头颈癌患者术前营养风险影响因素的分析及其预测模型的构建OA

Objective To identify independent influencing factors for preoperative nutritional risk in patients with head and neck cancer,construct a nomogram prediction model,and validate it.Methods A cross-sectional study was conducted by retrospectively collecting clinical data from 162 patients with head and neck cancer admitted to the Department of Otolaryngology Head and Neck Sur-gery of Drum Tower Hospital of Medical School of Nanjing University from October 2022 to October 2024.Nutritional Risk Screening 2002(NRS2002)was used for nutritional screening within 24 h of admission,and the incidence of nutritional risk was calculated.Univariate and multivariate Logistic regression analyses were employed to explore the influencing factors of preoperative nutritional risk in patients with head and neck cancer,and a nomogram prediction model for nutritional risk was con-structed.The performance of the nomogram model was evaluated by receiver operating characteristic(ROC)curves,calibration curves,conducting the Hosmer-Lemeshow goodness-of-fit test,and performing decision curve analysis(DCA).Results Among the 162 patients,68 had nutritional risk(nutritional risk group),and 94 had no nutritional risk(non-nutritional risk group).Multivariate logistic re-gression analysis revealed that living in urban areas was a protective factor(P=0.029).Clinical stage Ⅲ/Ⅳ,low body mass index(BMI),and low hemoglobin level were independent risk factors for nutritional risk(P＜0.05).The area under the ROC curve(AUC)of the nomogram model was 0.892(95％CI,0.840 to 0.944),with an optimal cut-off value of 0.656,corresponding to a sensi-tivity of 0.721 and a specificity of 0.947.The AUC in ten-fold cross-validation was 0.875(95％CI,0.777 to 0.973).The calibration curve showed that the predicted probability curve was basically consistent with the actual probability curve,and the Hosmer-Lemeshow test indicated a good model fit.DCA curve analysis demonstrated good clinical utility of the model.Conclusion The incidence of preoperative nutritional risk is relatively high in patients with head and neck cancer.Low BMI,clinical stage Ⅲ/Ⅳ,and low hemoglobin level are risk factors for preoperative nutritional risk,while living in urban areas is a protective factor.The nomogram model constructed based on these influencing factors has high predictive value for preoperative nutritional risk in patients with head and neck cancer and can provide a reference for clinical nutritional management.