The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China.
Department of General Surgery, General Hospital of Central Theater Command, 627 Wuluo Road, Wu Chang District, Wuhan, 430070, China.
BMC Surg. 2022 Jul 23;22(1):283. doi: 10.1186/s12893-022-01734-5.
BACKGROUND & AIMS: Lymphocyte-C-reactive Protein Ratio (LCR) has been demonstrated as a promising new marker for predicting surgical and oncological outcomes in colorectal carcinoma (CRC). However, anastomotic leakage (AL) is also likely related to this inflammatory marker. Herein, we aimed to identify preoperative predictors of AL and build and develop a novel model able to identify patients at risk of developing AL.
We collected 858 patients with CRC undergoing elective radical operation between 2007 and 2018 at a single center were retrospectively reviewed. We performed univariable and multivariable analyses and built a multivariable model that predicts AL based on preoperative factors. Propensity adjustment was used to correct the bias introduced by non-random matching of the LCR. The model's performance was evaluated by using the area under the receiver operator characteristic curves (AUROCs), decision curve analysis (DCA), Brier scores, D statistics, and R2 values.
Age, nutrition risk screening 2002 (NRS2002) score, tumor location and LCR, together with hemoglobin < 90 g/l, were independent predictors of AL. The models built on these variables showed good performance (internal validation: c-statistic = 0.851 (95%CI 0.803-0.965), Brier score = 0.049; temporal validation: c-statistic = 0.777 (95%CI 0.823-0.979), Brier score = 0.096). A regression equation to predict the AL was also established by multiple linear regression analysis: [Age(≥ 60 year) × 1.281] + [NRS2002(≥ 3) × 1.341] + [Tumor location(pt.) × 1.348]-[LCR(≤ 6000) × 1.593]-[Hemoglobin(< 90 g/L) × 1.589]-6.12.
Preoperative LCR is an independent predictive factor for AL. A novel model combining LCR values, age, tumor location, and NRS2002 provided an excellent preoperative prediction of AL in patients with CRC. The nomogram can help clinical decision-making and support future research.
淋巴细胞- C 反应蛋白比值（LCR）已被证明是预测结直肠癌（CRC）手术和肿瘤学结果的有前途的新标志物。然而，吻合口漏（AL）也可能与这种炎症标志物有关。在此，我们旨在确定 AL 的术前预测因子，并建立和开发一种能够识别发生 AL 风险患者的新模型。
我们回顾性分析了 2007 年至 2018 年间在一家单中心接受择期根治手术的 858 例 CRC 患者。我们进行了单变量和多变量分析，并建立了一个基于术前因素预测 AL 的多变量模型。使用倾向调整来纠正 LCR 非随机匹配引入的偏差。使用接收者操作特征曲线下面积（AUROCs）、决策曲线分析（DCA）、Brier 评分、D 统计量和 R2 值来评估模型的性能。
年龄、营养风险筛查 2002 评分（NRS2002）、肿瘤位置和 LCR，以及血红蛋白<90g/L，是 AL 的独立预测因子。基于这些变量建立的模型表现良好（内部验证：c 统计量=0.851（95%CI 0.803-0.965），Brier 评分=0.049；时间验证：c 统计量=0.777（95%CI 0.823-0.979），Brier 评分=0.096）。还通过多元线性回归分析建立了预测 AL 的回归方程：[年龄（≥60 岁）×1.281]+[NRS2002（≥3）×1.341]+[肿瘤位置（pt.）×1.348]-[LCR（≤6000）×1.593]-[血红蛋白（<90g/L）×1.589]-6.12。
术前 LCR 是 AL 的独立预测因子。结合 LCR 值、年龄、肿瘤位置和 NRS2002 的新型模型为 CRC 患者的 AL 提供了出色的术前预测。该列线图可帮助临床决策并支持未来的研究。
