软组织肉瘤切除术后手术部位感染预测列线图的建立与验证。

Development and validation of a nomogram to predict surgical site infection after soft-tissue sarcoma resection.

机构信息

Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan.

出版信息

Bone Joint J. 2024 May 1;106-B(5):492-500. doi: 10.1302/0301-620X.106B5.BJJ-2023-1052.R1.

DOI:10.1302/0301-620X.106B5.BJJ-2023-1052.R1

PMID:38688512

Abstract

AIMS

Surgical site infection (SSI) after soft-tissue sarcoma (STS) resection is a serious complication. The purpose of this retrospective study was to investigate the risk factors for SSI after STS resection, and to develop a nomogram that allows patient-specific risk assessment.

METHODS

A total of 547 patients with STS who underwent tumour resection between 2005 and 2021 were divided into a development cohort and a validation cohort. In the development cohort of 402 patients, the least absolute shrinkage and selection operator (LASSO) regression model was used to screen possible risk factors of SSI. To select risk factors and construct the prediction nomogram, multivariate logistic regression was used. The predictive power of the nomogram was evaluated by receiver operating curve (ROC) analysis in the validation cohort of 145 patients.

RESULTS

LASSO regression analysis selected possible risk factors for SSI, including age, diabetes, operating time, skin graft or flap, resected tumour size, smoking, and radiation therapy. Multivariate analysis revealed that age, diabetes, smoking during the previous year, operating time, and radiation therapy were independent risk factors for SSI. A nomogram was developed based on the results of multivariate logistic regression analysis. In the development cohort, the incidence of SSI was 4.5% in the low-risk group (risk score < 6.89) and 26.6% in the high-risk group (risk score ≥ 6.89; p < 0.001). In the validation cohort, the incidence of SSI was 2.0% in the low-risk group and 15.9% in the high-risk group (p = 0.004).

CONCLUSION

Our nomogram will enable surgeons to assess the risk of SSI in patients with STS. In patients with high risk of SSI, frequent monitoring and aggressive interventions should be considered to prevent this.

摘要

目的

软组织肉瘤（STS）切除术后的手术部位感染（SSI）是一种严重的并发症。本回顾性研究的目的是探讨 STS 切除术后 SSI 的危险因素，并开发一个允许患者特定风险评估的列线图。

方法

共纳入 2005 年至 2021 年间接受肿瘤切除术的 547 例 STS 患者，分为开发队列和验证队列。在 402 例患者的开发队列中，使用最小绝对收缩和选择算子（LASSO）回归模型筛选 SSI 的可能危险因素。为了选择风险因素并构建预测列线图，使用多变量逻辑回归进行分析。在 145 例患者的验证队列中，通过接受者操作曲线（ROC）分析评估列线图的预测能力。

结果

LASSO 回归分析筛选出 SSI 的可能危险因素，包括年龄、糖尿病、手术时间、植皮或皮瓣、切除肿瘤大小、吸烟和放射治疗。多变量分析显示，年龄、糖尿病、前一年吸烟、手术时间和放射治疗是 SSI 的独立危险因素。基于多变量逻辑回归分析的结果，建立了一个列线图。在开发队列中，低风险组（风险评分<6.89）的 SSI 发生率为 4.5%，高风险组（风险评分≥6.89）为 26.6%（p<0.001）。在验证队列中，低风险组的 SSI 发生率为 2.0%，高风险组为 15.9%（p=0.004）。