近端胃切除术后反流性食管炎危险因素分析及列线图预测模型构建

Risk factors analysis and construction of a nomogram prediction model for reflux esophagitis after proximal gastrectomy

摘要:

背景与目的 近端胃切除术是治疗胃上部早期胃癌及部分进展期胃癌的重要术式，但术后反流性食管炎（RE）的发生影响患者生活质量。目前，针对近端胃切除术后RE危险因素及风险预测模型的研究仍较少。本研究旨在分析近端胃切除术后RE发生的危险因素，并构建和验证列线图预测模型，为术后RE风险评估及个体化防治提供参考。方法 以2022年10月—2024年10月南阳医学高等专科学校第一附属医院接受近端胃切除胃癌根治术的100例胃癌患者为研究对象。根据术后6个月随访期间RE发生情况将患者分为RE组和非RE组，比较两组患者一般资料、肿瘤相关因素、手术相关因素及术后恢复情况。采用单因素分析和多因素Logistic回归分析筛选术后RE发生的独立危险因素，并基于独立危险因素构建列线图模型。采用受试者工作特征曲线、Hosmer-Lemeshow（H-L）检验及决策曲线分析评价模型预测性能。结果 100例患者中术后发生RE 24例（24.0%）。单因素分析显示，两组患者消化道重建方式、食管切除长度及术后胃排空障碍比较，差异有统计学意义（均P<0.05）。多因素Logistic回归分析显示，食管-胃前壁吻合（OR=5.842，95% CI=4.621~7.062）、食管切除长度增加（OR=2.735，95% CI=1.023~4.446）及术后胃排空障碍（OR=3.136，95% CI=1.035~5.237）是近端胃切除术后RE发生的独立危险因素（均P<0.05）。基于上述因素构建的列线图模型预测RE风险的曲线下面积为0.784（95% CI=0.701~0.858）；H-L检验显示模型拟合良好（χ²=1.434，P=0.261），决策曲线分析显示模型具有较好的临床应用价值。结论 消化道重建方式、食管切除长度及术后胃排空障碍与近端胃切除术后RE发生密切相关。基于上述因素构建的列线图模型具有较好的预测效能，可用于近端胃切除术后RE风险分层，并为临床制订个体化预防策略提供依据。

Abstract:

Background and Aims Proximal gastrectomy is an important surgical procedure for upper gastric cancer; however, postoperative reflux esophagitis (RE) remains a common complication that significantly affects patients' quality of life. Few studies have investigated the risk factors and prediction models for RE after proximal gastrectomy. This study aimed to identify independent risk factors for postoperative RE and to construct and validate a nomogram for individualized risk prediction.Methods A total of 100 patients with gastric cancer who underwent radical proximal gastrectomy between October 2022 and October 2024 were enrolled. Patients were divided into the RE group and the non-RE group according to the occurrence of RE during the 6-month follow-up. Clinical characteristics, tumor-related factors, surgical factors, and postoperative complications were compared between groups. Independent risk factors for postoperative RE were identified using univariate analysis and multivariate Logistic regression analysis. A nomogram model was developed based on independent risk factors and evaluated using receiver operating characteristic (ROC) curve analysis, the Hosmer-Lemeshow (H-L) test, and decision curve analysis.Results Among the 100 patients, 24 (24.0%) developed postoperative RE. Significant differences were observed between the RE and non-RE groups regarding digestive tract reconstruction methods, esophageal resection length, and postoperative gastric emptying disorder (all P<0.05). Multivariate Logistic regression analysis demonstrated that anterior esophagogastric anastomosis (OR=5.842, 95% CI=4.621-7.062), longer esophageal resection length (OR=2.735, 95% CI=1.023-4.446), and postoperative gastric emptying disorder (OR=3.136, 95% CI=1.035-5.237) were independent risk factors for postoperative RE. The nomogram model showed good predictive performance, with an area under the ROC curve (AUC) of 0.784 (95% CI=0.701-0.858). The H-L test indicated good calibration (χ²=1.434, P=0.261), and decision curve analysis demonstrated favorable clinical utility.Conclusion Digestive tract reconstruction methods, esophageal resection length, and postoperative gastric emptying disorder are independent risk factors for RE after proximal gastrectomy. The proposed nomogram model may provide an effective tool for risk stratification and individualized prevention of postoperative RE.