Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 21, 2018; 24(39): 4499-4509
Published online Oct 21, 2018. doi: 10.3748/wjg.v24.i39.4499
Postoperative survival analysis and prognostic nomogram model for patients with portal hypertension
Ya-Fei Zhang, Hong Ji, Hong-Wei Lu, Le Lu, Lei Wang, Jin-Long Wang, Yi-Ming Li
Ya-Fei Zhang, Hong Ji, Hong-Wei Lu, Le Lu, Lei Wang, Jin-Long Wang, Yi-Ming Li, Department of General Surgery, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710004, Shaanxi Province, China
Author contributions: Li YM conceived the research and critically reviewed and revised the paper; Zhang YF, Ji H, Lu HW and Lu L designed the research and analysed the data; Zhang YF and Li YM performed the research; all authors participated in the operations; Zhang YF drafted the paper.
Supported by the National Natural Science Foundation of China, No. 81170454, No. 30772049 and No. 30571765.
Institutional review board statement: The study was reviewed and approved by the Second Affiliated Hospital of Xi’an Jiaotong University Institutional Review Board.
Informed consent statement: The requirement for written informed patient consent was waived due to the retrospective and anonymous nature of this study; all data were used only for statistical analysis.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this study.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yi-Ming Li, MD, Professor, Department of General Surgery, the Second Affiliated Hospital of Xi’an Jiaotong University, No. 157, Xiwu Road, Xi’an 710004, Shaanxi Province, China. liyiming@xjtu.edu.cn
Telephone: +86-29-87679746 Fax: +86-29-87679746
Received: August 8, 2018
Peer-review started: August 8, 2018
First decision: August 30, 2018
Revised: September 6, 2018
Accepted: October 5, 2018
Article in press: October 5, 2018
Published online: October 21, 2018
Processing time: 71 Days and 20.1 Hours
Abstract
AIM

To analyse the postoperative survival of patients with portal hypertension and determine the factors that influence survival and construct nomograms.

METHODS

We retrospectively followed 1045 patients who underwent splenectomy plus pericardial devascularisation (SPD) between January 2002 and December 2017. Two SPD types are used in our department: splenectomy plus simplified pericardial devascularisation (SSPD) and splenectomy plus traditional pericardial devascularisation (STPD). The Kaplan-Meier method and Cox regression analysis were used to evaluate the prognostic effects of multiple parameters on overall survival (OS), disease-specific survival (DSS) and bleeding-free survival (BFS). Significant prognostic factors were combined to build nomograms to predict the survival rate of individual patients.

RESULTS

Five hundred and fifty-seven (53.30%) patients were successfully followed with 192 in the SSPD group and 365 in the STPD group; 93 (16.70%) patients died, of whom 42 (7.54%) died due to bleeding. Postoperative bleeding was observed in 84 (15.10%) patients. The 5- and 10-year OS, DSS and BFS rates in the group of patients who underwent SSPD were not significantly different from those in patients who underwent STPD. Independent prognostic factors for OS were age, operative time, alanine transaminase level and albumin-bilirubin score. Independent prognostic factors for BFS were male sex, age, intraoperative blood loss and time to first flatus. Independent prognostic factors for DSS were the Comprehensive Complication Index and age. These characteristics were used to establish nomograms, which showed good accuracy in predicting 1-, 3- and 5-year OS and BFS.

CONCLUSION

SSPD achieves or surpasses the long-term survival effect of traditional pericardial devascularisation and is worthy of clinical promotion and application. Nomograms are effective at predicting prognosis.

Keywords: Nomogram; Portal hypertension; Pericardial devascularisation; Survival analysis

Core tip: The mortality and re-bleeding rate are still extremely high among patients with portal hypertension after splenectomy plus pericardial devascularisation. This study aimed to analyse the postoperative survival, identify risk factors, construct nomograms, and explore the clinical effect of splenectomy plus simplified pericardial devascularisation (SSPD). Five hundred and fifty-seven (53.30%) patients were successfully followed, and the results suggested that the 5- and 10-year overall survival, disease-specific survival and bleeding-free survival rates were not significantly different between patients who underwent SSPD and patients who underwent splenectomy plus traditional pericardial devascularisation. Age, operative time, alanine transaminase level and albumin-bilirubin score were independent prognostic factors influencing overall survival. Male sex, age, intraoperative blood loss and time to first flatus were independent prognostic factors influencing bleeding-free survival. Comprehensive Complication Index and age were independent prognostic factors influencing disease-specific survival.