老年结直肠癌患者化疗期间症状困扰的影响因素及列线图模型构建OA

Objective To explore the influencing factors of symptom distress in elderly patients during chemotherapy for colorectal cancer and to construct a nomogram model.Method A total of 217 elderly patients with colorectal cancer admitted to The Second People's Hospital of Huai'an from January 2022 to January 2025 were selected and divided into a training set(152 cases)and a validation set(65 cases)at a 7 vs.3 ratio.Select 87 elderly colorectal cancer patients admitted to Huai'an First People's Hospital from January 2022 to January 2025 as external validation.The symptom distress was assessed using the Chinese version of the M.D.Anderson symptom inventory(MDASI-C)gastrointestinal cancer-specific module.Multivariate Logistic regression analysis was employed to identify independent risk factors for symptom distress in elderly patients undergoing chemotherapy for colorectal cancer.A nomogram prediction model was constructed,and its discriminative ability,calibration,and clinical applicability were evaluated using receiver operator characteristic curve(ROC curve),Hosmer-Lemeshow goodness-of-fit,and decision curves,respectively.Result Among the 152 patients in the training set,97 cases experienced symptom distress,accounting for 63.82%.The results of univariate analysis showed that there were no significant differences in the proportion of body mass index,hypertension,diabetes mellitus,hyperlipidemia and smoking history between the two groups(all P＞0.05).There were significant differences in gender,age,family income,clinical stage,chemotherapy cycle,chemotherapy regimen,chemotherapy dosage,negative emotions and family support between the two groups(all P＜0.05).Through multiple Logistic regression analysis,gender,age,family income,clinical stage,chemotherapy cycle,chemotherapy drug dosage,negative emotions,and family support were identified as independent risk factors for symptom distress during chemotherapy in elderly patients with colorectal cancer(all P＜0.05).According to the ROC curve evaluation of the model's discrimination,the results showed that the AUC of the training set was 0.990(95%CI:0.980-1.000),the sensitivity was 96.4%,and the specificity was 95.5%;the AUC of the internal validation set was 0.991(95%CI:0.983-1.000),with a sensitivity of 97.9%and a specificity of 95.5%;the AUC of the external validation set was 0.969(95%CI:0.980-1.000),with a sensitivity of 92.5%and a specificity of 92.5%.The Hosmer-Lemeshow goodness of fit test was applied to evaluate the calibration of the model,and a calibration curve was drawn.The test results showed that the C-index index of the training set was 0.983(95%CI:0.954-1.000),the C-index of the internal validation set was 0.991(95%CI:0.962-1.000),and the C-index of the external validation set was 0.952(95%CI:0.923-0.981).The results of drawing clinical decision curves showed that the model can achieve high clinical application value and clinical benefits.Conclusion The incidence of symptom distress in elderly patients with colorectal cancer during chemotherapy is relatively high and is influenced by multiple factors.Constructing a Nomogram model can help clinical doctors identify high-risk patients with symptoms early and implement personalized prevention strategies,thereby reducing the occurrence of symptom distress.