Risk factors for postoperative gastrointestinal dysfunction in elderly NSCLC patients

ZHU Haiyan; WANG Ye; YIN Yan

doi:10.11958/20252946

Abstract：Objective To investigate the risk factors of postoperative gastrointestinal dysfunction in elderly patients with non-small cell lung cancer(NSCLC),and to develop and validate an individualized nomogram.Methods A retrospective cohort study was conducted and included 309 elderly NSCLC patients who underwent radical resection of lung cancer in the single center of our hospital.Patients were divided into the disorder group(117 cases)and the control group(192 cases)based on whether gastrointestinal dysfunction occurred after the operation.Demographic,clinical and laboratory indicators were collected.The independent influencing factors were analyzed through multivariate Logistic regression,and a nomogram was constructed based on these results.Internal validation was conducted using the Bootstrap method(1 000 resampling),and the discrimination,calibration and clinical practicability of the model were evaluated through area under the curve(AUC),calibration curve and decision curve analysis(DCA).Results Multivariate Logistic regression analysis identified that preoperative malnutrition[OR(95%CI):4.276(2.388-7.658)],preoperative frailty[OR(95%CI):2.163(1.211-3.865)],diabetes[OR(95%CI):2.366(1.330-4.208)]and preoperative chemotherapy[OR(95%CI):2.153(1.214-3.819)]were independent risk factors for postoperative gastrointestinal dysfunction in elderly NSCLC patients after surgery(P＜0.05).The higher preoperative maximum voluntary ventilation as a percentage of predicted value(MVV%pred)[OR(95%CI):0.902(0.874-0.932)]was a protective factor(P＜0.05).A nomogram prediction model integrating these five factors demonstrated excellent discriminative ability(AUC=0.873,95%CI:0.827-0.919),calibration(mean absolute error=0.021)and clinical applicability.Conclusion Nomograms constructed based on factors such as malnutrition,frailty,diabetes,preoperative chemotherapy and high MVV%can effectively predict the risk of postoperative gastrointestinal dysfunction in elderly NSCLC patients.