食管癌手术后肺部感染：对实际情况的影响、危险因素及预测列线图的构建

Pulmonary infection after esophageal cancer surgery: impact on the reality, risk factors and development of a predictive nomogram.

作者信息

Chen Junfeng, Zhao Yan, Yang Wanli, Duan Lili, Niu Liaoran, Li Zhenshun, Zhang Yujie, Miao Yan, Fan Aqiang, Wei Siyu, Bai Han, Li Yiding, Wang Xiaoqian, Zhou Wei, Xie Qibin, Wang Chenyang, Chen Xi, Han Yu, Hong Liu

机构信息

Department of Digestive Surgery, State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Xijing Hospital of Digestive Diseases, Air Force Military Medical University, Xi'an, 710032, China.

Department of Gastroenterology, Chinese PLA 95861 Military Hospital, Jiuquan, 735000, China.

出版信息

World J Surg Oncol. 2025 Apr 21;23(1):149. doi: 10.1186/s12957-025-03806-1.

DOI:10.1186/s12957-025-03806-1

PMID:40259387

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12013179/

Abstract

BACKGROUND

As a major complication after esophageal cancer (EC) surgery, postoperative pulmonary infection (PPI) is speculated to be associated with quality of life and survival after surgery. This study is aimed to explore the influence of PPI on the reality and establish a nomogram to predict PPI.

METHODS

Data of patients undergoing esophagectomy was collected between January, 2016 and December, 2020 and divided into PPI and without PPI groups. Hospital costs and overall survival (OS) were compared between two groups. Univariate-multivariate analysis and LASSO-multivariate logistic regression were carried out to identify risk factors, and then two models were established based on them. To choose the better one, the receiver operating characteristic (ROC), the area under curve (AUC) and K-fold cross validation were compared between the models.

RESULTS

The incidence of PPI in 633 esophageal cancer patients was 30.2% (191/633). PPI caused a total economic burden of RMB11,872.31 yuan on each patient and a poorer overall survival (60.5% vs. 54.0%, P = 0.002). The final nomogram was established by Univariate-multivariate logistic regression, including four independent risk factors of BMI < 18 kg/m (OR 2.516, 95%CI 1.264-5.059, P = 0.009), lung diseases (OR 1.805, 95%CI 0.995-3.259, P = 0.050), approach to chest (open) (OR 1.182, 95%CI 1.075-1.440, P < 0.001) and operation time (OR 1.001, 95%CI 1.001-1.002, P < 0.001).

CONCLUSION

Individual prevention of PPI after esophagectomy would lead a lower financial burden and a better survival for EC patients.

摘要

背景

作为食管癌（EC）手术后的一种主要并发症，术后肺部感染（PPI）被推测与手术后的生活质量和生存率相关。本研究旨在探讨PPI的影响并建立一个预测PPI的列线图。

方法

收集2016年1月至2020年12月期间接受食管切除术患者的数据，并将其分为PPI组和无PPI组。比较两组之间的住院费用和总生存期（OS）。进行单因素-多因素分析以及LASSO-多因素逻辑回归以识别危险因素，然后基于这些因素建立两个模型。为了选择更好的模型，比较了模型之间的受试者工作特征（ROC）、曲线下面积（AUC）和K折交叉验证。

结果

633例食管癌患者中PPI的发生率为30.2%（191/633）。PPI给每位患者造成了总计11,872.31元人民币的经济负担，且总生存期较差（60.5%对54.0%，P = 0.002）。通过单因素-多因素逻辑回归建立了最终的列线图，包括四个独立危险因素，即BMI < 18 kg/m（OR 2.516，95%CI 1.264 - 5.059，P = 0.009）、肺部疾病（OR 1.805，95%CI 0.995 - 3.259，P = 0.050）、开胸手术方式（OR 1.182, 95%CI 1.075 - 1.440, P < 0.001）和手术时间（OR 1.001, 95%CI 1.001 - 1.002, P < 0.001）。