胰头十二指肠切除术后胰腺导管腺癌患者延迟胃排空的风险分层：一项国际验证队列研究

Delayed gastric emptying risk stratification in patients with pancreatic ductal adenocarcinoma after pancreatoduodenectomy: An international validation cohort study

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United European Gastroenterology Journal

影响因子:6.7

分区:医学2区 / 胃肠肝病学3区

发表日期:2025 May

作者: Zongting Gu, Yongxing Du, Yunjie Duan, Xiaohao Zheng, Chengfeng Wang, Jianwei Zhang

DOI: 10.1002/ueg2.12688

摘要

目前，尚缺乏一种准确预测胰头十二指肠切除术（PD）后胰腺导管腺癌（PDAC）患者延迟胃排空（DGE）风险的模型。本研究旨在开发一种简明有效的模型以预测DGE风险。本回顾性队列研究纳入了美国多中心ACS-NSQIP数据库中接受PD的1251例连续PDAC患者的训练队列。此外，还纳入了来自中国国家癌症中心的934例接受PD的连续PDAC患者的验证队列。分析中共纳入了46个围手术期指标。利用Lasso-logistic回归方法开发并验证了DGE风险分层（DGERS）模型。通过Lasso-logistic筛选，确定了与DGE显著相关的四个独立预测因素：胰腺引流管拔除的天数（HR，1.05；95% CI，1.02-1.08；p < 0.001）、胰腺瘘（HR，2.61；95% CI，1.65-4.12；p < 0.001）、败血症/感染性休克（HR，2.46；95% CI，1.52-3.91；p < 0.001）以及再手术（HR，4.16；95% CI，2.27-7.57；p < 0.001）。基于这些因素，我们开发了一个预测术后DGE的列线图。该模型在验证队列中表现出良好的校准性和优异的性能（AUC，0.73；95% CI，0.67-0.73）。在验证队列中，DGERS显示出显著的风险分层能力，低、中、高风险组的AUC值分别为0.7、0.61和0.74。本研究识别出四个独立增加PD后PDAC患者DGE发生风险的因素，包括胰腺引流管拔除天数、胰腺瘘、败血症/感染性休克和再手术。基于这些发现，我们开发了一种个性化且简便的DGERS，能够动态、精准地预测DGE风险，从而有效进行个体风险分层。

Abstract

Currently, there is still a lack of an accurate predictive model for delayed gastric emptying (DGE) following pancreaticoduodenectomy (PD) in patients with pancreatic ductal adenocarcinoma (PDAC). The aim of this study was to develop a concise model that could effectively predict the risk of DGE.This retrospective cohort study included a training cohort of 1251 consecutive PDAC patients who underwent PD from the US multicenter ACS-NSQIP database. Additionally, a validation cohort of 934 consecutive PDAC patients who underwent PD was included from the National Cancer Center in China. A total of 46 perioperative indicators were incorporated in the analysis. The DGE risk stratification (DGERS) model was then developed and validated using Lasso-logistic regression.After screening using Lasso-logistic regression, we identified four independent predictors that were significantly correlated with DGE: days to pancreatic drain removal (HR, 1.05; 95% CI, 1.02-1.08; p < 0.001), pancreatic fistula (HR, 2.61; 95% CI, 1.65-4.12; p < 0.001), sepsis/septic shock (HR, 2.46; 95% CI, 1.52-3.91; p < 0.001), and reoperation (HR, 4.16; 95% CI, 2.27-7.57; p < 0.001). Based on these factors, we developed a nomogram to predict postoperative DGE. The model demonstrated excellent calibration and optimal performance in the validation cohorts (AUC, 0.73; 95% CI, 0.67-0.73). In the validation cohort, the DGERS exhibited significant risk stratification ability, with AUC values of 0.7, 0.61, and 0.74 for the low-, moderate-, and high-risk groups, respectively.This study identified four factors that independently increased the occurrence of DGE in patients with PDAC after PD, including days to pancreatic drain removal, pancreatic fistula, sepsis/septic shock, and reoperation. Based on these findings, we developed a personalized and straightforward DGERS that enables dynamic and precise prediction of DGE risk, allowing for effective stratification of individuals based on their risk profiles.