Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
BMC Cancer. 2024 Jul 22;24(1):874. doi: 10.1186/s12885-024-12642-7.
For patients with rectal cancer, the utilization of temporary ileostomy (TI) has proven effective in minimizing the occurrence of severe complications post-surgery, such as anastomotic leaks; however, some patients are unable to reverse in time or even develop a permanent stoma (PS). We aimed to determine the preoperative predictors associated with TS failure and develop and validate appropriate predictive models to improve patients' quality of life.
This research included 403 patients with rectal cancer who underwent temporary ileostomies between January 2017 and December 2021. All patients were randomly divided into either the developmental (70%) or validation (30%) group. The independent risk factors for PS were determined using univariate and multivariate logistic regression analyses. Subsequently, a nomogram was constructed, and the prediction probability was estimated by calculating the area under the curve (AUC) using receiver operating characteristic (ROC) analysis. A calibration plot was used to evaluate the nomogram calibration.
Of the 403 enrolled patients, 282 were randomized into the developmental group, 121 into the validation group, and 58 (14.39%) had a PS. The development group consisted of 282 patients, of whom 39 (13.81%) had a PS. The validation group consisted of 121 patients, of whom, 19 (15.70%) had a PS; 37 related factors were analyzed in the study. Multivariate logistic regression analysis demonstrated significant associations between the occurrence of PS and various factors in this patient cohort, including tumor location (OR = 6.631, P = 0.005), tumor markers (OR = 2.309, P = 0.035), American Society of Anesthesiologists (ASA) score (OR = 4.784, P = 0.004), T4 stage (OR = 2.880, P = 0.036), lymph node metastasis (OR = 4.566, P = 0.001), and distant metastasis (OR = 4.478, P = 0.036). Furthermore, a preoperative nomogram was constructed based on these data and subsequently validated in an independent validation group.
We identified six independent preoperative risk factors associated with PS following rectal cancer resection and developed a validated nomogram with an area under the ROC curve of 0.7758, which can assist surgeons in formulating better surgical options, such as colostomy, for patients at high risk of PS.
对于直肠癌患者，临时造口术（TI）的应用已被证明可有效降低术后严重并发症的发生，如吻合口漏；但部分患者无法及时还纳，甚至发展为永久性造口（PS）。我们旨在确定与 TS 失败相关的术前预测因素，并建立和验证合适的预测模型，以提高患者的生活质量。
本研究纳入了 2017 年 1 月至 2021 年 12 月期间接受临时造口术的 403 例直肠癌患者。所有患者均被随机分为发展组（70%）和验证组（30%）。使用单因素和多因素逻辑回归分析确定 PS 的独立风险因素。随后，构建了一个列线图，并通过计算接受者操作特征（ROC）分析的曲线下面积（AUC）来估计预测概率。使用校准图评估列线图的校准度。
403 例患者中，282 例被随机分配到发展组，121 例分配到验证组，58 例（14.39%）发生 PS。发展组包括 282 例患者，其中 39 例（13.81%）发生 PS；验证组包括 121 例患者，其中 19 例（15.70%）发生 PS；研究分析了 37 个相关因素。多因素逻辑回归分析显示，在该患者队列中，PS 的发生与多种因素显著相关，包括肿瘤位置（OR=6.631，P=0.005）、肿瘤标志物（OR=2.309，P=0.035）、美国麻醉医师协会（ASA）评分（OR=4.784，P=0.004）、T4 期（OR=2.880，P=0.036）、淋巴结转移（OR=4.566，P=0.001）和远处转移（OR=4.478，P=0.036）。此外，基于这些数据构建了一个术前列线图，并在独立的验证组中进行了验证。
我们确定了与直肠癌切除术后 PS 相关的六个独立的术前危险因素，并建立了一个验证后的列线图，其 ROC 曲线下面积为 0.7758，可帮助外科医生为 PS 风险较高的患者制定更好的手术方案，如结肠造口术。
