一种用于预测接受食管癌切除术的食管癌患者术后谵妄的列线图模型。

A nomogram model to predict postoperative delirium in esophageal cancer patients undergoing esophagectomy.

作者信息

Chen Chen, Wang Jiayu, Li Yang

机构信息

Department of Thoracic Surgery, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, 223300, China.

Department of Anesthesiology, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, 223300, China.

出版信息

BMC Cancer. 2025 Jul 1;25(1):1082. doi: 10.1186/s12885-025-14478-1.

DOI:10.1186/s12885-025-14478-1

PMID:40597926

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12211344/

Abstract

BACKGROUND

Postoperative delirium (POD) after esophagectomy is one of the most serious complications for cases with esophageal cancer (EC). This study determined to obtain predictive factors for POD and develop a nomogram model to predict the occurrence of POD among EC patients.

METHODS

LASSO and multivariate logistic regression analyses were utilized to identify potential predictive factors. A nomogram model was developed based on the results of multivariate logistic regression analysis.

RESULTS

Totally, 924 EC patients undergoing esophagectomy were included, and 157 (16.99%) patients developed POD. Results of LASSO and multivariate logistic analyses showed that age > 70 years, use of penehyclidine hydrochloride, open surgery, preoperative lymphocyte ≤ 1.45*10/L, preoperative albumin ≤ 43.6 g/L, preoperative prognostic nutritional index (PNI) ≤ 50.9, preoperative neutrophil-to-lymphocyte ratio (NLR) > 2.33, preoperative platelet-to-white cell ratio (PWR) ≤ 34.97, and postoperative PNI ≤ 39.40 were independent risk factors for POD. This nomogram model showed a good predictive ability with a C-index value of 0.832 (95% CI: 0.797-0.867). The calibration curve suggested that the predicted results of this nomogram model were in concordance with the actual results. The decision curve analysis (DCA) of this nomogram indicated that there were net benefits for predicting POD.

CONCLUSION

This nomogram model helps clinicians to predict the occurrence of POD in patients with EC.

摘要

背景

食管癌（EC）患者行食管切除术后的术后谵妄（POD）是最严重的并发症之一。本研究旨在确定POD的预测因素，并建立一个列线图模型来预测EC患者中POD的发生情况。

方法

采用LASSO和多因素logistic回归分析来识别潜在的预测因素。基于多因素logistic回归分析结果建立列线图模型。

结果

共纳入924例行食管切除术的EC患者，其中157例（16.99%）发生POD。LASSO和多因素logistic分析结果显示，年龄>70岁、使用盐酸戊乙奎醚、开放手术、术前淋巴细胞≤1.45×10⁹/L、术前白蛋白≤43.6 g/L、术前预后营养指数（PNI）≤50.9、术前中性粒细胞与淋巴细胞比值（NLR）>2.33、术前血小板与白细胞比值（PWR）≤34.97以及术后PNI≤39.40是POD的独立危险因素。该列线图模型显示出良好的预测能力，C指数值为0.832（95%CI：0.797 - 0.867）。校准曲线表明该列线图模型的预测结果与实际结果一致。该列线图的决策曲线分析（DCA）表明预测POD存在净效益。