行电视胸腔镜辅助手术的老年食管癌患者心血管不良反应发生风险的影响因素及列线图模型构建

李峰; 唐学虎; 曾棒; 陈明华

doi:10.19401/j.cnki.1007-3639.2023.03.012

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行电视胸腔镜辅助手术的老年食管癌患者心血管不良反应发生风险的影响因素及列线图模型构建

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- 行电视胸腔镜辅助手术的老年食管癌患者心血管不良反应发生风险的影响因素及列线图模型构建
- Influencing factors of cardiovascular adverse events risk in elderly patients with esophageal cancer undergoing video-assisted thoracoscopic surgery and nomogram prediction model construction
- 中国癌症杂志 2023年33卷第3期页码：282-287
- 作者机构：
  
  1. 丹江口市第一医院普胸外科，湖北十堰 442700
  2. 丹江口市第一医院麻醉科，湖北十堰 442700
- 作者简介：
  
  [ "李峰（ORCID: 0000-0002-8004-2483），硕士，副主任医师，丹江口市第一医院普胸外科副主任。" ]
  陈明华（ORCID: 0000-0003-0426-9165），本科，副主任医师，丹江口市第一医院麻醉科副主任。
- 基金信息：
- DOI：10.19401/j.cnki.1007-3639.2023.03.012
  中图分类号： R735.1
- 收稿：2022-06-30，
  
  修回：2022-10-10，
  
  纸质出版：2023-03-30
- 稿件说明：
移动端阅览
李峰, 唐学虎, 曾棒, 等. 行电视胸腔镜辅助手术的老年食管癌患者心血管不良反应发生风险的影响因素及列线图模型构建[J]. 中国癌症杂志, 2023,33(3):282-287.

Feng LI, Xuehu TANG, Bang ZENG, et al. Influencing factors of cardiovascular adverse events risk in elderly patients with esophageal cancer undergoing video-assisted thoracoscopic surgery and nomogram prediction model construction[J]. China Oncology, 2023, 33(3): 282-287.
李峰, 唐学虎, 曾棒, 等. 行电视胸腔镜辅助手术的老年食管癌患者心血管不良反应发生风险的影响因素及列线图模型构建[J]. 中国癌症杂志, 2023,33(3):282-287. DOI： 10.19401/j.cnki.1007-3639.2023.03.012.

Feng LI, Xuehu TANG, Bang ZENG, et al. Influencing factors of cardiovascular adverse events risk in elderly patients with esophageal cancer undergoing video-assisted thoracoscopic surgery and nomogram prediction model construction[J]. China Oncology, 2023, 33(3): 282-287. DOI： 10.19401/j.cnki.1007-3639.2023.03.012.

摘要

背景与目的：

电视胸腔镜手术中人工气胸的建立可能影响胸内压，使上腔静脉回流受阻，并导致住院期间心血管不良反应发生风险升高

；而老年食管癌患者因机能状态显著下降，在围手术期更易发生心血管不良反应，严重影响康复进程。本研究通过探讨行电视胸腔镜辅助手术的老年食管癌患者心血管不良反应发生风险的影响因素，并构建列线图模型，旨在为后续心血管不良反应预防及临床早期干预提供更多参考。

方法：

回顾性纳入2015年1月—2020年10月丹江口市第一医院收治的行电视胸腔镜辅助手术的老年食管癌患者共546例，根据围手术期是否发生心血管不良反应分组，分析相关临床资料，采用logistic回归模型评价患者心血管不良反应发生的独立影响因素，基于上述因素构建列线图预测模型，描绘受试者工作特征（receiver operating characteristic，ROC）曲线评价模型的预测效能。

结果：

546例患者中围手术期心血管不良反应共发生84例（15.38%）。单因素分析结果显示，美国麻醉医师协会（American Society of Anesthesiologists，ASA）分级、临床危险因素数量、血流动力学变化水平、气道压水平及中心静脉压（central venous pressure，CVP）水平均与患者心血管不良反应发生有关（

0.05）；多因素分析结果显示，ASA分级、临床危险因素数量、血流动力学变化水平及CVP水平均是患者心血管不良反应发生的独立影响因素（

0.05）。根据多因素分析证实心血管不良反应发生风险的独立影响因素构建列线图预测模型，描绘ROC曲线评价上述列线图模型用于患者心血管不良反应发生风险预测的曲线下面积（area under curve，AUC）为0.88（95% CI：0.81~0.97），灵敏度和特异度分别为87.26%和91.60%。

结论：

行电视胸腔镜辅助手术的老年食管癌患者多种因素与其心血管不良反应发生独立相关，其中ASA分级

Ⅲ级、临床危险因素数量

3个、血流动力学变化水平≥30%基础值、气道压水平

30 cm H

O及CVP水平

20 cm H

O人群发生风险更高；基于上述因素构建列线图模型具有良好的预测效能，可指导临床干预方案的制定。

Abstract

Background and purpose:

The establishment of artificial pneumothorax during video-assisted thoracoscopic surgery may affect the intrathoracic pressure

cause the obstruction of superior vena cava reflux

and lead to the increased risk of adverse cardiovascular events during hospitalization. However

elderly patients with esophageal cancer are more likely to have adverse cardiovascular events during the perioperative period due to the significant decline in functional status

which seriously affects the rehabilitation process. This study aimed to investigate the influencing factors of cardiovascular adverse events risk in elderly patients with esophageal cancer undergoing video-assisted thoracoscopic surgery and construct nomograph model to guide the formulation of clinical intervention plan.

Methods:

Five hundred and forty-six elderly patients with esophageal cancer undergoing video-assisted thoracoscopic surgery who were trea

ted in The First Hospital of Danjiangkou City were retrospectively chosen in the period from January 2015 to October 2020. All patients were grouped according to the occurrence of cardiovascular adverse events in perioperative period

the related clinical data were analyzed

and the independent influencing factors of cardiovascular adverse events were evaluated by logistic regression model. Based on the above factors

the nomogram prediction model was constructed and receiver operating characteristic (ROC) curve was drawn to evaluate the prediction efficiency of nomogram model.

Results:

Eighty-four cases (15.38%) had perioperative cardiovascular adverse events in all 546 patients. Univariate analysis showed that American Society of Anesthesiologists (ASA) grade

the number of clinical risk factors

the level of hemodynamic changes

the level of airway pressure and the level of central venous pressure (CVP) were all related to the occurrence of cardiovascular adverse events (

0.05). Multivariate analysis showed that ASA classification

the number of clinical risk factors

the level of hemodynamic changes and CVP were the independent influencing factors of cardiovascular adverse events (

0.05). The nomogram prediction model was constructed according to the independent influencing factors of cardiovascular adverse event risk confirmed by multivariate analysis. The area under curve (AUC) of above nomogram model for predicting the risk of cardiovascular adverse events was 0.88 (95% CI: 0.81-0.97)

and the sensitivity and specificity were 87.26% and 91.60% respectively.

Conclusion:

The incidence of cardiovascular adverse events in elderly patients with esophageal cancer undergoing video-assisted thoracoscopic surgery is independently related to many factors

of which ASA grade

Ⅲ

number of clinical risk factors

hemodynamic change level ≥30%

airway pressure level

30 cm H

O and CVP level

20 cm H

O have higher ris

k. The nomogram model based on the above factors has good prediction efficiency and may guide the formulation of clinical intervention programs.

关键词

Keywords

references

OHI M , TOIYAMA Y , OMURA Y , et al . Risk factors and measures of pulmonary complications after thoracoscopic esophagectomy for esophageal cancer [J ] . Surg Today , 2019 , 49 ( 2 ): 176 - 186 . DOI: 10.1007/s00595-018-1721-0 http://doi.org/10.1007/s00595-018-1721-0

NACHIRA D , MEACCI E , MASTROMARINO M G , et al . Initial experience with uniportal video-assisted thoracic surgery esophagectomy [J ] . J Thorac Dis , 2018 , 10 ( Suppl 31 ): S3686 - S3695 . DOI: 10.21037/jtd http://doi.org/10.21037/jtd http://jtd.amegroups.com/ http://jtd.amegroups.com/

SCHMIDT H M , GISBERTZ S S , MOONS J , et al . Defining benchmarks for transthoracic esophagectomy: a multicenter analysis of total minimally invasive esophagectomy in low risk patients [J ] . Ann Surg , 2017 , 266 ( 5 ): 814 - 821 . DOI: 10.1097/SLA.0000000000002445 http://doi.org/10.1097/SLA.0000000000002445

ALDERSON D , CUNNINGHAM D , NANKIVELL M , et al . Neoadjuvant cisplatin and fluorouracil versus epirubicin, cisplatin, and capecitabine followed by resection in patients with oesophageal adenocarcinoma (UK MRC OE05): an open-label, randomised phase 3 trial [J ] . Lancet Oncol , 2017 , 18 ( 9 ): 1249 - 1260 . DOI: S1470-2045(17)30447-3 http://doi.org/S1470-2045(17)30447-3

CHEN J Y , LIU Q W , ZHANG X , et al . Comparisons of short-term outcomes between robot-assisted and thoraco-laparoscopic esophagectomy with extended two-field lymph node dissection for resectable thoracic esophageal squamous cell carcinoma [J ] . J Thorac Dis , 2019 , 11 ( 9 ): 3874 - 3880 . DOI: 10.21037/jtd.2019.09.05 http://doi.org/10.21037/jtd.2019.09.05

JIN D C , YAO L , YU J , et al . Robotic-assisted minimally invasive esophagectomy versus the conventional minimally invasive one: a meta-analysis and systematic review [J ] . Int J Med Robot , 2019 , 15 ( 3 ): e 1988.

CHAO Y K , WEN Y W , CHUANG W Y , et al . Transition from video-assisted thoracoscopic to robotic esophagectomy: a single surgeon's experience [J ] . Dis Esophagus , 2020 , 33 ( 2 ): doz033 .

CHAO Y K , LI Z G , WEN Y W , et al . Robotic-assisted Esophagectomy vs Video-Assisted Thoracoscopic Esophagectomy (REVATE): study protocol for a randomized controlled trial [J ] . Trials , 2019 , 20 ( 1 ): 346 . DOI: 10.1186/s13063-019-3441-1 http://doi.org/10.1186/s13063-019-3441-1

CHAI T C , SHEN Z M , CHEN S , et al . Right versus left thoracic approach oesophagectomy for oesophageal cancer: a systematic review and meta-analysis protocol [J ] . BMJ Open , 2019 , 9 ( 7 ): e030157.

HAYASHI M , TAKEUCHI H , NAKAMURA R , et al . Determination of the optimal surgical procedure by identifying risk factors for pneumonia after transthoracic esophagectomy [J ] . Esophagus , 2020 , 17 ( 1 ): 50 - 58 . DOI: 10.1007/s10388-019-00692-x http://doi.org/10.1007/s10388-019-00692-x

SALEM A I , THAU M R , STROM T J , et al . Effect of body mass index on operative outcome after robotic-assisted Ivor-Lewis esophagectomy: retrospective analysis of 129 cases at a single high-volume tertiary care center [J ] . Dis Esophagus , 2017 , 30 ( 1 ): 1 - 7 . DOI: 10.1111/dote.12476 http://doi.org/10.1111/dote.12476

HUANG L Y , CHEN C , LIN M Q , et al . Understanding the pattern of lymph node metastasis for trans-segmental thoracic esophageal cancer to develop precise delineation of clinical target volume for radiotherapy [J ] . Ann Palliat Med , 2020 , 9 ( 3 ): 788 - 794 . DOI: 10.21037/apm.2020.04.10 http://doi.org/10.21037/apm.2020.04.10

AKIYAMA Y , SASAKI A , ENDO F , et al . Outcomes of esophagectomy after chemotherapy with biweekly docetaxel plus cisplatin and fluorouracil for advanced esophageal cancer: a retrospective cohort analysis [J ] . World J Surg Oncol , 2018 , 16 ( 1 ): 122 . DOI: 10.1186/s12957-018-1420-8 http://doi.org/10.1186/s12957-018-1420-8

NAKAJIMA M , MUROI H , KIKUCHI M , et al . Salvage esophagectomy combined with partial aortic wall resection following thoracic endovascular aortic repair [J ] . Gen Thorac Cardiovasc Surg , 2018 , 66 ( 12 ): 736 - 743 . DOI: 10.1007/s11748-018-1013-z http://doi.org/10.1007/s11748-018-1013-z

HAISLEY K R , ABDELMOATY W F , DUNST C M . Laparoscopic transhiatal esophagectomy for invasive esophageal adenocarcinoma [J ] . J Gastrointest Surg , 2021 , 25 ( 1 ): 9 - 15 . DOI: 10.1007/s11605-019-04506-4 http://doi.org/10.1007/s11605-019-04506-4

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