Wang Wei, Yu Yongkui, Sun Haibo, Wang Zongfei, Zheng Yan, Liang Guanghui, Chen Peinan, Cheng Jiwei, Xu Xiaoxia, Yang Funa, Liu Qi, Xing Weiqun
Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China.
J Gastrointest Oncol. 2022 Apr;13(2):488-498. doi: 10.21037/jgo-22-149.
Postoperative pneumonia (PP) is the most common pulmonary complication of esophagectomy. It is of great importance to identify any high-risk factors and prevent pulmonary complications to improve the prognosis of patients with esophageal cancer undergoing esophagectomy. Thus, we established a predictive model of PP in patients with neoadjuvant immunochemotherapy for resectable esophageal squamous cell carcinoma (ESCC), and provide suggestions for the best strategy for the perioperative period of the patients.
We retrospectively analyzed 78 patients who underwent esophagectomy for squamous cell carcinoma after neoadjuvant immunochemotherapy between September 2019 and August 2021.We used the "glmnet" language package in R to perform least absolute shrinkage and selection operator (LASSO) regression to screen the best predictors of PP, and nomograms predicting PP were constructed utilizing screened factors. The performance of nomograms was internally validated by calibration curves, concordance index (C-index), and the Brier score for overall performance.
Twenty-six patients (33.3%) had postoperative pneumonia. After LASSO regression, the factors that were independently associated with PP were diffusing capacity of the lungs for carbon monoxide (DLCO) (P=0.0002), white blood cell (WBC) difference before after neoadjuvant immunochemotherapy (P=0.0133). We constructed a prediction model, plotted the nomogram, and verified its accuracy. Its Brier score was 0.147, its calibration slope was 0.98, and its C-index was 0.85 (95% CI: 0.75-0.95). Internal validation demonstrated a good discrimination power that the actual probability corresponds closely with the predicted probability.
Our prediction model can predict the possibility of PP in patients with neoadjuvant immunochemotherapy for resectable esophageal squamous cell carcinoma and may facilitate physicians' efforts to reduce the incidence of postoperative pneumonia.
术后肺炎（PP）是食管癌切除术后最常见的肺部并发症。识别任何高危因素并预防肺部并发症对于改善接受食管癌切除术的患者的预后至关重要。因此，我们建立了新辅助免疫化疗的可切除食管鳞状细胞癌（ESCC）患者术后肺炎的预测模型，并为患者围手术期的最佳策略提供建议。
我们回顾性分析了2019年9月至2021年8月期间78例接受新辅助免疫化疗后行鳞状细胞癌食管癌切除术的患者。我们使用R语言中的“glmnet”软件包进行最小绝对收缩和选择算子（LASSO）回归，以筛选术后肺炎的最佳预测因素，并利用筛选出的因素构建预测术后肺炎的列线图。通过校准曲线、一致性指数（C指数）和整体性能的Brier评分对列线图的性能进行内部验证。
26例患者（33.3%）发生术后肺炎。经过LASSO回归，与术后肺炎独立相关的因素是肺一氧化碳弥散量（DLCO）（P=0.0002）、新辅助免疫化疗前后白细胞（WBC）差值（P=0.0133）。我们构建了一个预测模型，绘制了列线图，并验证了其准确性。其Brier评分为0.147，校准斜率为0.98，C指数为0.85（95%CI：0.75-0.95）。内部验证显示出良好的区分能力，实际概率与预测概率密切相关。
我们的预测模型可以预测新辅助免疫化疗的可切除食管鳞状细胞癌患者发生术后肺炎的可能性，并可能有助于医生努力降低术后肺炎的发生率。
