Department of Gastroenterology, Wuhan University Renmin Hospital, Wuhan, 430060, Hubei, China.
Key Laboratory of Hubei Province for Digestive System Disease, Wuhan University Renmin Hospital, Wuhan, Hubei, China.
Surg Endosc. 2024 Jul;38(7):3967-3975. doi: 10.1007/s00464-024-10923-7. Epub 2024 Jun 6.
To investigate the risk factors for delayed postoperative bleeding after endoscopic submucosal dissection (ESD) in patients with gastric precancerous lesions and to construct a risk prediction model.
This retrospective analysis included clinical data from patients with gastric precancerous lesions who underwent ESD at Wuhan University People's Hospital between November 2016 and June 2022. An XGBoost model was built to predict delayed bleeding after ESD using risk factors identified by univariable and multivariate logistic regression analysis. The model was evaluated using receiver operating characteristic curves (ROC), and SHapely Additive exPlanations (SHAP) analysis was used to interpret the model.
Seven factors were statistically associated with delayed postoperative bleeding in gastric precancerous lesions after ESD: age, low-grade intraepithelial neoplasia, hypertension, lesion size ≥ 40 mm, operative time ≥ 120 min, female, and nonuse of hemoclips. A risk prediction model was established. In the training cohort, the model achieved an AUC of 0.97 (0.96-0.98), a sensitivity of 0.90, a specificity of 0.94, and an F1 score of 0.91. In the validation cohort, the AUC was 0.94(0.90-0.98), with a sensitivity of 0.85, a specificity of 0.89, and an F1 score of 0.85. In the test cohort, the AUC was 0.94 (0.89-0.99), the sensitivity was 0.80, the specificity was 0.92, and the F1 score was 0.84, indicating strong predictive capability.
In this study, an XGBoost prediction model for assessing the risk of delayed postoperative bleeding after ESD in patients with gastric precancerous lesions was developed and validated. This model can be applied in clinical practice to effectively predict the risk of post-ESD bleeding for individual patients.
探讨胃黏膜前病变患者内镜黏膜下剥离术（ESD）后延迟性术后出血的危险因素，并构建风险预测模型。
本回顾性分析纳入了 2016 年 11 月至 2022 年 6 月期间在武汉大学人民医院接受 ESD 治疗的胃黏膜前病变患者的临床资料。采用单变量和多变量逻辑回归分析确定风险因素，然后使用 XGBoost 模型预测 ESD 后延迟性出血。采用受试者工作特征曲线（ROC）评估模型，并采用 SHapely Additive exPlanations（SHAP）分析对模型进行解释。
有 7 个因素与胃黏膜前病变患者 ESD 后延迟性术后出血相关：年龄、低级别上皮内瘤变、高血压、病变大小≥40mm、手术时间≥120min、女性和未使用止血夹。建立了风险预测模型。在训练队列中，该模型的 AUC 为 0.97（0.96-0.98），灵敏度为 0.90，特异性为 0.94，F1 评分为 0.91。在验证队列中，AUC 为 0.94（0.90-0.98），灵敏度为 0.85，特异性为 0.89，F1 评分为 0.85。在测试队列中，AUC 为 0.94（0.89-0.99），灵敏度为 0.80，特异性为 0.92，F1 评分为 0.84，表明该模型具有较强的预测能力。
本研究构建并验证了一种用于评估胃黏膜前病变患者 ESD 后延迟性术后出血风险的 XGBoost 预测模型。该模型可应用于临床实践，有效预测个体患者 ESD 后出血的风险。
