Construction of risk prediction model for recurrent laryngeal nerve injury after radical resection of esophageal cancer
Objective To analyze the influencing factors of recurrent laryngeal nerve injury in patients with esophageal cancer after radical resection,and to construct a nomogram model.Methods From January 2017 to December 2022,508 patients with esophageal cancer in Henan Cancer Hospital were divided into injury group(n=43)and no-injury group(n=465)according to the presence or absence of recurrent laryngeal nerve injury after surgery.The clinical data were recorded,including the age,gender,diameter of tumor,tumor location,histopathological classification,T stage,N stage,clinical stage,preoperative radiotherapy and chemotherapy,number of lymph node dissection,and number of recurrent laryngeal nerve lymph node dissection.Lasso regression was used to screen and predict the influencing factors of recurrent laryngeal nerve injury after radical resection of esophageal cancer.According to the influencing factors,a nomogram model was constructed to predict recurrent laryngeal nerve injury after radical resection of esophageal cancer.The decision curve and clinical impact curve were drawn to evaluate the predictive efficiency of the nomogram model.Results The patients were older in injury group[(70.91±10.41)years]than no-injury group[(62.07±14.83)years](t=3.820,P＜0.001),and the tumor diameter was longer in injury group[(58.60±21.62)mm]than that in no-injury group[(42.78±26.07)mm](t=3.858,P＜0.001).The proportions of patients with tumor located in the upper esophagus,≥T2 stage,≥N1stage,clinical stage Ⅲ,and preoperative radiotherapy and chemotherapy were higher in injury group(86.0％,81.4％,34.9％,34.9％,58.1％,81.4％)than those in no-injury group(17.0％,50.8％,11.2％,7.7％,10.5％,8.2％)(P＜0.05).The numbers of lymph node dissection and recurrent laryngeal nerve lymph node dissection were more in injury group(11.53±10.35,4.09±3.22)than those in no-injury group(9.03±6.43,1.97±1.02)(t=2.294,P=0.022;t=9.909,P＜0.001).There were no significant differences in the gender ratio and histopathological classification between two groups(P＞0.05).Lasso regression analysis showed that tumor diameter,tumor location,preoperative radiotherapy,preoperative chemotherapy,and number of recurrent laryngeal nerve lymph node dissection were the influencing factors of recurrent laryngeal nerve injury after radical resection of esophageal cancer.Decision curve and clinical impact curve showed that the nomogram model achieved a high net benefit to predict laryngeal recurrent nerve injury after radical resection of esophageal cancer,with a great clinical practicality.Conclusions The long tumor diameter,tumor location in the upper esophagus,preoperative radiotherapy and chemotherapy,and the large number of recurrent laryngeal nerve lymph nodes dissection increase the risk of recurrent laryngeal nerve injury after radical resection of esophageal cancer.The nomogram model for predicting recurrent laryngeal nerve injury after radical resection of esophageal cancer has a high clinical application value.
esophageal cancerradical resection of esophageal cancerrecurrent laryngeal nerve injurylasso regressionnomogram
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