{"title":"胰十二指肠切除术后胰腺导管腺癌患者的胃排空延迟风险分层:一项国际验证队列研究。","authors":"Zongting Gu, Yongxing Du, Yunjie Duan, Xiaohao Zheng, Chengfeng Wang, Jianwei Zhang","doi":"10.1002/ueg2.12688","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Currently, there is still a lack of an accurate predictive model for delayed gastric emptying (DGE) following pancreaticoduodenectomy (PD) in patients with pancreatic ductal adenocarcinoma (PDAC). The aim of this study was to develop a concise model that could effectively predict the risk of DGE.</p><p><strong>Methods: </strong>This retrospective cohort study included a training cohort of 1251 consecutive PDAC patients who underwent PD from the US multicenter ACS-NSQIP database. Additionally, a validation cohort of 934 consecutive PDAC patients who underwent PD was included from the National Cancer Center in China. A total of 46 perioperative indicators were incorporated in the analysis. The DGE risk stratification (DGERS) model was then developed and validated using Lasso-logistic regression.</p><p><strong>Results: </strong>After screening using Lasso-logistic regression, we identified four independent predictors that were significantly correlated with DGE: days to pancreatic drain removal (HR, 1.05; 95% CI, 1.02-1.08; p < 0.001), pancreatic fistula (HR, 2.61; 95% CI, 1.65-4.12; p < 0.001), sepsis/septic shock (HR, 2.46; 95% CI, 1.52-3.91; p < 0.001), and reoperation (HR, 4.16; 95% CI, 2.27-7.57; p < 0.001). Based on these factors, we developed a nomogram to predict postoperative DGE. The model demonstrated excellent calibration and optimal performance in the validation cohorts (AUC, 0.73; 95% CI, 0.67-0.73). In the validation cohort, the DGERS exhibited significant risk stratification ability, with AUC values of 0.7, 0.61, and 0.74 for the low-, moderate-, and high-risk groups, respectively.</p><p><strong>Conclusions: </strong>This study identified four factors that independently increased the occurrence of DGE in patients with PDAC after PD, including days to pancreatic drain removal, pancreatic fistula, sepsis/septic shock, and reoperation. Based on these findings, we developed a personalized and straightforward DGERS that enables dynamic and precise prediction of DGE risk, allowing for effective stratification of individuals based on their risk profiles.</p>","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":null,"pages":null},"PeriodicalIF":5.8000,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Delayed gastric emptying risk stratification in patients with pancreatic ductal adenocarcinoma after pancreatoduodenectomy: An international validation cohort study.\",\"authors\":\"Zongting Gu, Yongxing Du, Yunjie Duan, Xiaohao Zheng, Chengfeng Wang, Jianwei Zhang\",\"doi\":\"10.1002/ueg2.12688\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Currently, there is still a lack of an accurate predictive model for delayed gastric emptying (DGE) following pancreaticoduodenectomy (PD) in patients with pancreatic ductal adenocarcinoma (PDAC). The aim of this study was to develop a concise model that could effectively predict the risk of DGE.</p><p><strong>Methods: </strong>This retrospective cohort study included a training cohort of 1251 consecutive PDAC patients who underwent PD from the US multicenter ACS-NSQIP database. Additionally, a validation cohort of 934 consecutive PDAC patients who underwent PD was included from the National Cancer Center in China. A total of 46 perioperative indicators were incorporated in the analysis. The DGE risk stratification (DGERS) model was then developed and validated using Lasso-logistic regression.</p><p><strong>Results: </strong>After screening using Lasso-logistic regression, we identified four independent predictors that were significantly correlated with DGE: days to pancreatic drain removal (HR, 1.05; 95% CI, 1.02-1.08; p < 0.001), pancreatic fistula (HR, 2.61; 95% CI, 1.65-4.12; p < 0.001), sepsis/septic shock (HR, 2.46; 95% CI, 1.52-3.91; p < 0.001), and reoperation (HR, 4.16; 95% CI, 2.27-7.57; p < 0.001). Based on these factors, we developed a nomogram to predict postoperative DGE. The model demonstrated excellent calibration and optimal performance in the validation cohorts (AUC, 0.73; 95% CI, 0.67-0.73). In the validation cohort, the DGERS exhibited significant risk stratification ability, with AUC values of 0.7, 0.61, and 0.74 for the low-, moderate-, and high-risk groups, respectively.</p><p><strong>Conclusions: </strong>This study identified four factors that independently increased the occurrence of DGE in patients with PDAC after PD, including days to pancreatic drain removal, pancreatic fistula, sepsis/septic shock, and reoperation. Based on these findings, we developed a personalized and straightforward DGERS that enables dynamic and precise prediction of DGE risk, allowing for effective stratification of individuals based on their risk profiles.</p>\",\"PeriodicalId\":23444,\"journal\":{\"name\":\"United European Gastroenterology Journal\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":5.8000,\"publicationDate\":\"2024-10-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"United European Gastroenterology Journal\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1002/ueg2.12688\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"United European Gastroenterology Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/ueg2.12688","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
Delayed gastric emptying risk stratification in patients with pancreatic ductal adenocarcinoma after pancreatoduodenectomy: An international validation cohort study.
Background: Currently, there is still a lack of an accurate predictive model for delayed gastric emptying (DGE) following pancreaticoduodenectomy (PD) in patients with pancreatic ductal adenocarcinoma (PDAC). The aim of this study was to develop a concise model that could effectively predict the risk of DGE.
Methods: This retrospective cohort study included a training cohort of 1251 consecutive PDAC patients who underwent PD from the US multicenter ACS-NSQIP database. Additionally, a validation cohort of 934 consecutive PDAC patients who underwent PD was included from the National Cancer Center in China. A total of 46 perioperative indicators were incorporated in the analysis. The DGE risk stratification (DGERS) model was then developed and validated using Lasso-logistic regression.
Results: After screening using Lasso-logistic regression, we identified four independent predictors that were significantly correlated with DGE: days to pancreatic drain removal (HR, 1.05; 95% CI, 1.02-1.08; p < 0.001), pancreatic fistula (HR, 2.61; 95% CI, 1.65-4.12; p < 0.001), sepsis/septic shock (HR, 2.46; 95% CI, 1.52-3.91; p < 0.001), and reoperation (HR, 4.16; 95% CI, 2.27-7.57; p < 0.001). Based on these factors, we developed a nomogram to predict postoperative DGE. The model demonstrated excellent calibration and optimal performance in the validation cohorts (AUC, 0.73; 95% CI, 0.67-0.73). In the validation cohort, the DGERS exhibited significant risk stratification ability, with AUC values of 0.7, 0.61, and 0.74 for the low-, moderate-, and high-risk groups, respectively.
Conclusions: This study identified four factors that independently increased the occurrence of DGE in patients with PDAC after PD, including days to pancreatic drain removal, pancreatic fistula, sepsis/septic shock, and reoperation. Based on these findings, we developed a personalized and straightforward DGERS that enables dynamic and precise prediction of DGE risk, allowing for effective stratification of individuals based on their risk profiles.
期刊介绍:
United European Gastroenterology Journal (UEG Journal) is the official Journal of the United European Gastroenterology (UEG), a professional non-profit organisation combining all the leading European societies concerned with digestive disease. UEG’s member societies represent over 22,000 specialists working across medicine, surgery, paediatrics, GI oncology and endoscopy, which makes UEG a unique platform for collaboration and the exchange of knowledge.