[1]徐迪,纪振华,程翔宇,等.早期喉癌患者术后并发吞咽困难风险列线图预测模型构建及验证[J].陕西医学杂志,2025,54(8):1056-1060,1065.[doi:DOI:10.3969/j.issn.1000-7377.2025.08.009]
　XU Di,JI Zhenhua,CHENG Xiangyu,et al.Construction and validation of a nomogram prediction model for postoperative dysphagia in patients with early-stage laryngeal cancer[J].,2025,54(8):1056-1060,1065.[doi:DOI:10.3969/j.issn.1000-7377.2025.08.009]
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早期喉癌患者术后并发吞咽困难风险列线图预测模型构建及验证

《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
54
期数:
2025年8期
页码:
1056-1060,1065
栏目:
临床研究
出版日期:
2025-08-05

文章信息/Info

Title:
Construction and validation of a nomogram prediction model for postoperative dysphagia in patients with early-stage laryngeal cancer
作者:
徐迪; 纪振华; 程翔宇; 葛青华
（海军军医大学第二附属医院耳鼻喉科，上海 200003）
Author(s):
XU Di; JI Zhenhua; CHENG Xiangyu; GE Qinghua
(Department of Otolaryngology,the Second Affiliated Hospital of Naval Medical University,Shanghai 200003,China)
关键词:
早期喉癌; 吞咽困难; 影响因素; 列线图; 预测模型
Keywords:
Early-stage laryngeal cancer; Dysphagia; Influencing factors; Nomogram; Prediction model
分类号:
R 739.65
DOI:
DOI:10.3969/j.issn.1000-7377.2025.08.009
文献标志码:
A
摘要:
目的：探讨早期喉癌术后并发吞咽困难的影响因素，并构建列线图预测模型。方法：选取本院收治并接受手术治疗的早期喉癌患者195例。根据洼田饮水试验分级将患者分为无吞咽困难组（133例）和吞咽困难组（62例）。通过单因素分析筛选指标，将其纳入多因素Logistic回归分析早期喉癌患者术后并发吞咽困难的影响因素。采用R软件构建预测模型，并绘制受试者工作特征(ROC)曲线评估模型预测效能；通过Bootstrap法进行内部验证；采用Hosmer-Lemeshow检验绘制校正曲线。结果：两组患者年龄、咽喉反流史、手术方式、张口受限程度及术后疼痛评分比较差异有统计学意义(均P<0.05)。年龄、咽喉反流史、手术方式、张口受限程度以及术后疼痛评分为早期喉癌患者术后并发吞咽困难的独立影响因素(均P<0.05)。基于上述指标构建列线图预测模型，模型一致性指数为0.798。模型拟合优度较好（Hosmer-Lemeshow χ2=8.231，P>0.05）。年龄、咽喉反流史、手术方式、张口受限程度、术后疼痛评分及列线图模型预测早期喉癌患者术后并发吞咽困难的曲线下面积(AUC)分别为0.741、0.751、0.702、0.860、0.723、0.936，其中列线图模型预测效能较好(均P<0.05)。结论：年龄、咽喉反流史、手术方式、张口受限程度以及术后疼痛评分为早期喉癌患者术后并发吞咽困难的影响因素，以此构建的列线图模型预测效能较好。
Abstract:
Objective:To investigate the influencing factors of postoperative dysphagia in patients with early-stage laryngeal cancer and construct a nomogram prediction model.Methods：A total of 195 patients with early-stage laryngeal cancer who underwent surgical treatment in our hospital were selected.Patients were divided into a non-dysphagia group (133 cases) and a dysphagia group (62 cases) based on the grading of the Wada water drinking test.Indicators were screened through univariate analysis and included in the multivariate logistic regression analysis to identify the influencing factors of postoperative dysphagia in patients with early-stage laryngeal cancer.A prediction model was constructed using R software,and the ROC curve was drawn to assess the model’s predictive efficacy.Internal validation was performed using the Bootstrap method,and the calibration curve was drawn using the Hosmer-Lemeshow test.Results:There were statistically significant differences between the two groups in age,history of laryngopharyngeal reflux,surgical approach,degree of mouth opening limitation,and postoperative pain score (all P<0.05).Age,history of laryngopharyngeal reflux,surgical approach,degree of mouth opening limitation,and postoperative pain score were identified as independent influencing factors of postoperative dysphagia in patients with early-stage laryngeal cancer (all P<0.05).A nomogram prediction model was constructed based on the above indicators,with a consistency index of 0.798.The model had good fit (Hosmer-Lemeshow χ2=8.231,P>0.05).The AUC of age,history of laryngopharyngeal reflux,surgical approach,degree of mouth opening limitation,postoperative pain score and the nomogram model for predicting postoperative dysphagia in early-stage laryngeal cancer patients were 0.741,0.751,0.702,0.860,0.723 and 0.936,respectively,with the nomogram model showing better predictive efficacy (all P<0.05).Conclusion:Age,history of laryngopharyngeal reflux,surgical approach,degree of mouth opening limitation,and postoperative pain score are influencing factors of postoperative dysphagia in patients with early-stage laryngeal cancer,and the nomogram model constructed based on these factors has good predictive efficacy.

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备注/Memo

备注/Memo:
国家耳鼻咽喉疾病临床医学研究中心开放课题（202300011）
更新日期/Last Update: 2025-08-04