瘫综合征发生风险的列线图模型构建

单位：1. 山西中医药大学第三临床学院, 山西太原 030000;
2. 山西省肿瘤医院中医科, 山西太原 030000

分类号：R735.2

出版年·卷·期（页码）：2025·44·第二期（175-182）

摘要：

目的:构建列线图模型用于预测腹腔镜胃癌根治术后发生术后胃瘫综合征(PGS)的风险。方法:选取2021年7月至2024年9月1 610例行腹腔镜胃癌根治术的患者作为观察对象,根据7∶3的比例随机分为建模组1 127例和验证组483例,建模组分为亚组PGS组(n=62)和非PGS组(n=1 065)。记录患者临床资料,采用多因素Logistic回归分析筛选影响因素;采用R软件构建列线图预测模型,采用Hosmer-Lemeshow检验、校准曲线、受试者工作特征(ROC)曲线检验列线图模型的预测效能;采用临床决策曲线分析列线图模型的临床效益。结果:建模组和验证组临床资料比较差异无统计学意义(P＞0.05)。年龄≥60岁、有术前幽门梗阻、毕Ⅱ式消化道重建方式、有焦虑、有术前低蛋白血症、有腹部手术史是发生PGS的独立危险因素(P＜0.05)。以多因素分析结果中的独立危险因素作为建模的预测因子构建列线图预测模型,Hosmer-Lemeshow检验及校准曲线建模组和验证组结果显示,实际观测值和风险预测值间的偏差无统计学意义(χ²=5.672、4.526,P=0.579、0.807),建模组和验证组ROC曲线下面积(AUC)分别为0.895(95%CI 0.840~0.949)、0.878(95%CI 0.819~0.936),提示列线图模型校准度和区分度较高。当建模组和验证组列线图模型的风险阈值概率范围在0.08~0.96、0.06~0.95时,模型的临床净收益大于全干预和全不干预方案,提示列线图模型的临床适用性较高。结论:本研究构建的列线图模型对腹腔镜胃癌根治术后发生PGS有较高的预测价值。

Objective: To construct a column chart model for predicting the risk of postoperative gastroparesis syndrome(PGS) in laparoscopic radical gastrectomy for gastric cancer. Methods: 1 610 patients who underwent laparoscopic radical gastrectomy for gastric cancer between July 2021 and September 2024 were selected as the observation subjects. They were randomly assigned into modeling group of 1 127 cases and validation group of 483 cases according to 7∶3 ratio. The modeling group were divided into subgroups PGS group(n=62) and non PGS group(n=1 065). The clinical data were recorded. Multivariate Logistic regression analysis was used to screen for influencing factors. R software was used to construct column chart prediction model. Hosmer-Lemeshow test, calibration curve, and receiver operating characteristic(ROC) curve were used to test the predictive performance of the column chart model. Clinical decision curve was used to analyze the clinical practicality of the column chart model. Results: There was no statistically prominent difference in clinical data between the modeling group and the validation group(P>0.05). Age≥60 years, preoperative pyloric obstruction, type Ⅱ gastrointestinal reconstruction, anxiety, preoperative hypoalbuminemia, and history of abdominal surgery were independent risk factors for PGS(P<0.05). A column chart prediction model was constructed using independent risk factors from the results of multiple factor analysis as predictive factors for modeling, the Hosmer-Lemeshow test and modeling group and validation group results of the calibration curve showed that there was no statistically prominent deviation between the actual observed values and the risk prediction values(χ²=5.672, 4.526, P=0.579, 0.807). The ROC curve results showed that the area under the cure(AUC) was 0.895(95% CI 0.840-0.949), 0.878(95% CI 0.819-0.936), indicating that the column chart model had high calibration and discrimination. When the risk threshold probability range of the column chart model for the modeling and validation groups was between 0.08-0.96 and 0.06-0.95, respectively, the clinical net benefit of the model was greater than that of the complete intervention and incomplete intervention plans, indicating that the clinical applicability of the column chart model was high. Conclusion: The column chart model constructed in this study has high predictive value for the occurrence of PGS in laparoscopic radical gastrectomy for gastric cancer.

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