Objective To explore the factors influencing the permanence of prophylactic ileostomy after radical resection of rectal cancer,and establish a nomogram prediction model.Methods A total of 320 patients underwent radical resection of rectal cancer and prophylactic ileostomy were randomly divided into a training set of 240 cases and a test set of 80 cases by using R software in a ratio of 3∶1.Univariate and multivariate logistic regression were used to analyze the influencing factors for the permanence of prophylactic ileostomy after radical resection of rectal cancer.A nomogram model was constructed for predicting the permanence of prophylactic ileostomy after radical resection of rectal cancer.ROC curve,calibration curve and clinical decision curve were used to analyze the predictive value,fitting effect and net benefit rate of the model.Results Compared to the patients with successful prophylactic ileostomy closure,the patients with permanence of prophylactic ileostomy in the training set were older,and had the higher preoperative Vaizey score,carcinoembryonic antigen(CEA)level and proportion of tumor stage Ⅲ,the lower preoperative hemoglobin level and the closer distance from the lower margin to the anal(P＜0.05).The preoperative Vaizey score ≥3.00 points,preoperative hemoglobin level ≤ 114.50 g/L,preoperative CEA level ≥5.67 U/mL,preoperative tumor stage Ⅲ and distance from the lower margin to the anal ≤4.50 cm were the independent risk factors for the permanence of prophylactic ileostomy after radical resection of rectal cancer(P＜0.05).The AUC value of predicting the permanence of prophylactic ileostomy after radical resection of rectal cancer in the training set by the nomogram model was 0.942[95％CI(0.912-0.972),P＜0.05],with the sensitivity of 92.5％,the specificity of 89.5％and the accuracy of 82.0％.The C index of the nomogram model was 0.947.The results of calibration curve showed that the nomogram model fitted well.The clinical decision curve showed that the nomogram model had more net benefits.Conclusion The increased preoperative Vaizey score and CEA level,decreased hemoglobin level,higher tumor stage and closer distance from the lower margin to the anal are the independent risk factors for the permanence of prophylactic ileostomy after radical resection of rectal cancer.The established nomogram model has a good predictive ability for the permanence of prophylactic ileostomy after radical resection of rectal cancer.
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