早期胃癌内镜黏膜下剥离术术后迟发性出血的BEST-J评分验证及新模型开发

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Abstract Objective To evaluate the prediction model of delayed bleeding after endoscopic submucosal dissection (ESD) for early gastric cancer and to develop a new model. Methods A retrospective analysis was conducted on clinical data of patients with early gastric cancer who received ESD treatment in Gastroenterology Department of the 910th Hospital of PLA Joint Logistics Support Force from January 2017 to December 2022. All patients were divided into delayed bleeding group and non-bleeding group according to whether bleeding occurrence. Univariate and multivariate logistic regression analysis were conducted on clinical data of the two groups to identify factors affecting delayed bleeding, and a new delayed bleeding prediction model was constructed. The predictive performance of the new model and the BEST-J score was evaluated using the receiver operating characteristic (ROC) curve. Results A total of 428 patients with early gastric cancer who received ESD were included, with 26 cases (6.07%) of delayed bleeding. Compared with the non-bleeding group, the delayed bleeding group had higher mean BEST-J score (P< 0.001) and higher proportion of high-risk and very high-risk patients (P=0.013). Multivariate logistic regression analysis showed that smoking history (OR=2.219, 95%CI: 1.068-4.610,P=0.040), tumor maximum diameter >20 mm (OR=2.563,95%CI:1.244-5.283,P=0.010), resection of multiple tumors (OR=3.179,95%CI:1.134-8.913,P=0.033), and prolonged APTT (OR=5.959,95%CI:1.867-19.015,P=0.002) were independent risk factors, while intraoperative use of hemostatic clips (OR=0.312,95%CI:0.118-0.826, P=0.021) was a protective factor. The risk prediction model for delayed bleeding was constructed as follows: Logit(P) =-3.867 +0.797×(smoking history)-1.165×(intraoperative use of hemostatic clips)+1.157×(resection of multiple tumors)+0.941×(tumor>20 mm)+1.785×(APTT prolongation). ROC curve analysis showed that the new prediction model based on influencing factors had a larger area under the curve (AUC) than the BEST-J score (0.622 vs 0.809, P< 0.001). Conclusions The new prediction model based on smoking history, tumor size >20 mm, intraoperative use of hemostatic clips, resection of multiple tumors, and APTT prolongation is more suitable for predicting the risk of bleeding after ESD surgery in Chinese patients with early gastric cancer than BEST-J score than BEST-J score.

Key words： endoscopic submucosal dissection early gastric cancer delayed bleeding forecast

Received: 16 January 2024

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	Articles by authors
	WU Yayun
	ZENG Qingfang
	LIAN Lifeng
	SHI Yazhu
	HUANG Yongde

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WU Yayun,ZENG Qingfang,LIAN Lifeng等. Validation of BEST-J score and development of a new model for delayed bleeding after endoscopic submucosal dissection for early gastric cancer[J]. Med. J. Chin. Peop. Armed Poli. Forc., 2024, 35(7): 572-577.

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https://journal08.magtechjournal.com/Jwk_wjyx/EN/ OR https://journal08.magtechjournal.com/Jwk_wjyx/EN/Y2024/V35/I7/572

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