个体化预测喉癌术后患者并发咽瘘风险列线图模型的构建

目的：构建个体化的喉癌术后患者发生咽瘘的风险预测列线图模型。方法：选取2018 年1 月至2021 年7月于温州医科大学附属第一医院行喉全切或喉部分切除术的患者252 例，按照术后是否发生咽瘘分为咽瘘组（n =49）和非咽瘘组（n =203），并对两组资料进行对比，利用单因素分析和Logistic回归分析探讨喉癌术后患者发生咽瘘的影响因素，建立风险预测模型并绘制列线图，采用一致性指数（C-index）、Calibration校准曲线及Hosmer-Lemeshow检验评估模型预测效果。结果：肿瘤分期、术前放疗史、存在营养风险、术中合并皮瓣修复是喉癌术后患者发生咽瘘的独立危险因素，计算C-index为0.842（95%CI =0.776～0.908），Calibration校准曲线证实模型预测结果与实际发生结果有较好一致性，Hosmer-Lemeshow拟合优度检验（χ2=7.564，P =0.477）。结论：肿瘤分期、术前放疗史、存在营养风险、术中合并皮瓣修复等因素可增加喉癌术后患者咽瘘的发生率，构建的列线图预测模型可以有效预测喉癌术后咽瘘的发生。

Construction of an individualized nomogram model for predicting the risk of pharyngocutaneous fistula in postoperative patients with laryngeal carcinoma

Objective: To construct an individualized nomogram model for predicting the risk of pharyngocutaneous fistula in postoperative patients with laryngeal carcinoma. Methods: Altogether 252 patients who underwent total laryngectomy or partial laryngectomy in the First Affiliated Hospital of Wenzhou Medical University from January 2018 to July 2021 were divided into pharyngocutaneous fistula group (n=49) and non-pharyngocutaneous fistula group (n=203) according to whether pharyngocutaneous fistula occurred after operation. The data were compared between the two groups. Univariate analysis and Logistic regression analysis were made of the influencing factors of pharyngocutaneous fistula in patients with laryngeal carcinoma after operation; the risk prediction model was established and the nomogram was drawn; C-index, calibration curve and Hosmer-Lemeshow test were used to evaluate the prediction value of the model. Results: Tumor stage, preoperative radiotherapy history, nutritional risk and intraoperative flap repair were independent risk factors for pharyngocutaneous fistula in patients with postoperative laryngeal carcinoma. The calculated C-index was 0.842 (95%CI=0.776-0.908). The calibration curve confirmed that the predicted results of the model were in good agreement with the actual results and Hosmer-Lemeshow goodness of fit test (χ2=7.564, P=0.477). Conclusion:Tumor stage, preoperative radiotherapy history, nutritional risk and intraoperative flap repair can increase the incidence of pharyngocutaneous fistula in patients with postoperative laryngeal carcinoma. The nomogram prediction model can effectively predict the incidence of pharyngocutaneous fistula after laryngeal carcinoma surgery.