摘要
目的 探讨经新辅助放化疗后中低位局部进展期直肠癌术后并发症发生情况,分析相关影响因素并构建并发症的预测模型.方法 收集2020年6月—2022年12月在青岛大学附属烟台毓璜顶医院行新辅助放化疗序贯直肠癌根治术的70例患者的临床病理资料,统计患者术后并发症发生情况,并将其分为并发症组和无并发症组.收集两组患者临床病理资料,分析直肠癌术后并发症的影响因素,并构建术后并发症的预测模型.结果 70例患者中,术后有24例出现并发症,46例未发生并发症,并发症发生率为34.28％.单因素分析结果显示,并发症组手术时间、直肠周围区域平均表观弥散系数(ADC)值、壁外血管侵犯(EMVI)阳性比例、肿瘤距肛缘距离＜5 cm比例、肿瘤低分化比例均高于无并发症组(P＜0.05);Logistic多因素回归分析结果显示,直肠周围区域平均ADC值、EMVI、肿瘤距肛缘距离为术后发生并发症的独立危险因素(P均＜0.05);受试者工作特征(ROC)曲线显示,直肠周围区域平均ADC值、EMVI、肿瘤距肛缘距离均对病人术后发生并发症的预测价值均良好,曲线下面积(AUC)分别为0.802、0.734、0.727;根据这3个危险因素构建了预测术后发生并发症的列线图模型,C指数为0.905(95％CI:0.838～0.972),ROC曲线及校准曲线显示该列线图模型具有较好的预测能力.结论 行新辅助放化疗序贯手术的直肠癌患者的术后并发症发生率较高.并发症危险因素包括直肠周围区域平均ADC值、EMVI、肿瘤距肛缘距离.本研究开发和验证的列线图预测模型可用于计算个体化术后并发症风险,能够帮助临床医生识别术后并发症高风险患者并可据此采取针对性预防措施.
Abstract
Objective To explore the postoperative complications of locally advanced middle to low rectal cancer after neoadjuvant chemoradiotherapy,analyze relevant influencing factors,and construct a predictive model for complications.Methods The paper collected clinical and pathological data of 70 rectal cancer patients with neoadjuvant chemoradiotherapy sequential radical resection in Qingdao University affiliated Yantai Yuhuangding Hospital from June 2020 to December 2022,analyzed postoperative complications statistically and divided them into the complication group and non complication group,collected clinical and pathological data of two groups,analyzed influencing factors of postoperative complications of rectal cancer,and constructed a predictive model for postoperative complications.Results 24 out of 70 cases in the group developed complications after surgery,while 46 had no complications,with incidence of complications of 34.28％.Univariate analysis showed,the complication group had higher surgical time,average apparent dispersion coefficient(ADC)in perirectal area,positive proportion of extramural vascular invasion(EMVI),proportion of tumors to anal margin distance＜5 cm,and proportion of poorly differentiated tumors than non complication group,with statistically significant difference(P＜0.05).Logistic multiple regression analysis showed,average ADC value,EMVI,and tumor to anal margin distance in perirectal area were independent risk factors of postoperative complications(P＜0.05).The receiver operating characteristic(ROC)curve showed,average ADC value,EMVI,and tumor to anal margin distance in perirectal area had good predictive value for postoperative complications.The area under the curve(AUC)was 0.802,0.734,and 0.727 respectively.A column chart model was constructed to predict postoperative complications based on three risk factors,with c-index of 0.905(95％CI0.838～0.972).The ROC curve and calibration curve showed,the column chart model had good predictive effect.Conclusion Rectal cancer patients with neoadjuvant chemoradiotherapy sequential surgery have higher incidence of postoperative complications.Risk factors of complications include average ADC value in perirectal area,EMVI,and tumor to anal margin distance.The column chart prediction model developed and validated in the study can be used to calculate risks of individualized postoperative complications,help clinical doctors identify patients with high-risk postoperative complications and take targeted preventive measures accordingly.
维普
万方数据