Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Sep 27, 2023; 15(9): 1978-1985
Published online Sep 27, 2023. doi: 10.4240/wjgs.v15.i9.1978
Prediction model of stress ulcer after laparoscopic surgery for colorectal cancer established by machine learning algorithm
Dong-Mei Yu, Chun-Xiao Wu, Jun-Yi Sun, Hui Xue, Zhe Yuwen, Jiang-Xue Feng
Dong-Mei Yu, Hui Xue, School of Nursing, Hebei University of Traditional Chinese Medicine, Shijiazhuang 050000, Hebei Province, China
Chun-Xiao Wu, Jiang-Xue Feng, Department I of Anorectal, Hebei Traditional Chinese Medicine Hospital, Shijiazhuang 050000, Hebei Province, China
Jun-Yi Sun, Department of Inspection Center, Hebei Traditional Chinese Medicine Hospital, Shijiazhuang 050000, Hebei Province, China
Zhe Yuwen, Department of Perivascular, Hebei Traditional Chinese Medicine Hospital, Shijiazhuang 050000, Hebei Province, China
Author contributions: Yu DM designed and performed the research and wrote the paper; Feng JX designed the research and supervised the report; Yu DM and Feng JX designed the research and contributed to the analysis; Sun JY, Wu CX, Xue H and Yuwen Z provided clinical advice; Sun JY, Wu CX, Xue H and Yuwen Z supervised the report; all authors have read and approved the final version to be published.
Institutional review board statement: The study was reviewed and approved by the Hebei Traditional Chinese Medicine Hospital.
Informed consent statement: All study participants or their legal guardian provided informed written consent regarding personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: The authors declare no conflicts of interest for this article.
Data sharing statement: The data set for this study can be obtained from the corresponding author.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jiang-Xue Feng, BSc, Associate Chief Nurse, Department I of Anorectal, Hebei Traditional Chinese Medicine Hospital, No. 389 Zhongshan East Road, Chang'an District, Shijiazhuang 050000, Hebei Province, China. fengjiangxue0330@163.com
Received: May 31, 2023
Peer-review started: May 31, 2023
First decision: June 14, 2023
Revised: June 25, 2023
Accepted: July 19, 2023
Article in press: July 19, 2023
Published online: September 27, 2023
Processing time: 114 Days and 10.4 Hours
Abstract
BACKGROUND

Patients with colorectal cancer (CRC) are prone to stress ulcer after laparoscopic surgery. The analysis of risk factors for stress ulcer (SU) in patients with CRC is important to reduce mortality and improve patient prognosis.

AIM

To identify risk factors for SU after laparoscopic surgery for CRC, and develop a nomogram model to predict the risk of SU in these patients.

METHODS

The clinical data of 135 patients with CRC who underwent laparoscopic surgery between November 2021 and June 2022 were reviewed retrospectively. They were divided into two categories depending on the presence of SUs: The SU group (n = 23) and the non-SU group (n = 112). Univariate analysis and multivariate logistic regression analysis were used to screen for factors associated with postoperative SU in patients undergoing laparoscopic surgery, and a risk factor-based nomogram model was built based on these risk factors. By plotting the model's receiver operating characteristic (ROC) curve and calibration curve, a Hosmer-Lemeshow goodness of fit test was performed.

RESULTS

Among the 135 patients with CRC, 23 patients had postoperative SU, with an incidence of 17.04%. The SU group had higher levels of heat shock protein (HSP) 70, HSP90, and gastrin (GAS) than the non-SU group. Age, lymph node metastasis, HSP70, HSP90, and GAS levels were statistically different between the two groups, but other indicators were not statistically different. Logistic regression analysis showed that age ≥ 65 years, lymph node metastasis, and increased levels of HSP70, HSP90 and GAS were all risk factors for postoperative SU in patients with CRC (P < 0.05). According to these five risk factors, the area under the ROC curve for the nomogram model was 0.988 (95%CI: 0.971-1.0); the calibration curve demonstrated excellent agreement between predicted and actual probabilities, and the Hosmer-Lemeshow goodness of fit test revealed that the difference was not statistically significant (χ2 = 0.753, P = 0.999), suggesting that the nomogram model had good discrimination, calibration, and stability.

CONCLUSION

Patients with CRC aged ≥ 65 years, with lymph node metastasis and elevated HSP70, HSP90, GAS levels, are prone to post-laparoscopic surgery SU. Our nomogram model shows good predictive value.

Keywords: Colorectal cancer; Laparoscope; Stress ulcer; Risk factors; Nomogram

Core Tip: Colorectal cancer (CRC) can cause hematochezia, dizziness, abdominal pain, diarrhea, constipation and other symptoms. We evaluated 135 patients who underwent laparoscopic surgery for CRC, identified 17 risk factors for post-surgery stress ulcer (SU), and established a nomogram model to predict the risk of SU in these patients. This model is useful for clinical prevention of postoperative SU in patients with CRC.