Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Psychology, Wuchang Hospital, Wuhan, China.
Neurosurg Rev. 2023 Oct 31;46(1):288. doi: 10.1007/s10143-023-02198-8.
To identify risk factors for major postoperative complications in meningioma patients and to construct and validate a nomogram that identify patients at high risk of these complications.
The medical records of meningioma patients who underwent surgical resection in our hospital from January 2018 to December 2020 were collected. The patients were divided into a training set (815 cases from the main campus in 2018 and 2019) and a validation set (300 cases from two other campuses in 2020). Major postoperative complications were defined as any new neurological deficits and complications classified as Clavien-Dindo Grading (CDG) II or higher. Univariate and multivariate analyses were conducted using the training set to identify independent risk factors. A nomogram was constructed based on these results. And then validated the nomogram through bootstrap re-sampling in both the training and validation sets. The concordance index (C-index) and the area under the curve (AUC) were used to assess the discriminative ability of the nomogram. The Hosmer-Lemeshow test was performed to evaluate the goodness-of-fit. The optimal cutoff point for the nomogram was calculated using Youden's index.
In the training set, 135 cases (16.56%) experienced major postoperative complications. The independent risk factors identified were male sex, recurrent tumors, American Society of Anesthesiologists (ASA) class III-IV, preoperative Karnofsky Performance Scale (KPS) score < 80, preoperative serum albumin < 35 g/L, tumor in the skull base or central sulcus area, subtotal tumor resection (STR), allogeneic blood transfusion, and larger tumor size. A nomogram was constructed based on these risk factors. It demonstrated good predictive performance, with a C-index of 0.919 for the training set and 0.872 for the validation set. The area under the curve (AUC) > 0.7 indicated satisfactory discriminative ability. The Hosmer-Lemeshow test showed no significant deviation from the predicted probabilities. And the cutoff for nomogram total points was about 200 (specificity 0.881 and sensitivity 0.834).
The constructed nomogram demonstrated robust predictive performance for major postoperative complications in meningioma patients. This model can be used by surgeons as a reference in clinical decision-making.
确定脑膜瘤患者术后发生主要并发症的风险因素，并构建和验证一个列线图，以识别这些并发症风险较高的患者。
收集了 2018 年 1 月至 2020 年 12 月在我院接受手术切除的脑膜瘤患者的病历。将患者分为训练集（2018 年和 2019 年主校区的 815 例）和验证集（2020 年两个其他校区的 300 例）。主要术后并发症定义为任何新的神经功能缺损和分类为 Clavien-Dindo 分级（CDG）Ⅱ级或更高的并发症。使用训练集进行单变量和多变量分析，以确定独立的风险因素。基于这些结果构建列线图。然后通过训练集和验证集的 bootstrap 重采样对列线图进行验证。一致性指数（C 指数）和曲线下面积（AUC）用于评估列线图的判别能力。Hosmer-Lemeshow 检验用于评估拟合优度。使用 Youden 指数计算列线图的最佳截断点。
在训练集中，135 例（16.56%）发生主要术后并发症。确定的独立风险因素为男性、复发性肿瘤、美国麻醉师协会（ASA）分级Ⅲ-Ⅳ级、术前卡诺夫斯基表现量表（KPS）评分＜80 分、术前血清白蛋白＜35 g/L、肿瘤位于颅底或中央沟区、次全切除（STR）、异体输血和肿瘤较大。基于这些风险因素构建了一个列线图。它显示出良好的预测性能，训练集的 C 指数为 0.919，验证集为 0.872。曲线下面积（AUC）＞0.7 表明具有良好的判别能力。Hosmer-Lemeshow 检验表明无显著偏离预测概率。列线图总分的截断值约为 200（特异性 0.881，敏感性 0.834）。
构建的列线图对脑膜瘤患者术后发生主要并发症具有较强的预测性能。外科医生可以在临床决策中使用该模型作为参考。
