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. 2024 May 1;16(9):7733-7751.
doi: 10.18632/aging.205780. Epub 2024 May 1.

A real-world study was conducted to develop a nomogram that predicts the occurrence of anastomotic leakage in patients with esophageal cancer following esophagectomy

Chenglin Li  1 , Wei Song  2 , Jialing Zhang  2 , Zhongneng Xu  1 , Yonggang Luo  1
Affiliations

A real-world study was conducted to develop a nomogram that predicts the occurrence of anastomotic leakage in patients with esophageal cancer following esophagectomy

Chenglin Li et al. Aging (Albany NY). .

Abstract

Background: The incidence of anastomotic leakage (AL) following esophagectomy is regarded as a noteworthy complication. There is a need for biomarkers to facilitate early diagnosis of AL in high-risk esophageal cancer (EC) patients, thereby minimizing its morbidity and mortality. We assessed the predictive abilities of inflammatory biomarkers for AL in patients after esophagectomy.

Methods: In order to ascertain the predictive efficacy of biomarkers for AL, Receiver Operating Characteristic (ROC) curves were generated. Furthermore, univariate, LASSO, and multivariate logistic regression analyses were conducted to discern the risk factors associated with AL. Based on these identified risk factors, a diagnostic nomogram model was formulated and subsequently assessed for its predictive performance.

Results: Among the 438 patients diagnosed with EC, a total of 25 patients encountered AL. Notably, elevated levels of interleukin-6 (IL-6), IL-10, C-reactive protein (CRP), and procalcitonin (PCT) were observed in the AL group as compared to the non-AL group, demonstrating statistical significance. Particularly, IL-6 exhibited the highest predictive capacity for early postoperative AL, exhibiting a sensitivity of 92.00% and specificity of 61.02% at a cut-off value of 132.13 pg/ml. Univariate, LASSO, and multivariate logistic regression analyses revealed that fasting blood glucose ≥7.0mmol/L and heightened levels of IL-10, IL-6, CRP, and PCT were associated with an augmented risk of AL. Consequently, a nomogram model was formulated based on the results of multivariate logistic analyses. The diagnostic nomogram model displayed a robust discriminatory ability in predicting AL, as indicated by a C-Index value of 0.940. Moreover, the decision curve analysis provided further evidence supporting the clinical utility of this diagnostic nomogram model.

Conclusions: This predictive instrument can serve as a valuable resource for clinicians, empowering them to make informed clinical judgments aimed at averting the onset of AL.

Keywords: anastomotic leakage; esophageal cancer; immunology; inflammatory biomarkers; target.

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Conflict of interest statement

CONFLICTS OF INTEREST: The authors declare no conflicts of interest related to this study.

Figures

Figure 1
Figure 1
Study flowchart.
Figure 2
Figure 2
Hospital stay time between anastomotic leakage group and non-anastomotic leakage group. ***P < 0.001.
Figure 3
Figure 3
The receiver operating characteristic curve of inflammatory biomarkers in predicting anastomotic leakage in EC patients.
Figure 4
Figure 4
Forest plot of the parameters in the multivariate regression analysis.
Figure 5
Figure 5
Calibration and clinical use of a diagnostic nomogram for predicting anastomotic leakage in patients with EC.
Figure 6
Figure 6
Calibration curve of the nomogram model of anastomotic leakage in patients with EC.
Figure 7
Figure 7
Decision curve analysis of the nomogram model of anastomotic leakage in patients with EC.
See this image and copyright information in PMC

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