作者：滕玉芳1，杨华1，徐桂芳1，于铃1，陈亚楠2

单位：1.南京大学医学院附属鼓楼医院 消化内科，江苏 南京210008； 2.南京市高淳人民医院 消化内科，江苏 南京 211302

Authors:  Teng Yufang1, Yang Hua1, Xu Guifang1, Yu Ling1, Chen Yanan2

Unit:  1.Department of Gastroenterology, Nanjing Drum Tower Hospital The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu, China； 2.Department of Gastroenterology, Nanjing Gaochun People’s Hospital, Nanjing 210008, Jiangsu, China

摘要：

目的  探讨早期食管癌内镜黏膜下剥离术（endoscopic submucosal dissection, ESD）后并发食管狭窄的危险因素，建立列线图风险预测模型。方法  回顾性分析2018年1月至2022年12月在南京大学医学院附属鼓楼医院和南京市高淳人民医院消化内科行ESD治疗的921 例早期食管癌患者相关资料，采用单因素和多因素Logistic回归分析筛选，通过R 软件建立列线图预测模型并进行验证。结果  吸烟、饮酒、喜食腌制食物、喜食辛辣食物、喜食滚烫食物、血小板/淋巴细胞比值（platelet to lymphocyte ratio, PLR）＜100，环周比例＜1/2 均显著影响早期食管癌ESD 术后发生食管狭窄（P＜0.05），基于此建立列线图预测模型，受试者工作特性曲线（receiver operator characteristic curve, ROC）的曲线下面积为0.892（95%CI: 0.845~0.938），显示模型区分度较好，临床预测模型校准曲线显示模型精准度较好。结论  本研究中的列线图预测效果较好，有利于临床直观判断早期食管癌患者ESD 术后并发食管狭窄风险率，为早期干预提供参考。

关键词： 早期食管癌；内镜黏膜下剥离术；食管狭窄；列线图

Abstract：

Objective  To investigate the risk factors of postoperative esophageal stenosis in patients with early esophageal cancer undergoing endoscopic submucosal dissection (ESD), and to establish a risk prediction model based on a graph. Method The data of 921 patients with early esophageal cancer who received ESD treatment in the Department of Gastroenterology, Nanjing Drum Tower Hospital The Affiliated Hospital of Nanjing University Medical School and Nanjing Gaochun People's Hospital from January 2018 to December 2022 were retrospectively analyzed. Univariate and multifactor Logistic regression analysis was used for screening. The prediction model of line graph was constructed and verified by R software. Result Smoking, drinking, like pickled food, like spicy food, like hot food, platelet to lymphocyte ratio(PLR)＜100, circumferential ratio＜1/2 were the factors influencing esophageal stenosis after ESD operation for early esophageal cancer (P＜0.05). A Calibration curve model was established based on these 7 independent factors. The area under receiver operator characteristic curve(ROC) was 0.892 (95%CI: 0.845-0.938), and the calibration curve showed better model differentiation. Conclusion The column graph prediction model constructed in this study has a good prediction effect, which is conducive to the clinical intuitive judgment of the risk rate of postoperative esophageal stenosis in patients with early esophageal cancer undergoing ESD, and provides reference for early intervention.

Key Words:  Early esophageal carcinoma; Endoscopic submucosal dissection; Esophageal stenosis; Column diagram