Li Bo, Pu Ning, Chen Qiangda, Mei Yong, Wang Dansong, Jin Dayong, Wu Wenchuan, Zhang Lei, Lou Wenhui
Department of Pancreatic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China.
Front Oncol. 2021 Jul 1;11:717087. doi: 10.3389/fonc.2021.717087. eCollection 2021.
Clinically relevant postoperative pancreatic fistula (CR-POPF) remains a severe and challenging complication of pancreaticoduodenectomy (PD). This study aimed to establish a novel postoperative nomogram-based diagnostic model for the early detection of CR-POPF in patients subjected to PD.
Consecutive patients who underwent PD in Zhongshan Hospital, Fudan University from December 2018 to October 2020 were retrospectively enrolled. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for CR-POPF. Then, a novel predictive nomogram was established accordingly.
Among the consecutive 176 patients who underwent PD, 37 (21.1%) patients developed CR-POPF. Through univariate and multivariate analyses, the drain amylase (P = 0.002), serum creatinine (P = 0.009), and serum C reactive protein (P = 0.045) at postoperative day 1 (POD1) as well as the neutrophil count (P = 0.025) and temperature (P = 0.025) at POD3 were identified as independent risk factors for CR-POPF. Based on this, a novel predictive nomogram containing these factors was constructed to predict the probability of CR-POPF after PD. The formulated nomogram showed better performance to detect CR-POPF after PD with a sensitivity of 0.784, specificity of 0.770, positive predictive value of 0.475, and negative predictive value of 0.930 when compared to other predictors. In addition, the predictive value of the nomogram was assessed by a concordance index of 0.814 (95% CI, 0.736-0.892), which was significantly higher than indicators alone. This was further validated and depicted by decision curve analysis and clinical impact curve.
This study established a diagnostic nomogram of postoperative objective parameters that can predict the development of CR-POPF after PD with a good discriminative ability and predictive accuracy.
临床相关的术后胰瘘（CR-POPF）仍然是胰十二指肠切除术（PD）的一种严重且具有挑战性的并发症。本研究旨在建立一种基于术后列线图的新型诊断模型，用于早期检测接受PD患者的CR-POPF。
回顾性纳入2018年12月至2020年10月在复旦大学附属中山医院接受PD的连续患者。进行单因素和多因素逻辑回归分析以确定CR-POPF的独立危险因素。然后，据此建立了一种新型预测列线图。
在连续176例接受PD的患者中，37例（21.1%）发生CR-POPF。通过单因素和多因素分析，术后第1天（POD1）的引流淀粉酶（P = 0.002）、血清肌酐（P = 0.009）和血清C反应蛋白（P = 0.045）以及POD3时的中性粒细胞计数（P = 0.025）和体温（P = 0.025）被确定为CR-POPF的独立危险因素。基于此，构建了一个包含这些因素的新型预测列线图，以预测PD后CR-POPF的概率。与其他预测指标相比，制定的列线图在检测PD后CR-POPF方面表现更好，灵敏度为0.784，特异性为0.770，阳性预测值为0.475，阴性预测值为0.930。此外，列线图的预测价值通过一致性指数0.814（95%CI，0.736-0.892）进行评估，该指数显著高于单独指标。这通过决策曲线分析和临床影响曲线得到进一步验证和描述。
本研究建立了一个术后客观参数的诊断列线图，该列线图能够以良好的辨别能力和预测准确性预测PD后CR-POPF的发生。
