关键词: 食管癌；老年；并发症；Clavien-Dindo；影响因素；列线图

Abstract: ObjectiveTo investigate the influencing factors of postoperative complications with Clavien-Dindo grade ≥Ⅲ in elderly patients with esophageal cancer and construct a line graph prediction model.Methods 376 esophageal cancer patients who underwent radical esophagectomy in our hospital from January 2021 to December 2022 were selected as the study subjects.According to the Claven Mindo surgical complication grading system,the groups were divided into two groups:Clavien Mindo grading ≥ Grade Ⅲ group (93 cases) and Clavien Mindo gradingLogistic regression were used to analyze the influencing factors of postoperative complications of esophageal cancer with Clavien-Dindo grade ≥Ⅲ,and establish a risk prediction column chart model using R 3.5.1 software; The discrimination and calibration of the area verification model under the ROC curve; Use calibration curves and Hosmer Lemeshoe goodness of fit tests to evaluate the fit of the column chart model.Results 376 patients with esophageal cancer,93 patients with Clavien-Dindo grade ≥Ⅲ had complications,accounting for 24.73%.The results of univariate analysis showed that chronic respiratory disease,intraoperative blood loss,surgical time,ASA grading,prognostic nutritional index,and Charlson comorbidities index were significantly correlated with postoperative complications in elderly esophageal cancer patients with Clavien Dundo grading ≥ grade Ⅲ (P<0.05).The results of the logistic multiple regression model showed that intraoperative bleeding volume,surgical time,ASA grading,prognostic nutritional index,and Charlson Comorbidity Index were independent risk factors for postoperative complications in elderly esophageal cancer patients with Clavien Dundo grading ≥ grade Ⅲ (all P<0.05)，Based on five variables,a nomogram prediction model for postoperative complications in elderly patients with esophageal cancer with Clavien-Dindo grade ≥Ⅲ was constructed.ROC curve analysis verified that the area under ROC curve was 0.835 (0.794~0.876),indicating a good differentiation of the model.The calibration curve is drawn.The slope of the calibration curve is close to 1,and the predicted probability is basically consistent with the actual probability.Hosmer-Lemeshow goodness of fit test,χ²=5.737,df=8,P=0.676.The analysis results of decision curve show that the threshold probability is less than 0.8 and the net benefit rate is greater than 0.Conclusion The prediction model based on 5 independent risks can reliably predict the probability of postoperative complications with Clavien-Dindo grade ≥Ⅲ,which is helpful to provide targeted preventive measures for high-risk patients and reduce the occurrence of complications with Clavien-Dindo grade ≥Ⅲ.

Key words: esophageal cancer;old age;complications;Clavien-Dindo;influencing factors;nomograph