影响食管肿瘤内镜黏膜下剥离术后电凝综合征发生的相关因素分析

doi:10.3760/cma.j.cn371439-20240727-00103

摘要/Abstract

摘要：

目的分析食管肿瘤内镜黏膜下剥离术（ESD）后电凝综合征（PEECS）发生的影响因素，基于此构建列线图预测模型并进行验证。方法选取2018年10月至2024年5月于西安医学院第一附属医院、陕西省渭南市华州区人民医院和陕西省城固县医院收集的240例行食管肿瘤ESD的患者作为研究对象，采用R软件中“caret”包的“createDataPartition”按照7:3的比例将患者分为建模组和验证组，采用单因素及多因素logistic回归分析建模组食管肿瘤PEECS发生的相关因素并构建列线图预测模型，采用一致性指数（C-index）和校正曲线对预测模型进行验证。结果建模组（n=168）和验证组（n=72）所有资料均具有可比性。单因素分析显示，性别（OR=2.15，95%CI为1.38~3.76，P=0.004）、年龄（OR=2.53，95%CI为1.39~4.61，P=0.001）、手术时间（OR=5.88，95%CI为2.15~8.41，P<0.001）和病变长径（OR=5.16，95%CI为1.85~7.33，P<0.001）均是食管肿瘤PEECS发生的影响因素。多因素分析显示，性别（OR=2.94，95%CI为1.46~5.33，P=0.011）、年龄（OR=2.12，95%CI为1.20~3.88，P=0.042）、手术时间（OR=4.62，95%CI为2.11~7.26，P<0.001）和病变长径（OR=3.93，95%CI为1.78~5.94，P=0.003）均是食管肿瘤PEECS发生的独立影响因素。基于上述指标构建食管肿瘤发生PEECS的列线图预测模型，其C-index值为0.787（95%CI为0.692~0.863）。校准曲线显示，建模组作为内部验证，验证组作为外部验证，预测概率与实际发生概率均具有较好的一致性。结论性别、年龄、手术时间和病变长径均是食管肿瘤PEECS发生的独立影响因素，基于上述指标构建的列线图预测模型具有较高的预测效能。

关键词: 食管肿瘤, 内窥镜黏膜切除术, 内镜黏膜下剥离术后电凝综合征

Abstract:

Objective To analyze the factors related to the occurrence of electrocoagulation syndrome after esophageal tumor endoscopic submucosal dissection （ESD）， thus to construct and validate a nomogram prediction model. Methods A total of 240 patients who underwent esophageal tumor ESD in the First Affiliated Hospital of Xi'an Medical University， Huazhou District of Weinan City People's Hospital of Shaanxi Province， and Chenggu County Hospital of Shaanxi Province from October 2018 to May 2024 were selected as the study objects. The patients were divided into a modeling group and a validation group using the "createDataPartition" of caret package in R software at a ratio of 7:3. Univariate and multivariate logistic regression were used to analyze the factors related to the occurrence of esophageal tumor post-endoscopic submusocal dissection electrocoagulation syndrome （PEECS） in the modeling group， and the nomogram prediction model was constructed. C-index and calibration curve were used to verify the prediction model. Results All data in the modeling group （n=168） and the validation group （n=72） were comparable. Univariate analysis showed that gender （OR=2.15， 95%CI： 1.38-3.76， P=0.004）， age （OR=2.53， 95%CI： 1.39-4.61， P=0.001）， surgical time （OR=5.88， 95%CI： 2.15-8.41， P<0.001） and lesion length （OR=5.16， 95%CI： 1.85-7.33， P<0.001） were related factors influencing the occurrence of esophageal tumor PEECS. Multivariate analysis showed that gender （OR=2.94， 95%CI： 1.46-5.33， P=0.011）， age （OR=2.12， 95%CI： 1.20-3.88， P=0.042）， surgical time （OR=4.62， 95%CI： 2.11-7.26， P<0.001） and lesion length （OR=3.93， 95%CI： 1.78-5.94， P=0.003） were independent factors for the occurrence of esophageal tumor PEECS. Based on the above indexes， a nomogram prediction model for the occurrence of esophageal tumor PEECS was constructed， and its C-index value was 0.787 （95%CI： 0.692-0.863）. The calibration curve showed that with the modeling group as the internal verification and the validation group as the external verification， the predicted probability was in good agreement with the actual probability. Conclusion Gender， age， surgical time and lesion length are independent factors influencing the occurrence of esophageal tumor PEECS. The nomogram prediction model based on the above indexes has high predictive efficacy.

Key words: Esophageal neoplasms, Endoscopic mucosal resection, Post-endoscopic submucosal dissection electrocoagulation syndrome

谢超, 张明鑫, 路宁, 苗涛. 影响食管肿瘤内镜黏膜下剥离术后电凝综合征发生的相关因素分析[J]. 国际肿瘤学杂志, 2024, 51(10): 614-619.

Xie Chao, Zhang Mingxin, Lu Ning, Miao Tao. Analysis of related factors of electrocoagulation syndrome after esophageal tumor endoscopic submucosal dissection[J]. Journal of International Oncology, 2024, 51(10): 614-619.

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参考文献 17

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项目	建模组（n=168）	验证组（n=72）	χ²值	P值
性别
男	92	35	0.76	0.382
女	76	37	0.76	0.382
年龄（岁）
≤60	74	38	1.54	0.214
>60	94	34	1.54	0.214
BMI（kg/m²）
<24	116	46	0.61	0.434
≥24	52	26	0.61	0.434
高血压
无	115	43	1.71	0.191
有	53	29	1.71	0.191
冠心病
无	153	62	1.33	0.249
有	15	10	1.33	0.249
糖尿病
无	160	66	0.61	0.435
有	8	6	0.61	0.435
手术时间（min）
≤45	100	50	2.12	0.146
>45	68	22	2.12	0.146
病变长径（cm）
≤2	138	53	2.26	0.133
>2	30	19	2.26	0.133
病理类型
平滑肌瘤	79	32	0.14	0.713
早期鳞状细胞癌	89	40	0.14	0.713
食管病变部位
上段	10	6
中段	111	54	3.64	0.162
下段	47	12
术中出血
无	73	34	0.29	0.590
有	95	38	0.29	0.590
整块切除
无	16	5	0.42	0.517
有	152	67	0.42	0.517
PEECS
无	144	64	0.44	0.507
有	24	8	0.44	0.507

变量	β值	SE值	Wald χ²值	OR值（95%CI）	P值
性别
男				Ref
女	0.765	0.511	8.41	2.15（1.38~3.76）	0.004
年龄（岁）
≤60				Ref
>60	0.928	0.306	11.04	2.53（1.39~4.61）	0.001
BMI（kg/m²）
<24				Ref
≥24	-0.078	0.552	2.71	0.93（0.31~2.73）	0.095
高血压
无				Ref
有	0.128	0.604	0.38	1.14（0.35~3.71）	0.592
冠心病
无				Ref
有	0.103	0.258	0.62	1.10（0.47~2.01）	0.436
糖尿病
无				Ref
有	0.246	0.419	3.26	1.28（0.82~1.66）	0.085
手术时间（min）
≤45				Ref
>45	1.771	0.295	16.71	5.88（2.15~8.41）	<0.001
病变长径（cm）
≤2				Ref
>2	1.641	0.478	14.48	5.16（1.85~7.33）	<0.001
病理类型
平滑肌瘤				Ref
早期鳞状细胞癌	0.026	0.511	0.32	1.03（0.42~1.91）	0.581
食管病变部位
上段				Ref
中段	-0.140	0.369	1.55	0.87（0.22~1.56）	0.212
下段	0.117	0.517	0.41	1.12（0.47~1.99）	0.575
术中出血
无				Ref
有	0.176	0.228	2.25	1.19（0.78~2.85）	0.119
整块切除
无				Ref
有	0.337	0.411	2.85	1.40（0.93~3.12）	0.092

变量	β值	SE值	Wald χ²值	OR值（95%CI）	P值
性别（女）	1.077	0.364	6.42	2.94（1.46~5.33）	0.011
年龄（>60岁）	0.749	0.227	4.11	2.12（1.20~3.88）	0.042
手术时间（>45 min）	1.530	0.516	10.66	4.62（2.11~7.26）	<0.001
病变长径（>2 cm）	1.368	0.348	8.96	3.93（1.78~5.94）	0.003