肺癌患者胸腔镜下切除术术后气胸的影响因素及列线图预测模型构建OA
Influencing Factors for Postoperative Pneumothorax After Thoracoscopic Resection in Lung Cancer Patients and Development of A Nomogram Prediction Model
目的 探讨肺癌患者胸腔镜下切除术术后气胸发生的影响因素,并构建列线图预测模型.方法 选取2024年8月至2025年5月南京医科大学第一附属医院收治的224例肺癌患者作为研究对象,根据术后是否发生气胸分为气胸组(20例)和非气胸组(204例).采用多因素Logistic逐步回归分析肺癌患者胸腔镜下切除术术后气胸发生的影响因素;构建肺癌患者胸腔镜下切除术术后气胸发生的列线图模型并进行验证.结果 气胸组年龄≥60岁、身体质量指数≥24 kg/m2、临床分期Ⅱa～Ⅱb期、手术时间≥1.5 h、术前接受新辅助治疗、合并肺气肿比例、白细胞计数高于非气胸组,白蛋白水平及呼气峰流速低于非气胸组,差异均有统计学意义(P<0.05).年龄≥60岁(OR=1.976,95%CI:1.419～2.752)、手术时间≥1.5 h(OR=2.212,95%CI:1.527～3.204)、术前接受新辅助治疗(OR=2.732,95%CI:1.785～4.180)、合并肺气肿(OR=2.330,95%CI:1.587～3.422)、低水平白蛋白(OR=0.393,95%CI:0.259～0.597)是肺癌患者胸腔镜下切除术术后气胸发生的危险因素(P<0.05).列线图模型的一致性指数为0.885(95%CI:0.832～0.938),原始曲线位于理想曲线附近.列线图模型预测肺癌患者胸腔镜下切除术术后气胸发生的曲线下面积(95%CI)为0.904(0.851～0.957),特异度为0.682,灵敏度为0.918.结论 肺癌患者胸腔镜下切除术术后气胸发生的影响因素包括年龄、手术时间、术前接受新辅助治疗、合并肺气肿、白蛋白水平,以此构建的列线图模型在预测气胸方面具有较高的应用价值.
Objective To analyze the influencing factors of pneumothorax after thoracoscopic resection in lung cancer patients and construct a nomogram prediction model.Methods A total of 224 patients with lung cancer admitted to the First Affiliated Hospital of Nanjing Medical University from August 2024 to May 2025 were selected as the study subjects.They were divided into a pneumothorax group(n=20)and a non-pneumothorax group(n=204)based on the occurrence of postoperative pneumothorax.Multivariate logistic stepwise regression analysis was used to identify the influencing factors of postoperative pneumothorax after thoracoscopic resection in lung cancer patients.A nomogram model was constructed and validated.Results The pneumothorax group had a higher proportion of patients aged≥60 years,body mass index≥24 kg/m²,clinical stage Ⅱa-Ⅱb,operation time≥1.5 h,preoperative neoadjuvant therapy,and comorbid emphysema,along with higher white blood cell counts,lower albumin levels,and lower peak expiratory flow compared to the non-pneumothorax group.All differences were statistically significant(P<0.05).Age≥60 years(OR=1.976,95%CI:1.419-2.752),operation time≥1.5 h(OR=2.212,95%CI:1.527-3.204),preoperative neoadjuvant therapy(OR=2.732,95%CI:1.785-4.180),comorbid emphysema(OR=2.330,95%CI:1.587-3.422),and low albumin level(OR=0.393,95%CI:0.259-0.597)were risk factors for postoperative pneumothorax in lung cancer patients(P<0.05).The consistency index of the nomogram model was 0.885(95%CI:0.832-0.938).The calibration curve closely aligned with the ideal curve.The area under the curve(95%CI)of the nomogram for predicting postoperative pneumothorax was 0.904(0.851-0.957),with a specificity of 0.682 and a sensitivity of 0.918.Conclusion The influencing factors of postoperative pneumothorax after thoracoscopic resection in lung cancer patients include age,operation time,preoperative neoadjuvant therapy,comorbid emphysema,and albumin level.The constructed nomogram model has high application value in predicting pneumothorax.
高瑄瑄;夏阳;朱媛;储丽娟;张世希;赵慧;胡矜娜
南京医科大学第一附属医院(江苏省人民医院)胸外科,南京 210029南京医科大学第一附属医院(江苏省人民医院)胸外科,南京 210029南京医科大学第一附属医院(江苏省人民医院)胸外科,南京 210029南京医科大学第一附属医院(江苏省人民医院)胸外科,南京 210029南京医科大学第一附属医院(江苏省人民医院)胸外科,南京 210029南京医科大学第一附属医院(江苏省人民医院)胸外科,南京 210029南京医科大学第一附属医院(江苏省人民医院)胸外科,南京 210029
肺肿瘤手术气胸危险因素列线图
lung cancersurgerypneumothoraxrisk factorsnomogram
《转化医学杂志》 2026 (1)
6-10,5
国家自然科学基金(82372639)
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