Quan Zhenhao, Lin Lin, Huang Renwei, Sun Kaiyu, Xu Feipeng
Department of Gastrointestinal Surgery, Affiliated Hospital of Guangdong Medical University, No. 57 South Renmin Avenue, Xiashan District, Zhanjiang, Guangdong Province, 524001, China.
BMC Gastroenterol. 2025 Jul 30;25(1):540. doi: 10.1186/s12876-025-04128-y.
To build a nomogram model for predicting the risk of anastomotic leakage (AL) postoperative low rectal cancer based on Lasso-Logistic regression.
A total of 482 patients with rectal cancer who underwent low rectal cancer surgery in our hospital from June 2017 to May 2023 were selected as the training set, and 127 patients with rectal cancer who underwent low rectal cancer surgery in our hospital from June 2023 to April 2025 were selected as the validation set. According to whether AL occurred postoperative, the patients in the training set were divided into AL group (n = 54) and N-AL group (n = 428). The data of each group were collected, and the influencing factors of AL in patients postoperative with rectal cancer in the training set were analyzed by Lasso-Logistic regression model. H-L goodness-of-fit test, ROC curve and calibration curve were used to analyze the discrimination and consistency of the model. The nomogram model was validated using the validation set. The DCA curve was used to evaluate the clinical utility of the model.
In the training set, the AL group had a higher proportion of patients with tumor stage ≥ T3 and longer operation times compared to the N-AL group; additionally, fewer AL patients had a protective stoma, and the tumor was located a shorter distance from the tumor to the anal verge than in the N-AL group. (P < 0.05). Lasso-Logistic regression analysis showed that when the penalty coefficient λ = 0.02735463, the model demonstrated good performance, gender (OR = 3.107), NRS2002 score (OR = 8.619), protective stoma (OR = 0.297), distance from tumor to anal verge (OR = 0.284), operation time (OR = 1.033) were the influencing factors of postoperative AL in low rectal cancer (P < 0.05). The 5 influencing factors were introduced into R software to establish a nomogram model for the risk of postoperative AL in low rectal cancer. The area under the ROC curve was 0.940. H-L goodness of fit test showed that there was no significant difference between the predicted value of the model and the actual observed value (χ = 6.438, P = 0.598). The slope of the calibration curve was close to 1. The validation set showed that the nomogram model had good discrimination and consistency. The DCA curve showed that the model had high clinical utility and net benefit when the risk threshold was between 0.08 and 0.85.
Gender, NRS2002 rating, diverting ostomy, distance from tumor to anal margin, and operation time are all influencing factors of postoperative AL in low rectal cancer. The nomogram prediction model based on Lasso-Logistic regression has high consistency, discrimination and clinical application value.
基于Lasso-Logistic回归构建预测低位直肠癌术后吻合口漏（AL）风险的列线图模型。
选取2017年6月至2023年5月在我院接受低位直肠癌手术的482例直肠癌患者作为训练集，选取2023年6月至2025年4月在我院接受低位直肠癌手术的127例直肠癌患者作为验证集。根据术后是否发生AL，将训练集患者分为AL组（n = 54）和非AL组（n = 428）。收集每组数据，采用Lasso-Logistic回归模型分析训练集中直肠癌患者术后AL的影响因素。采用H-L拟合优度检验、ROC曲线和校准曲线分析模型的判别能力和一致性。用验证集对列线图模型进行验证。采用DCA曲线评估模型的临床实用性。
在训练集中，与非AL组相比，AL组肿瘤分期≥T3的患者比例更高，手术时间更长；此外，行预防性造口的AL患者较少，肿瘤距肛缘的距离比非AL组短。（P < 0.05）。Lasso-Logistic回归分析显示，当惩罚系数λ = 0.02735463时，模型表现良好，性别（OR = 3.107）、NRS2002评分（OR = 8.619）、预防性造口（OR = 0.297）、肿瘤距肛缘距离（OR = 0.284）、手术时间（OR = 1.033）是低位直肠癌术后AL的影响因素（P < 0.05）。将这5个影响因素引入R软件，建立低位直肠癌术后AL风险的列线图模型。ROC曲线下面积为0.940。H-L拟合优度检验显示模型预测值与实际观察值之间无显著差异（χ = 6.438，P = 0.598）。校准曲线斜率接近1。验证集显示列线图模型具有良好的判别能力和一致性。DCA曲线显示，当风险阈值在0.08至0.85之间时，该模型具有较高的临床实用性和净效益。
性别、NRS2002评分、转流造口、肿瘤距肛缘距离和手术时间均为低位直肠癌术后AL的影响因素。基于Lasso-Logistic回归的列线图预测模型具有较高的一致性、判别能力和临床应用价值。
