【作者】 杨刚；

【导师】 周晓俊；

【作者基本信息】 苏州大学 ， 外科学（普通外科）（专业学位）， 2022， 硕士

【摘要】 目的:探讨结直肠癌术后短期并发症的影响因素;评价代谢综合征及其相关因素对结直肠癌术后短期并发症的影响作用,构建结直肠癌术后并发症预测模型并验证。方法:收集苏州大学附属第一医院胃肠外科2013年1月至2018年12月行结直肠癌根治术的919例患者的临床信息资料,统计其术后一月内并发症发生的情况,单因素、多因素Logistic回归分析代谢综合征及其相关因素对结直肠癌患者术后短期并发症的影响;采用R软件建立列线图模型,并进行内部验证评价模型的区分度、校准度和临床获益度。结果:本组919例患者中119例(12.9%)发生术后并发症;MS(Metabolic syndrom)组的术后并发症的发生率(17.9%)较非MS组(11.5%)高(P=0.014)。单因素分析显示MS、高血压、高血糖、肿瘤位置、年龄、手术时间、造口影响结直肠癌术后并发症的发生(P均<0.05),多因素分析显示高血糖、年龄、肿瘤位置、手术时间是术后发生并发症的独立危险因素(P均<0.05)。并由此建立的列线图模型经内部验证具有良好的区分度、校准度和临床获益度。结论:MS对结直肠癌术后并发症的发生有明显的影响作用,年龄、肿瘤位置、高血糖、手术时间是影响结直肠癌患者术后并发症的独立影响因素;基于多因素分析的结果建立的结直肠癌术后并发症预测模型能很好的预测结直肠癌术后的并发症的发生,对临床医生的临床决策具有一定的指导意义。目的:探讨代谢综合征及其组份和炎症反应相关参数对结直肠癌根治术后的生存预后的影响,和构建结直肠癌术后生存预测模型并验证。方法:收集苏州大学附属第一医院胃肠外科2013年1月至2018年12月行结直肠癌根治术的919例患者的临床信息资料,对其中术后满5年的684例结直肠癌患者进行随访调查;采用Kaplan-Meier法单因素和COX多因素回归分析代谢综合征及其组份和炎症指标及相关因素对684例结直肠癌患者术后无病生存期和总生存期的影响,并根据多因素分析结果构建预测模型,并进行内部验证模型的性能。结果:单因素分析结果显示:年龄、性别、高密度脂蛋白、BMI、肿瘤分期、肿瘤分化程度、淋巴结清扫数目、淋巴结转移情况、联合脏器切除、肿瘤浸润深度、术前治疗、复发转移、造口、术后化疗、NLR、SII、PLR、LMR、LDH与结直肠癌根治术后生存预后显著性关联;多因素生存分析结果显示:年龄、高密度脂蛋白、肿瘤分化程度、淋巴结转移情况、复发转移、造口、NLR、PLR与结直肠癌患者术后的总生存期和无病生存期有关;术后化疗与总生存期有关,淋巴结清扫数目与无病生存期有关;基于多因素分析结果纳入预测模型构建,并内部验证该模型具有良好的预测性能。结论:年龄、肿瘤分化程度、淋巴结转移情况、复发转移、造口、NLR、PLR是结直肠癌患者预后的独立危险因素;淋巴结清扫数目、术后化疗、高密度脂蛋白结直肠癌患者预后的独立保护因素;基于代谢相关指标及炎症反应参数建立的结直肠癌生存预后模型以列线图形式呈现,经内部验证显示模型性能良好,有助于帮助临床医生对术后患者制定个体化临床决策。更多还原

【Abstract】 Objective:To explore the influencing factors of short-term postoperative complications of colorectal cancer,to evaluate the effect of metabolic syndrome and its related factors on short-term postoperative complications of colorectal cancer,and to construct and verify the prediction model of postoperative complications of colorectal cancer.Methods:The clinical information of 919 patients who underwent radical resection of colorectal cancer from January 2013 to December 2018 in the Department of Gastrointestinal Surgery of the First Affiliated Hospital of Soochow University were collected.Multivariate Logistic regression analysis of the effects of metabolic syndrome and its related factors on short-term postoperative complications in patients with colorectal cancer;R software was used to establish a nomogram model,and internal validation was performed to evaluate the discrimination,calibration and clinical benefit of the model Spend.Results:Postoperative complications occurred in 119patients(12.9%).The incidence of postoperative complications in MS group(17.9%)was higher than that in non-MS group(11.5%)(P=0.014).Univariate analysis showed that MS,hypertension,hyperglycemia,tumor location,age,operation time and colostomy affected the occurrence of postoperative complications of colorectal cancer(all P<0.05).Multivariate analysis showed that hyperglycemia,age,tumor location and operation time were independent risk factors for postoperative complications(all P<0.05).The established nomogram model has been internally verified to have good differentiation,calibration and clinical benefit.Conclusion:MS has a significant effect on the development of postoperative complications in colorectal cancer.Age,tumor location,hyperglycemia and operation time are the independent influencing factors of postoperative complications in patients with colorectal cancer.The prediction model of based on the results of multivariate analysis can well predict the occurrence of postoperative complications of colorectal cancer and has a certain guiding significance for clinicians’ clinical decision-making.Objective:To investigate the impact of metabolic syndrome and its components and parameters related to inflammatory response on survival prognosis after radical colorectal cancer surgery,and to construct and validate a survival prediction model after colorectal cancer surgery.Methods:The clinical data of 919 patients who underwent radical resection of colorectal cancer in the Department of Gastrointestinal Surgery of the First Affiliated Hospital of Soochow University from January 2013 to December 2018 were collected.Among them,684 patients with colorectal cancer were followed up for 5 years.The effects of metabolic syndrome,its components,inflammatory indexes and related factors on the disease-free survival and overall survival of 684 patients with colorectal cancer were analyzed by Kaplan-Meier univariate and COX multivariate regression.The predictive model was constructed according to the results of multivariate analysis,and the performance of the model was verified internally.Results:Univariate analysis showed that age,sex,high density lipoprotein,BMI,tumor stage,tumor differentiation,number of lymph nodes dissection,lymph node metastasis,combined organ resection,depth of tumor invasion,preoperative treatment,recurrence and metastasis,colostomy,postoperative chemotherapy,NLR,SII,PLR,LMR,LDH were significantly associated with survival after radical resection of colorectal cancer.The results of multivariate survival analysis showed that age,high density lipoprotein,tumor differentiation,lymph node metastasis,recurrence and metastasis,colostomy,NLR and PLR were related to the overall survival and disease-free survival of patients with colorectal cancer,postoperative chemotherapy was related to overall survival,and the number of lymph node dissection was related to disease-free survival.Based on the results of multi-factor analysis,the prediction model is built,and the good prediction performance of the model is verified internally.Conclusion:Age,tumor differentiation,lymph node metastasis,recurrence and metastasis,colostomy,NLR and PLR were independent risk factors for the prognosis of patients with colorectal cancer,while number of lymph nodes dissection,postoperative chemotherapy and high density lipoprotein were independent protective factors for prognosis of patients with colorectal cancer.A prognostic model for colorectal cancer survival based on metabolism-related indicators and inflammatory response parameters is presented in the form of a line graph,which has been internally validated to show that the model performs well and helps clinicians to make individualized clinical decisions for postoperative patients更多还原