卵巢癌患者肿瘤细胞减灭术异体输血危险因素分析及预测模型构建OA

Objective To explore the independent risk factors of allogeneic blood transfusion during perioperative peri-od of cytoreductive surgery in patients with ovarian cancer,and to construct a predictive model to facilitate clinical risk as-sessment and optimize perioperative blood management.Methods Clinical data of 156 patients who underwent cytoreduc-tive surgery for ovarian cancer in our hospital from January 2020 to December 2025 were retrospectively collected.The pa-tients were divided into transfusion group(n=51)and non-transfusion group(n=105)according to whether they received allogeneic blood transfusion during perioperative period.The 1∶1 propensity score matching(PSM)was used to correct the confounding factors.Independent sample t test or Mann-Whitney U test was used for measurement data,and chisquare test was used for enumeration data.Variables with P<0.05 in univariate analysis were included in binary logistic regression for multivariate analysis to determine independent risk factors.A nomogram model for perioperative allogeneic blood transfusion risk prediction was constructed based on independent risk factors.Bootstrap method(100 samples)was used for internal calibration verification.ROC curve was used to evaluate the discrimination efficiency,and decision curve analysis(DCA)was used to evaluate the clinical net benefit of the model.Results After propensity matching,the baseline data of the two groups were balanced and comparable.Multivariate logistic regression analysis showed that preoperative prothrombin time(PT)(OR=2.666,95%CI 1.249～5.693,P=0.011),preoperative hemoglobin(Hb)(OR=0.953,95%CI 0.923～0.984,P=0.003),intraoperative blood loss(OR=1.004,95%CI 1.001-1.006,P=0.004),preoperative anemia grade(OR=3.052,95%CI 1.007-9.252,P=0.049)were independent influencing factors of perioperative allogeneic blood transfusion.The nomogram model based on the above four factors was significant(LR χ2=58.617,P<0.001),and the internal calibration curve showed that the predicted probability of the model was in good agreement with the actual probabili-ty(mean absolute error=0.042).The area under the ROC curve(AUC)was 0.890,indicating good discrimination effi-ciency.DCA showed that the clinical net benefit of the model was better than that of the unified transfusion/non-transfusion strategy in the 0-0.45 risk threshold range.Conclusion Intraoperative blood loss,preoperative PT,preoperative Hb and preoperative anemia grade are independent risk factors for perioperative allogeneic blood transfusion in patients undergoing cytoreductive surgery for ovarian cancer.The nomogram model based on the above factors has good predictive efficacy and clinical hierarchical decision-making value,which can provide reference for clinical implementation of individualized blood management for high-risk patients and reduction of unnecessary blood transfusion rate.