个体化预测老年下咽癌术后吞咽障碍的风险列线图模型的建立及验证

目的 探究老年下咽癌术后吞咽障碍的危险因素,以便于临床能够针对性制定防治措施。方法 收集2013年1月至2020年9月进入我院进行手术治疗的70例老年下咽癌患者的临床资料进行回顾性分析,根据吞咽障碍的发生情况将所选患者分为正常组和吞咽障碍组,发生吞咽障碍的独立危险因素选择Logistic回归进行分析,并建立老年下咽癌术后吞咽障碍的风险列线图模型。结果 所选70例老年下咽癌患者有41例患者术后发生吞咽障碍,发生率为58.57%。由单因素分析结果可知,吞咽障碍组与正常组年龄、抽烟史、手术方式、肿瘤T分期及术后放疗情况的差异具有统计学意义(P＜0.05)。多因素Logistic回归分析显示,年龄、抽烟史、手术方式、肿瘤T分期及术后放疗为老年下咽癌患者接受手术治疗后发生吞咽障碍的独立危险因素(P＜0.05),且与老年下咽癌患者接受手术治疗后发生吞咽障碍高度相关。基于年龄、抽烟史、手术方式、肿瘤T分期及术后放疗等5项老年下咽癌患者术后吞咽障碍的独立危险因素,建立预测老年下咽癌患者术后吞咽障碍风险列线图模型,并对该模型进行验证,预测值和实测值基本一致,表明本研究的列线图预测模型的预测能力良好,同时本研究使用Bootstrap内部验证法对老年下咽癌患者术后吞咽障碍的列线图模型进行验证,C-index指数达0.899(95%CI:0.863~0.935),表明本研究列线图模型的精准度和区分度良好。结论 年龄、抽烟史、手术方式、肿瘤T分期及术后放疗为老年下咽癌患者接受手术治疗后发生吞咽障碍的独立危险因素,所建立的列线图模型预测能力和区分度良好,临床上可以据此采取针对性的措施对吞咽障碍进行防治。

Establishment and verfication of a nomogram model for individualized prediction of the risk of dysphagia after surgery for elderly hypopharyngeal carcinoma

Objective To explore the risk factors of dysphagia after surgery for the elderly with hypopharyngeal carcinoma,so as to make clinically targeted prevention and treatment measures. Methods Collected the clinical data of 70 elderly patients with hypopharyngeal carcinoma who entered our hospital for surgical treatment from January 2013 to September 2020 for retrospective analysis.According to the occurrence of dysphagia,the selected patients were divided into normal group and dysphagia group.The screening of independent risk factors for dysphagia was selected by Logistic regression for analysis,and a nomogram model of the risk of dysphagia after surgery for elderly hypopharyngeal cancer was established. Results Among the selected 70 elderly patients with hypopharyngeal cancer,41 patients developed dysphagia after surgery,the incidence was 58.57%.The results of univariate analysis showed that there were statistical differences between the dysphagia group and the normal group in age,smoking history,surgical methods,tumor T staging,and postoperative radiotherapy (P＜0.05).Multivariate logistic regression analysis showed that age,smoking history,surgical methods,tumor T staging,and postoperative radiotherapy were independent risk factors for dysphagia after surgery in elderly patients with hypopharyngeal cancer (P＜0.05).Swallowing disturbances in cancer patients after surgery are highly correlated.Based on five independent risk factors of postoperative dysphagia in elderly patients with hypopharyngeal cancer,including age,smoking history,surgical methods,tumor T staging and postoperative radiotherapy,a nomogram model for predicting the risk of postoperative dysphagia in elderly patients with hypopharyngeal cancer was established.The model was verified and the predicted value was basically the same as the measured value,indicating that the predictive ability of the nomogram prediction model of this study is relatively good.At the same time,this study uses the Bootstrap internal verification method to analyze the postoperative dysphagia in elderly patients with hypopharyngeal cancer.The line graph model was verified,and the C-index index reached 0.899 (95%CI:0.863~0.935),indicating that the accuracy and discrimination of the nomogram model in this study is relatively good. Conclusion Age,smoking history,surgical methods,tumor T staging and postoperative radiotherapy are independent risk factors fordysphagia after surgical treatment in elderly patients with hypopharyngeal cancer.The nomogram model established by the author has relatively good predictive ability and discrimination.Clinically,targeted measures can be taken based on the above five factors to prevent and treat dysphagia.