Abstract
The aim of this retrospective study was to develop and validate a nomogram for predicting the risk of post-operative pulmonary infection (POI) in gastric cancer (GC) patients following radical gastrectomy. 2469 GC patients who underwent radical gastrectomy were enrolled, and randomly divided into the development and validation groups. The nomogram was constructed based on prognostic factors using logistic regression analysis, and was internally and crossly validated by bootstrap resampling and the validation dataset, respectively. Concordance index (C-index) value and calibration curve were used for estimating the predictive accuracy and discriminatory capability. Sixty-five (2.63%) patients developed POI within 30 days following surgery, with higher rates of requiring intensive care and longer post-operative hospital stays. The nomogram showed that open operation, chronic obstructive pulmonary disease (COPD), intra-operative blood transfusion, tumor located at upper and/or middle third and longer operation time (≥4 h) in a descending order were significant contributors to POI risk. The C-index value for the model was 0.756 (95% CI: 0.675−0.837), and calibration curves showed good agreement between nomogram predictions and actual observations. In conclusion, a nomogram based on these factors could accurately and simply provide a picture tool to predict the incidence of POI in GC patients undergoing radical gastrectomy.
Highlights
Development and validation of a prognostic nomogram for predicting post-operative pulmonary infection in gastric cancer patients following radical gastrectomy
A nomogram based on these factors could accurately and provide a picture tool to predict the incidence of pulmonary infection (POI) in gastric cancer (GC) patients undergoing radical gastrectomy
CI: confidence interval eThese factors are continuous variables, and in univariate logistic analysis there are no reference category groups. In this retrospective study including a large cohort of GC patients who underwent curative gastrectomy from a single high-volume tertiary center in China, we found that the incidence of POI following radical gastrectomy for GC was 2.63%, which was similar to previous findings ranging from 1.1% to 3.6%3,4,7
Summary
Development and validation of a prognostic nomogram for predicting post-operative pulmonary infection in gastric cancer patients following radical gastrectomy. GC patients who underwent radical gastrectomy were enrolled, and randomly divided into the development and validation groups. A nomogram based on these factors could accurately and provide a picture tool to predict the incidence of POI in GC patients undergoing radical gastrectomy. Mortality and morbidity following radical gastrectomy for GC have reduced significantly with improvements of surgical techniques and peri-operative managements, post-operative pulmonary complications (PPCs), including post-operative pulmonary infection (POI), remain a clinically important event, especially among older or immuno-compromised patients[2]. With an incidence rate ranging from 1.1–12.3%3–7, PPCs have been identified to be associated with the largest attributable healthcare costs and hospital stays; even with increased peri-operative death[8,9]. There is a growing body of evidence that post-operative infectious
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