The Second Department of General Surgery, Shaanxi Provincial People's Hospital, 256 West Youyi Road, Xi'an, 710068, Shaanxi, China.
Department of Graduate Studies, Xi'an Medicine University, Xi'an, 710021, China.
BMC Cancer. 2024 Sep 27;24(1):1185. doi: 10.1186/s12885-024-12965-5.
The occurrence of complications following radical gastrectomy for gastric cancer significantly impacts patients' quality of life. Elderly patients are susceptible to postoperative complications. This study seeks to investigate the risk factors associated with Clavien-Dindo ≥IIgrade complications following radical gastrectomy for advanced gastric cancer in elderly patients, develop a nomogram risk prediction model, and validate its accuracy.
Retrospective collection of clinical and pathological data was conducted on 442 elderly patients with advanced gastric cancer who underwent radical gastrectomy at Shaanxi Provincial People's Hospital from January 2015 to December 2020. They were randomly divided into a training set (n = 310) and a validation set (n = 132) in a 7:3 ratio. The severity of postoperative complications was graded using the Clavien-Dindo classification system, resulting in two complication groups: Clavien-Dindo <II group (n = 229) and Clavien-Dindo ≥II group (n = 81). Univariate and multivariate logistic regression analyses were performed to identify independent risk factors affecting the occurrence of Clavien-Dindo ≥II grade complications, and a predictive model was established based on the results. The model was then validated using the validation set.
Among the 442 patients included in the study, 121 cases (27.38%) experienced postoperative complications, with 111 cases (25.11%) classified as Clavien-Dindo ≥II grade complications. Multivariable logistic analysis revealed that the Prognostic Nutritional Index (PNI), surgical duration, age, and history of Diabetes mellitus were independent risk factors for the occurrence of Clavien-Dindo ≥IIgrade complications in elderly patients with advanced gastric cancer after surgery (P < 0.05). The nomogram model constructed based on these factors demonstrated good discriminative ability, as indicated by the area under the Receiver Operating Characteristic (ROC) curve. Calibration plots showed that the predicted probability of gastric cancer lymph node metastasis using the nomogram model was well aligned with actual outcomes. Decision curve analysis indicated the clinical utility of the nomogram model across a wide range of thresholds, demonstrating its practicality and potential for clinical benefit.
This study identified Prognostic Nutritional Index (PNI), surgical duration, age, and history of Diabetes mellitus as risk factors for the occurrence of Clavien-Dindo ≥ II grade complications in elderly patients with advanced gastric cancer after surgery. Based on these four risk factors, a nomogram risk prediction model was constructed. This model can be used to personalize the prediction of the risk of Clavien-Dindo ≥ II grade complications occurring after surgery in elderly patients with advanced gastric cancer.
胃癌根治术后并发症的发生显著影响患者的生活质量。老年患者易发生术后并发症。本研究旨在探讨影响老年胃癌患者根治性胃切除术后发生 Clavien-Dindo≥II 级并发症的风险因素，建立列线图风险预测模型，并验证其准确性。
回顾性收集 2015 年 1 月至 2020 年 12 月在陕西省人民医院接受根治性胃切除术的 442 例老年进展期胃癌患者的临床和病理资料。按 7:3 的比例随机分为训练集（n=310）和验证集（n=132）。采用 Clavien-Dindo 分级系统对术后并发症严重程度进行分级，分为 Clavien-Dindo＜II 级组（n=229）和 Clavien-Dindo≥II 级组（n=81）。采用单因素和多因素 logistic 回归分析影响发生 Clavien-Dindo≥II 级并发症的独立危险因素，并根据结果建立预测模型。然后使用验证集验证该模型。
本研究共纳入 442 例患者，其中 121 例（27.38%）发生术后并发症，111 例（25.11%）为 Clavien-Dindo≥II 级并发症。多因素 logistic 分析显示，预后营养指数（PNI）、手术时间、年龄和糖尿病史是老年进展期胃癌患者根治性胃切除术后发生 Clavien-Dindo≥II 级并发症的独立危险因素（P＜0.05）。基于这些因素构建的列线图模型显示出良好的区分能力，受试者工作特征曲线下面积（AUC）为 0.824。校准图显示，列线图模型预测胃癌淋巴结转移的概率与实际结果吻合良好。决策曲线分析表明，该列线图模型在广泛的阈值范围内具有临床实用性，具有潜在的临床获益。
本研究确定了预后营养指数（PNI）、手术时间、年龄和糖尿病史是老年进展期胃癌患者根治性胃切除术后发生 Clavien-Dindo≥II 级并发症的危险因素。基于这四个危险因素，构建了一个列线图风险预测模型。该模型可用于个性化预测老年进展期胃癌患者根治性胃切除术后发生 Clavien-Dindo≥II 级并发症的风险。
