摘要/Abstract

摘要： 目的·探究根治性胃癌切除术+D2淋巴结清扫术后并发症发生的危险因素，以此建立列线图模型并进行验证。方法·收集2016年7月—2019年6月于上海交通大学医学院附属仁济医院胃肠外科胃癌专业组接受根治性胃癌切除术+D2淋巴结清扫术的1 705例患者的临床资料。根据Clavien-Dindo分级系统对术后并发症进行分级，通过χ2检验对≥Ⅱ级术后并发症的危险因素进行统计学分析；经多因素Logistic回归分析筛选≥Ⅱ级术后并发症的潜在危险因素，并建立列线图模型。将此样本作为训练组，并将2019年7月—12月在该专业组接受同样手术的612例患者作为验证组进行验证。结果·共计416例（24.4%）胃癌患者发生≥Ⅱ级术后并发症。多因素Logistic回归分析显示男性（OR=1.507，P=0.002）、年龄≥60岁（OR=1.962，P=0.001）、肿瘤最大径≥5 cm（OR=1.456，P=0.002）和全胃切除（OR=1.313，P=0.026）是导致Ⅱ级术后并发症的独立危险因素。以此建立的列线图模型在训练组和验证组中均显示较好的区分度和预测一致性。结论·基于4个独立危险因素的列线图模型对根治性胃癌切除术后并发症有较好的预测性能，具备一定的临床推广和参考价值。
关键词: 胃癌, 术后并发症, 危险因素, 列线图, 预测模型
Abstract:
Objective · To explore the risk factors of postoperative complications after radical gastrectomy + D2 lymphadenectomy and establish a predictive nomogram model. Methods · From July 2016 to June 2019, 1 705 patients who received radical gastrectomy + D2 lymphadenectomy in the Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine were collected. According to Clavien-Dindo grading system, the postoperative complications were graded, and the risk factors of postoperative complications ≥grade Ⅱ were analyzed by χ2 test. Multivariate Logistic regression was used to analyze the independent risk factors of postoperative complications ≥grade Ⅱ. According to the selected independent risk factors, the nomogram model was established. For verification, above patients were used as the training set, and 612 patients undergoing the same operation in this department from July to December 2019 were used as the validation set. Results · A total of 416 (24.4%) gastric cancer patients had postoperative complications. Multivariate Logistic regression analysis showed that male (OR=1.507, P=0.002), age ≥60 years old (OR=1.962, P=0.001), maximum diameter of tumor ≥5 cm (OR=1.456, P=0.002) and total gastrectomy (OR=1.313, P=0.026) were independent risk factors for postoperative complications ≥ grade Ⅱ . Based on these independent risk factors, the nomogram was established and presented good discrimination and predictive consistency in training set and validation set. Conclusion · The nomogram based on these four independent risk factors has a good predictive performance in predicting postoperative complications after radical gastrectomy for gastric cancer, and has a certain clinical application and reference value.
Key words: gastric cancer, postoperative complication, risk factor, nomogram, predicting model


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