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。

IF 5.8 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY United European Gastroenterology Journal Pub Date : 2024-10-11 DOI:10.1002/ueg2.12688
Zongting Gu, Yongxing Du, Yunjie Duan, Xiaohao Zheng, Chengfeng Wang, Jianwei Zhang
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引用次数: 0

摘要

背景:目前,胰腺导管腺癌(PDAC)患者胰十二指肠切除术(PD)后胃排空延迟(DGE)仍缺乏准确的预测模型。本研究的目的是建立一个简明的模型,以有效预测 DGE 的风险:这项回顾性队列研究的训练队列包括来自美国多中心 ACS-NSQIP 数据库的 1251 例连续接受胰腺切除术的 PDAC 患者。此外,该研究还纳入了来自中国国家癌症中心的 934 例连续接受 PDAC 患者的验证队列。分析共纳入了 46 项围手术期指标。然后建立了DGE风险分层(DGERS)模型,并使用Lasso-逻辑回归进行了验证:结果:经过拉索-逻辑回归筛选,我们确定了四个与 DGE 显著相关的独立预测因素:胰腺引流管拔除天数(HR,1.05;95% CI,1.02-1.08;P 结论:该研究确定了四个可独立增加 DGE 风险的因素:本研究发现了四个因素会独立增加PDAC患者PD术后DGE的发生率,包括胰腺引流管拔除天数、胰腺瘘、脓毒症/败血症休克和再次手术。基于这些发现,我们开发了一种个性化、简单明了的 DGERS,它能动态、精确地预测 DGE 风险,并能根据个人的风险特征对其进行有效分层。
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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.

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来源期刊
United European Gastroenterology Journal
United European Gastroenterology Journal GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
10.50
自引率
13.30%
发文量
147
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.
期刊最新文献
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