Dong Zheng, Liu Gang, Tu Liqun, Su Xiaobao, Yu Yu
Gastrointestinal Minimally Invasive Surgery Department (Department of General Surgery), the Affiliated People's Hospital of Ningbo University, Ningbo, China.
Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China.
J Gastrointest Oncol. 2023 Jun 30;14(3):1250-1258. doi: 10.21037/jgo-23-231.
Postoperative infection delays postoperative adjuvant therapy and can lead to poor prognosis in gastric cancer patients. Therefore, accurately identifying patients at high risk of postoperative infection in patients with gastric cancer is critical. We therefore conducted a study to analyze the impact of postoperative infection complications on long-term prognosis.
From January 2014 to December 2017, we retrospectively collected the data of 571 patients with gastric cancer admitted to the Affiliated People's Hospital of Ningbo University. The patients were divided into an infection group (n=81) and control group (n=490) according to whether the patients experienced postoperative infection. The clinical characteristics of the 2 groups were compared, and the risk factors of postoperative infection complications in patients with gastric cancer were analyzed. Finally, the prediction model of postoperative infection complications was established.
There were significant differences in age, diabetes, preoperative anemia, preoperative albumin, preoperative gastrointestinal obstruction, and surgical methods between the 2 groups (P<0.05). Compared with that in the control group, the mortality rate of patients in the infection group at 5 years after surgery was significantly increased (39.51% 26.12%; P=0.013). Multivariate logistics regression analysis showed that age >65 years, preoperative anemia, albumin <30 g/L, and gastrointestinal obstruction were risk factors of postoperative infection in patients with gastric cancer (P<0.05). The data set was randomly divided into a training set and validation set; the sample size of the training set was 286 while the sample size of the validation set was 285. In terms of the predictive model's value in predicting postoperative infection in patients with gastric cancer, the area under the curve of the receiver operating characteristic (ROC) curve in the training set was 0.788 (95% confidence interval: 0.711-0.864), and the area under the curve of the ROC curve in the validation set was 0.779 (95% confidence interval: 0.703-0.855). In the validation set, the model was evaluated with the Hosmer-Lemeshow goodness-of-fit test, resulting in a chi-squared value of 5.589 and a P value of 0.693.
The present model can effectively identify patient as high risk of postoperative infection.
术后感染会延迟术后辅助治疗，并可能导致胃癌患者预后不良。因此，准确识别胃癌患者术后感染的高危人群至关重要。为此，我们开展了一项研究，分析术后感染并发症对长期预后的影响。
回顾性收集2014年1月至2017年12月在宁波大学附属人民医院住院的571例胃癌患者的数据。根据患者是否发生术后感染，将其分为感染组（n = 81）和对照组（n = 490）。比较两组的临床特征，分析胃癌患者术后感染并发症的危险因素。最后，建立术后感染并发症的预测模型。
两组患者在年龄、糖尿病、术前贫血、术前白蛋白、术前胃肠道梗阻及手术方式等方面存在显著差异（P < 0.05）。与对照组相比，感染组患者术后5年的死亡率显著升高（39.51% 对26.12%；P = 0.013）。多因素logistic回归分析显示，年龄>65岁、术前贫血、白蛋白<30 g/L及胃肠道梗阻是胃癌患者术后感染的危险因素（P < 0.05）。将数据集随机分为训练集和验证集；训练集样本量为286，验证集样本量为285。就预测模型对胃癌患者术后感染的预测价值而言，训练集的受试者操作特征（ROC）曲线下面积为0.788（95%置信区间：0.711 - 0.864），验证集的ROC曲线下面积为0.779（95%置信区间：0.703 - 0.855）。在验证集中，采用Hosmer-Lemeshow拟合优度检验对模型进行评估，卡方值为5.589，P值为0.693。
本模型可有效识别术后感染高危患者。
