Key result
A nomogram incorporating age, total cholesterol, extent of resection, duration of surgery, and oxycodone dose predicted the risk of postoperative pulmonary complications after gastrectomy with an AUC of 0.781 in the validation cohort.
Why the study?
Postoperative pulmonary complications are common after gastrectomy for gastric cancer, motivating the identification of perioperative risk factors and the development of a predictive nomogram.
Cohort (n=2,124)
No
Effect estimate: AUC 0.781 (95% CI 0.715-0.847)
A nomogram based on age, total cholesterol, extent of resection, duration of surgery, and oxycodone dose can effectively predict the risk of postoperative pulmonary complications in gastric cancer patients after elective gastrectomy.
Nomogram may stratify PPC risk after gastrectomy; hypothesis-generating and requires prospective validation.
Background: Postoperative pulmonary complications (PPCs) are common in gastric cancer patients after gastrectomy. The aim of our study was to investigate the perioperative risk factors and to develop a nomogram to identify patients who are at significant risk of PPCs. Methods: The clinical data of gastric cancer patients who underwent elective gastrectomy in the First Affiliated Hospital of Nanjing Medical University from 2017 to 2021 were retrospectively collected. All patients were randomly divided into a training and a validation cohort at a ratio of 7:3. Univariate and multivariate analysis were applied to identify the independent risk factors that might predict PPCs, and a nomogram was constructed. Both discrimination and calibration abilities were estimated by the area under a receiver operating characteristic curve (AUC) and calibration curves. The clinical effectiveness of the nomogram was further quantified with the decision curve analysis (DCA). Results: Of 2,124 included patients, one hundred and fifty patients (7.1%) developed PPCs. Binary logistic analysis showed that age > 65 years, higher total cholesterol level, longer duration of surgery, total gastrectomy, and the dose of oxycodone > 5.5 mg were independent risk factors for the occurrence of PPCs, which were contained in the nomogram. The predictive nomogram showed good discrimination and calibration [an AUC of 0.735 (95% CI: 0.687-0.783) in a training cohort and 0.781 (95% CI: 0.715-0.847) in a validation cohort]. The calibration curve and decision curve analysis showed a good agreement between nomogram predictions and actual observations. Conclusion: We developed a nomogram model based on age, total cholesterol, extent of resection, duration of surgery, and the dose of oxycodone to predict the risk of PPCs in gastric cancer patients after elective gastrectomy.
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Zhou et al. (2023) conducted a cohort in Gastric cancer (n=2,124). Perioperative risk factors (age > 65, lower total cholesterol, total gastrectomy, longer surgery duration, oxycodone > 5.5 mg) vs. Patients without these risk factors was evaluated on Predictive performance (AUC) of the nomogram for postoperative pulmonary complications in the validation cohort (AUC 0.781, 95% CI 0.715-0.847). A nomogram incorporating age, total cholesterol, extent of resection, duration of surgery, and oxycodone dose predicted the risk of postoperative pulmonary complications after gastrectomy with an AUC of 0.781 in the validation cohort.
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