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2026, 01, v.24 18-24+123-125
基于肌肉减少性肥胖的结直肠癌术后并发症风险预测模型的构建
基金项目(Foundation): 石河子大学第一附属医院院级课题(BS2024003)
邮箱(Email): yuanmingsg@126.com;
DOI: 10.27028/j.cnki.jbtmed.2026.01.005
摘要:

目的:探讨肌肉减少性肥胖(SO)与结直肠癌(CRC)术后并发症风险间的关联,并进行CRC术后并发症风险预测模型的构建。方法:纳入2017年11月至2020年10月在石河子大学第一附属医院接受根治性手术的467例Ⅰ~Ⅲ期CRC患者。将所有患者分为SO组和非SO组,比较两组临床病理资料差异。总数据按7:3比例随机分为训练集(327例)和验证集(140例)。利用LASSO回归和多因素logistic回归分析筛选变量并构建列线图预测模型。采用受试者工作特征(ROC)曲线、校准曲线、决策曲线分析(DCA)及临床影响曲线(CIC)分析对模型性能进行评估。结果:467例患者中,SO组82例,非SO组385例,两组在术后并发症上比较差异具有统计学意义(P<0.05)。LASSO-logistic回归分析显示:饮酒史、SO、手术方式、手术时间、术中失血量、癌胚抗原(CEA)均为术后总体并发症独立危险因素,术中输血是术后总体并发症独立保护因素。预测模型在训练集和验证集的ROC曲线下面积(AUC)分别为0.799和0.757。校准曲线显示模型预测风险和实际风险一致性良好,DCA和CIC分析均表明模型具有较好的临床实用性。结论:SO与CRC患者术后整体并发症风险升高有关,且本研究构建的术后并发症预测模型具有较好的效能,可以协助临床医生开展个性化诊疗。

Abstract:

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参考文献

[1]BRAY F,LAVERSANNE M,SUNG H,et al.Global cancer statistics 2022:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J].CA:A Cancer Journal for Clinicians,2024,74(3):229-263.

[2]HAN B,ZHENG R,ZENG H,et al.Cancer incidence and mortality in China, 2022[J].Journal of the National Cancer Center,2024,4(1):47-53.

[3]DEKKER E,TANIS P J,VLEUGELS J L A,et al.Colorectal cancer[J].The Lancet,2019,394(10207):1467-1480.

[4]KOEDAM T W A,BOOTSMA B T,DEIJEN C L,et al.Oncological Outcomes After Anastomotic Leakage After Surgery for Colon or Rectal Cancer:Increased Risk of Local Recurrence[J].Annals of Surgery,2022,275(2):e420-e427.

[5]XIAO J,CAAN B J,CESPEDES FELICIANO E M,et al.Association of Low Muscle Mass and Low Muscle Radiodensity With Morbidity and Mortality for Colon Cancer Surgery[J].JAMA Surgery,2020,155(10):942.

[6]LIU C,LIU T,DENG L,et al.Sarcopenic Obesity and Outcomes for Patients With Cancer[J].JAMA Network Open,2024,7(6):e2417115.

[7]YILDIZ KOPUZ T N,YILDIZ H F,ER S,et al.Prognostic Impact of Sarcopenic Obesity on Postoperative Outcomes in Colorectal Cancer Patients Undergoing Surgery:A Systematic Review and Meta-Analysis[J].Nutrition and Cancer,2025,77(3):360-371.

[8]BAJAWI M,CORRAL S,BLÁZQUEZ J,et al.Impact of CT-measured sarcopenic obesity on postoperative outcomes following colon cancer surgery[J].Langenbeck’s Archives of Surgery,2024,409(1):42.

[9]WANG W,FANG F,WANG T,et al.The impact of sarcopenic obesity on the prevalence and prognosis of nonmetastatic colorectal cancer:A systematic review and metaanalysis[J].Clinical Nutrition ESPEN,2025,69:492-502.

[10]中华人民共和国国家卫生健康委员会医政司.肥胖症中国诊疗指南(2024年版)[J].协和医学杂志,2025,16(1):90-108.

[11]MARTIN L,BIRDSELL L,MACDONALD N,et al.Cancer Cachexia in the Age of Obesity:Skeletal Muscle Depletion Is a Powerful Prognostic Factor, Independent of Body Mass Index[J].Journal of Clinical Oncology,2013,31(12):1539-1547.

[12]MA Y C,LI X P,LIN X Y,et al.Role of immunity and inflammation in sarcopenic obesity[J].The Journal of Nutritional Biochemistry,2025,146:110077.

[13]JANG S Y,CHOI K M.Impact of Adipose Tissue and Lipids on Skeletal Muscle in Sarcopenia[J].Journal of Cachexia, Sarcopenia and Muscle,2025,16(4):e70000.

[14]JIA G,SOWERS J R.Increased Fibro-Adipogenic Progenitors and Intramyocellular Lipid Accumulation in Obesity-Related Skeletal Muscle Dysfunction[J].Diabetes,2019,68(1):18-20.

[15]FRANGOS S M,BISHOP D J,HOLLOWAY G P.Revisiting the contribution of mitochondrial biology to the pathophysiology of skeletal muscle insulin resistance[J].Biochemical Journal,2021,478(21):3809-3826.

[16]RAZI O,ZAMANI N,SAEIDI A,et al.Muscle Insulin Resistance Elicits Muscle Atrophy in Obesity[J].Current Obesity Reports,2025,14(1):80.

[17]KALINKOVICH A,LIVSHITS G.Sarcopenic obesity or obese sarcopenia:A cross talk between age-associated adipose tissue and skeletal muscle inflammation as a main mechanism of the pathogenesis[J].Ageing Research Reviews,2017,35:200-221.

[18]ANGUS R,LEOW T W,HUMES D,et al.The relationship gastrointestinal surgery:a systematic review and meta-analysis[J].Alcohol and Alcoholism,2025,60(2):agaf002.

[19]KULKARNI N,ARULAMPALAM T.Laparoscopic surgery reduces the incidence of surgical site infections compared to the open approach for colorectal procedures:a meta-analysis[J].Techniques in Coloproctology,2020,24(10):1017-1024.

[20]KUO C Y,LEE C Y,KUNG C H,et al.A Predictive Model for Anastomotic Complications After SphincterPreserving Surgery for Rectal Cancer:Integrating Clinical and Anatomical Risk Factors[J].Diseases of the Colon&Rectum,2025,68(11):1296.

[21]JIANG W,XIA Y,LIU Y,et al.Impact of Preoperative Neutrophil to Prealbumin Ratio Index(NPRI)on ShortTerm Complications and Long-Term Prognosis in Patients Undergoing Laparoscopic Radical Surgery for Colorectal Cancer[J].Mediators of Inflammation,2024,2024:4465592.

[22]MORRIS F J D,FUNG Y L,CRASWELL A,et al.Outcomes following perioperative red blood cell transfusion in patients undergoing elective major abdominal surgery:a systematic review and meta-analysis[J].British Journal of Anaesthesia,2023,131(6):1002-1013.

[23]UNAL D,SENAYLI Y,POLAT R,et al.Peri-operative blood transfusion in elective major surgery:incidence,indications and outcome–an observational multicentre study[J].Blood Transfusion,2020,18(4):261-279.

[24]WARNER M A,HANSON A C,SCHULTE P J,et al.Preoperative Anemia&Postoperative Outcomes in Cardiac Surgery:A Mediation Analysis Evaluating Intraoperative Transfusion Exposures[J].Anesthesia and analgesia,2024,138(4):728-737.

[25]MUFTI H,ALSHARM F,BAHAWI M,et al.The association between preoperative anemia, blood transfusion need, and postoperative complications in adult cardiac surgery,a single center contemporary experience[J].Journal of Cardiothoracic Surgery,2023,18:10.

[26]XIANG Y C,LIU X Y,HAI Z X,et al.Nomogram for predicting the development of pneumonia after colorectal cancer surgery[J].Scientific Reports,2025,15(1):7417.

[27]OU Y,YANG Y,YANG W,et al.Analysis of risk factors and establishment of early warning model for recent postoperative complications of colorectal cancer[J].Frontiers in Oncology,2024,14:1411817.

[28]KAW P,KUMAR A.Predictive model for early postoperative stomal complications in colorectal cancer:A systematic review[J].World Journal of Gastrointestinal Oncology,2025,17(8):e1089.

[29]ZHENG H,LIU Y,CHEN Z,et al.Novel nomogram for predicting risk of early postoperative small bowel obstruction after right colectomy for cancer[J].World Journal of Surgical Oncology,2022,20(1):19.

[30]XIE H,WEI L,YUAN G,et al.Prognostic Value of Prognostic Nutritional Index in Patients With Colorectal Cancer Undergoing Surgical Treatment[J].Frontiers in Nutrition,2022,9:794489.

基本信息:

DOI:10.27028/j.cnki.jbtmed.2026.01.005

中图分类号:R735.34

引用信息:

[1]吴晓宇,徐佳鑫,衡怡鑫,等.基于肌肉减少性肥胖的结直肠癌术后并发症风险预测模型的构建[J].兵团医学,2026,24(01):18-24+123-125.DOI:10.27028/j.cnki.jbtmed.2026.01.005.

基金信息:

石河子大学第一附属医院院级课题(BS2024003)

发布时间:

2026-03-30

出版时间:

2026-03-30

引用

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