Analysis of influencing factors of textbook outcome after pancreaticoduodenectomy and construction of nomogram model
10.3760/cma.j.cn113884-20240129-00035
- VernacularTitle:胰十二指肠切除术后达到教科书式结局的影响因素分析及列线图模型构建
- Author:
Changqian TANG
1
;
Yuqi GUO
;
Yongnian REN
;
Hengli ZHU
;
Zhuangzhuang YAN
;
Xingbo WEI
;
Yifan ZHI
;
Jizhen LI
;
Deyu LI
;
Liancai WANG
Author Information
1. 河南大学人民医院肝胆胰外科，郑州 450003
- Keywords:
Pancreaticoduodenectomy;
Textbook outcome;
Pancreatic ductal adenocarcinoma;
Influencing factors;
Nomograph model
- From:
Chinese Journal of Hepatobiliary Surgery
2024;30(6):439-444
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the influencing factors of achieving textbook outcome (TO) after pancreaticoduodenectomy (PD) in patients with pancreatic ductal adenocarcinoma, and to construct a nomograph model to explore its predictive value in TO.Methods:The clinical data of 205 patients with pancreatic ductal adenocarcinoma treated by PD in Henan University People's Hospital from January 2019 to December 2022 were analyzed retrospectively, including 88 males and 117 females with the age of (61.3±9.8) years old. Patients were divided into two groups based on whether they achieved TO after surgery: TO group ( n=113) and non-TO group ( n=92). Clinical data such as age, gender, intraoperative blood loss, operation time, blood transfusion volume, pancreatic CT value, and tumor differentiation degree were collected. Logistic regression analysis screened the influencing factors of PD postoperative TO and built a nomogram model. The performance of the nomogram model was evaluated using receiver operating characteristic (ROC) curve, calibration diagram, and decision curve analysis. Results:Multivariate logistic regression analysis showed that the higher the degree of tumor differentiation was in patients with pancreatic ductal adenocarcinoma (high differentiation to medium differentiation: OR=7.20, 95% CI: 1.20-43.28; high differentiation to low differentiation: OR=16.55, 95% CI: 2.01-136.11), CT value>38.45 Hu ( OR=0.29, 95% CI: 0.13-0.65), blood transfusion volume ≤350 ml ( OR=8.05, 95% CI: 2.94-22.01) and operative time ≤407.5 min ( OR=10.88, 95% CI: 3.90-30.41), the easier it was to achieve TO after PD (all P<0.05). Based on the above influencing factors, a nomogram model of the postoperative effect of PD on TO was established, and the consistency index of this column graph model was 0.863 (95% CI: 0.816-0.911). The sensitivity and specificity of ROC curve were 0.804 and 0.752, respectively. The calibration diagram showed that the calibration curve fits well with the ideal curve, and the decision curve showed that the model had obvious positive net benefit. Conclusion:The degree of tumor differentiation, CT value, blood transfusion volume, and operation time are independent influencing factors for the achievement of TO after PD in patients with pancreatic ductal adenocarcinoma, and the nomogram model constructed based on which has good predictive performance for TO.
