Analysis Of Risk Factors For Postoperative Pulmonary Infection In Patients With Esophageal Cancer And Construction Of Nomogram

Background: Globally,esophageal cancer ranks among the highest incidence and mortality rates of all cancers.The epidemiological features of esophageal cancer have certain regional characteristics.Adenocarcinoma is the predominant pathological type in Western geographic regions such as Europe,while squamous carcinoma is the most common type in Asian regions,especially in China.Patients with esophageal cancer have different degrees of symptom onset,the disease develops slowly,early symptoms are not obvious,and most patients are diagnosed at intermediate to late stages with poor prognosis.For patients with limited stage,surgery is the primary option for patients.For some advanced stage patients,surgery can be performed after tumor downstaging through preoperative neoadjuvant therapy.Although the postoperative mortality rate of esophageal cancer has decreased significantly with the advancement of medical technology and further improvement of surgical protocols,there are still many complications caused by various factors that hinder the recovery of patients.Pulmonary complications are the most frequent postoperative diseases among patients.This includes pulmonary infection,which ranks the highest among all pulmonary complications and is difficult to avoid clinically,and has a major impact on patients’ postoperative treatment as well as recovery.Objective: The purpose of this study is to evaluate the occurrence of postoperative pulmonary infection in patients with esophageal cancer and to take appropriate measures to reduce the occurrence of postoperative pulmonary infection by analyzing the effect of different factors on postoperative pulmonary infection in patients with esophageal cancer.Methods: The data of patients with esophageal cancer who underwent surgery between January 2016 and December 2020 in the Department of Thoracic Surgery,Changzhou Second People’s Hospital,Nanjing Medical University were retrospectively analyzed.Patients were divided into two groups according to the occurrence of postoperative pulmonary infections,and the clinical data obtained from this study were analyzed and the role of relevant risk factors was explored,while a nomogram was established by analyzing the results and verifying their accuracy by correcting the curves,consistency index.Results: The incidence of pulmonary infection among 396 patients who underwent esophageal cancer surgery was 38.1%.Among them,163 were male and 82 were female;323 were elderly people and 73 were non-elderly people;130 had a body mass index >24kg/m2 and 266 had a body mass index ≤24 kg/m2;179 were smokers and 217 were nonsmokers.Univariate analysis showed that gender,advanced age(≥60 years old),preoperative smoking,body mass index,operation duration,operation mode,lung age,esophageal cancer stage,and pathological type were correlated with the incidence of postoperative lung infection in patients with esophageal cancer(P<0.05),age,diabetes,hypertension,FEV1%,FEV1%,PEF%,intraoperative bleeding,and clinical TNM stage were not correlated with postoperative pulmonary infection(P>0.05).Multivariate analysis showed that the occurrence of pulmonary infection was not associated with histology and staging(P>0.05),gender,advanced age(age ≥60 years),preoperative smoking,lung age,body mass index,and postoperative pulmonary infection in patients with esophageal cancer(P<0.05).Through the results of multi-factor analysis,R software was used to build a column graph of related factors.The concordance index of Nomogram is 0.713,and the calibration curve shows that the predicted results are in good agreement with the actual results.Conclusion: 1.Gender,advanced age(≥60 years old),smoking,body mass index and lung age are risk factors for pulmonary infection after esophageal cancer surgery.2.The nomogram of this study has good predictive ability.