Risk factors for postoperative respiratory failure in patients with esophageal cancer and the prediction model establishment_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YANG Bo ¹ ,  BAI Yue ¹ , LANG Lili ¹ , CAO Qun ¹ , ZHU Gongjian ¹ , ZHUANG Leiyun ² , SUN Daqiang ³

1. Department of Thoracic Surgery, Sun Yat-sen University Cancer Center Gansu Hospital, Lanzhou, 730050, P. R. China;
2. Gansu University of Chinese Medicine, Lanzhou, 730000, P. R. China;
3. Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin, 300222, P. R. China;

Corresponding?author：

BAI Yue, Email: surrealby@163.com

Keywords：

Esophageal cancer; respiratory failure; LASSO-logistic regression; prediction model

DOI：

10.7507/1007-4848.202407020

Video：

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Objective To explore the risk factors for postoperative respiratory failure (RF) in patients with esophageal cancer, construct a predictive model based on the least absolute shrinkage and selection operator (LASSO)-logistic regression, and visualize the constructed model. Methods A retrospective analysis was conducted on patients with esophageal cancer who underwent surgical treatment in the Department of Thoracic Surgery, Sun Yat-sen University Cancer Center Gansu Hospital from 2020 to 2023. Patients were divided into a RF group and a non-RF (NRF) group according to whether RF occurred after surgery. Clinical data of the two groups were collected, and LASSO-logistic regression was used to optimize feature selection and construct the predictive model. The model was internally validated by repeated sampling 1000 times based on the Bootstrap method. Results A total of 217 patients were included, among which 24 were in the RF group, including 22 males and 2 females, with an average age of (63.33±9.10) years; 193 were in the NRF group, including 161 males and 32 females, with an average age of (62.14±8.44) years. LASSO-logistic regression analysis showed that the percentage of forced expiratory volume in one second/forced vital capacity (FEV₁/FVC) to predicted value (FEV₁/FVC%pred) [OR=0.944, 95%CI (0.897, 0.993), P=0.026], postoperative anastomotic fistula [OR=4.106, 95%CI (1.457, 11.575), P=0.008], and postoperative lung infection [OR=3.776, 95%CI (1.373, 10.388), P=0.010] were risk factors for postoperative RF in patients with esophageal cancer. Based on the above risk factors, a predictive model was constructed, with an area under the receiver operating characteristic curve of 0.819 [95%CI (0.737, 0.901)]. The Hosmer-Lemeshow test for the calibration curve showed that the model had good goodness of fit (P=0.527). The decision curve showed that the model had good clinical net benefit when the threshold probability was between 5% and 50%. Conclusion FEV₁/FVC%pred, postoperative anastomotic fistula, and postoperative lung infection are risk factors for postoperative RF in patients with esophageal cancer. The predictive model constructed based on LASSO-logistic regression analysis is expected to help medical staff screen high-risk patients for early individualized intervention.

Citation： YANG Bo, BAI Yue, LANG Lili, CAO Qun, ZHU Gongjian, ZHUANG Leiyun, SUN Daqiang. Risk factors for postoperative respiratory failure in patients with esophageal cancer and the prediction model establishment. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2025, 32(3): 353-359. doi: 10.7507/1007-4848.202407020 Copy

1.	Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
2.	鄭榮壽, 陳茹, 韓冰峰, 等. 2022年中國惡性腫瘤流行情況分析. 中華腫瘤雜志, 2024, 46(3): 221-231.Zheng RS, Chen R, Han BF, et al. Cancer incidence and mortality in China, 2022. Chin J Oncol, 2024, 46(3): 221-231.
3.	Obermannová R, Alsina M, Cervantes A, et al. Oesophageal cancer: ESMO clinical practice guideline for diagnosis, treatment and follow-up. Ann Oncol, 2022, 33(10): 992-1004.
4.	Baiu I, Backhus L. Esophageal cancer surgery. JAMA, 2020, 324(15): 1580.
5.	Hirano Y, Konishi T, Kaneko H, et al. Impact of prophylactic corticosteroid use on in-hospital mortality and respiratory failure after esophagectomy for esophageal cancer: Nationwide inpatient data study in Japan. Ann Surg, 2023, 277(6): e1247-e1253.
6.	Dong J, Wang GD, Wang HZ. Clinical analysis of patients with respiratory failure after esophageal cancer operation. Transl Cancer Res, 2021, 10(12): 5238-5245.
7.	Su Q, Li H, Yan H, et al. Prognostic risk factors for respiratory failure after esophagectomy. Transl Cancer Res, 2020, 9(10): 6362-6368.
8.	Yu B, Liu Z, Zhang L, et al. Pre- and intra-operative risk factors predict postoperative respiratory failure after minimally invasive oesophagectomy. Eur J Cardiothorac Surg, 2024, 65(4): ezae107.
9.	Sauerbrei W, Royston P, Binder H. Selection of important variables and determination of functional form for continuous predictors in multivariable model building. Stat Med, 2007, 26(30): 5512-5528.
10.	Canet J, Gallart L. Postoperative respiratory failure: Pathogenesis, prediction, and prevention. Curr Opin Crit Care, 2014, 20(1): 56-62.
11.	Margraf A, Ludwig N, Zarbock A, et al. Systemic inflammatory response syndrome after surgery: Mechanisms and protection. Anesth Analg, 2020, 131(6): 1693-1707.
12.	王開旺, 張榮新. McKeown食管癌術后呼吸衰竭的危險因素分析及預測模型建立. 安徽醫學, 2022, 43(8): 918-922.Wang KW, Zhang RX. Analysis of risk factors and establishment of prediction model for respiratory failure after McKeown esophageal cancer surgery. Anhui Med J, 2022, 43(8): 918-922.
13.	支修益, 劉倫旭. 中國胸外科圍手術期氣道管理指南(2020版). 中國胸心血管外科臨床雜志, 2021, 28(3): 251-262.Zhi XY, Liu LX. Chinese guidelines for perioperative airway management in thoracic surgery (2020 edition). Chin J Clin Thorac Cardiovasc Surg, 2021, 28(3): 251-262.
14.	朱蕾, 陳榮昌. 成人肺功能診斷規范中國專家共識. 臨床肺科雜志, 2022, 27(7): 973-981.Zhu L, Chen RC. Chinese experts' consensus on the standardization of adult lung function diagnosis. J Clin Pulm Med, 2022, 27(7): 973-981.
15.	Ferguson MK, Celauro AD, Prachand V. Prediction of major pulmonary complications after esophagectomy. Ann Thorac Surg, 2011, 91(5): 1494-1500.
16.	Maruyama S, Okamura A, Ishizuka N, et al. Airflow limitation predicts postoperative pneumonia after esophagectomy. World J Surg, 2021, 45(8): 2492-2500.
17.	Sun Y, Zhu Y. Impairment of lung function increases the risk of postoperative respiratory failure for esophageal carcinoma: A systematic review and meta-analysis. J Healthc Eng, 2021, 2021: 5327682.
18.	Kim T, Jeon YJ, Lee H, et al. Preoperative DLCO and FEV₁ are correlated with postoperative pulmonary complications in patients after esophagectomy. Sci Rep, 2024, 14(1): 6117.
19.	Goense L, Meziani J, Bülbül M, et al. Pulmonary diffusion capacity predicts major complications after esophagectomy for patients with esophageal cancer. Dis Esophagus, 2019, 32(3): doy082.
20.	Hughes JM, Pride NB. Examination of the carbon monoxide diffusing capacity (DL(CO)) in relation to its KCO and VA components. Am J Respir Crit Care Med, 2012, 186(2): 132-139.
21.	Chevallay M, Jung M, Chon SH, et al. Esophageal cancer surgery: Review of complications and their management. Ann N Y Acad Sci, 2020, 1482(1): 146-162.
22.	Low DE, Kuppusamy MK, Alderson D, et al. Benchmarking complications associated with esophagectomy. Ann Surg, 2019, 269(2): 291-298.
23.	Kassis ES, Kosinski AS, Ross P, et al. Predictors of anastomotic leak after esophagectomy: An analysis of the society of thoracic surgeons general thoracic database. Ann Thorac Surg, 2013, 96(6): 1919-1926.
24.	朱開元, 李志剛. 食管癌術后吻合口瘺臨床管理進展. 中華胸部外科電子雜志, 2023, 10(1): 50-56.Zhu KY, Li ZG. Advances in clinical management of anastomotic leakage after esophageal cancer surgery. Chin J Thorac Surg (Electron Ed), 2023, 10(1): 50-56.
25.	Hummel R, Bausch D. Anastomotic leakage after upper gastrointestinal surgery: Surgical treatment. Visc Med, 2017, 33(3): 207-211.
26.	Xu QL, Li H, Zhu YJ, et al. The treatments and postoperative complications of esophageal cancer: A review. J Cardiothorac Surg, 2020, 15(1): 163.
27.	王明欣, 周春姣, 嵇星辰, 等. 食管癌患者術后肺部感染危險因素的系統評價與Meta分析. 中國胸心血管外科臨床雜志, 2023, 30(10): 1467-1474.Wang MX, Zhou CJ, Ji XC, et al. Risk factors for postoperative pulmonary infection in patients with esophageal cancer: A systematic review and meta-analysis. Chin J Clin Thorac Cardiovasc Surg, 2023, 30(10): 1467-1474.
28.	Booka E, Takeuchi H, Nishi T, et al. The impact of postoperative complications on survivals after esophagectomy for esophageal cancer. Medicine (Baltimore), 2015, 94(33): e1369.
29.	顧劍民, 譚黎杰. 食管癌術后并發癥的預防和治療. 中華胃腸外科雜志, 2023, 26(4): 330-333.Gu JM, Tan LJ. Prevention and treatment of postoperative complications of esophageal cancer. Chin J Gastrointest Surg, 2023, 26(4): 330-333.
30.	Yu Z, Li S, Liu D, et al. Society for Translational Medicine expert consensus on the prevention and treatment of postoperative pulmonary infection in esophageal cancer patients. J Thorac Dis, 2018, 10(2): 1050-1057.

1. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
2. 鄭榮壽, 陳茹, 韓冰峰, 等. 2022年中國惡性腫瘤流行情況分析. 中華腫瘤雜志, 2024, 46(3): 221-231.Zheng RS, Chen R, Han BF, et al. Cancer incidence and mortality in China, 2022. Chin J Oncol, 2024, 46(3): 221-231.
3. Obermannová R, Alsina M, Cervantes A, et al. Oesophageal cancer: ESMO clinical practice guideline for diagnosis, treatment and follow-up. Ann Oncol, 2022, 33(10): 992-1004.
4. Baiu I, Backhus L. Esophageal cancer surgery. JAMA, 2020, 324(15): 1580.
5. Hirano Y, Konishi T, Kaneko H, et al. Impact of prophylactic corticosteroid use on in-hospital mortality and respiratory failure after esophagectomy for esophageal cancer: Nationwide inpatient data study in Japan. Ann Surg, 2023, 277(6): e1247-e1253.
6. Dong J, Wang GD, Wang HZ. Clinical analysis of patients with respiratory failure after esophageal cancer operation. Transl Cancer Res, 2021, 10(12): 5238-5245.
7. Su Q, Li H, Yan H, et al. Prognostic risk factors for respiratory failure after esophagectomy. Transl Cancer Res, 2020, 9(10): 6362-6368.
8. Yu B, Liu Z, Zhang L, et al. Pre- and intra-operative risk factors predict postoperative respiratory failure after minimally invasive oesophagectomy. Eur J Cardiothorac Surg, 2024, 65(4): ezae107.
9. Sauerbrei W, Royston P, Binder H. Selection of important variables and determination of functional form for continuous predictors in multivariable model building. Stat Med, 2007, 26(30): 5512-5528.
10. Canet J, Gallart L. Postoperative respiratory failure: Pathogenesis, prediction, and prevention. Curr Opin Crit Care, 2014, 20(1): 56-62.
11. Margraf A, Ludwig N, Zarbock A, et al. Systemic inflammatory response syndrome after surgery: Mechanisms and protection. Anesth Analg, 2020, 131(6): 1693-1707.
12. 王開旺, 張榮新. McKeown食管癌術后呼吸衰竭的危險因素分析及預測模型建立. 安徽醫學, 2022, 43(8): 918-922.Wang KW, Zhang RX. Analysis of risk factors and establishment of prediction model for respiratory failure after McKeown esophageal cancer surgery. Anhui Med J, 2022, 43(8): 918-922.
13. 支修益, 劉倫旭. 中國胸外科圍手術期氣道管理指南(2020版). 中國胸心血管外科臨床雜志, 2021, 28(3): 251-262.Zhi XY, Liu LX. Chinese guidelines for perioperative airway management in thoracic surgery (2020 edition). Chin J Clin Thorac Cardiovasc Surg, 2021, 28(3): 251-262.
14. 朱蕾, 陳榮昌. 成人肺功能診斷規范中國專家共識. 臨床肺科雜志, 2022, 27(7): 973-981.Zhu L, Chen RC. Chinese experts' consensus on the standardization of adult lung function diagnosis. J Clin Pulm Med, 2022, 27(7): 973-981.
15. Ferguson MK, Celauro AD, Prachand V. Prediction of major pulmonary complications after esophagectomy. Ann Thorac Surg, 2011, 91(5): 1494-1500.
16. Maruyama S, Okamura A, Ishizuka N, et al. Airflow limitation predicts postoperative pneumonia after esophagectomy. World J Surg, 2021, 45(8): 2492-2500.
17. Sun Y, Zhu Y. Impairment of lung function increases the risk of postoperative respiratory failure for esophageal carcinoma: A systematic review and meta-analysis. J Healthc Eng, 2021, 2021: 5327682.
18. Kim T, Jeon YJ, Lee H, et al. Preoperative DLCO and FEV₁ are correlated with postoperative pulmonary complications in patients after esophagectomy. Sci Rep, 2024, 14(1): 6117.
19. Goense L, Meziani J, Bülbül M, et al. Pulmonary diffusion capacity predicts major complications after esophagectomy for patients with esophageal cancer. Dis Esophagus, 2019, 32(3): doy082.
20. Hughes JM, Pride NB. Examination of the carbon monoxide diffusing capacity (DL(CO)) in relation to its KCO and VA components. Am J Respir Crit Care Med, 2012, 186(2): 132-139.
21. Chevallay M, Jung M, Chon SH, et al. Esophageal cancer surgery: Review of complications and their management. Ann N Y Acad Sci, 2020, 1482(1): 146-162.
22. Low DE, Kuppusamy MK, Alderson D, et al. Benchmarking complications associated with esophagectomy. Ann Surg, 2019, 269(2): 291-298.
23. Kassis ES, Kosinski AS, Ross P, et al. Predictors of anastomotic leak after esophagectomy: An analysis of the society of thoracic surgeons general thoracic database. Ann Thorac Surg, 2013, 96(6): 1919-1926.
24. 朱開元, 李志剛. 食管癌術后吻合口瘺臨床管理進展. 中華胸部外科電子雜志, 2023, 10(1): 50-56.Zhu KY, Li ZG. Advances in clinical management of anastomotic leakage after esophageal cancer surgery. Chin J Thorac Surg (Electron Ed), 2023, 10(1): 50-56.
25. Hummel R, Bausch D. Anastomotic leakage after upper gastrointestinal surgery: Surgical treatment. Visc Med, 2017, 33(3): 207-211.
26. Xu QL, Li H, Zhu YJ, et al. The treatments and postoperative complications of esophageal cancer: A review. J Cardiothorac Surg, 2020, 15(1): 163.
27. 王明欣, 周春姣, 嵇星辰, 等. 食管癌患者術后肺部感染危險因素的系統評價與Meta分析. 中國胸心血管外科臨床雜志, 2023, 30(10): 1467-1474.Wang MX, Zhou CJ, Ji XC, et al. Risk factors for postoperative pulmonary infection in patients with esophageal cancer: A systematic review and meta-analysis. Chin J Clin Thorac Cardiovasc Surg, 2023, 30(10): 1467-1474.
28. Booka E, Takeuchi H, Nishi T, et al. The impact of postoperative complications on survivals after esophagectomy for esophageal cancer. Medicine (Baltimore), 2015, 94(33): e1369.
29. 顧劍民, 譚黎杰. 食管癌術后并發癥的預防和治療. 中華胃腸外科雜志, 2023, 26(4): 330-333.Gu JM, Tan LJ. Prevention and treatment of postoperative complications of esophageal cancer. Chin J Gastrointest Surg, 2023, 26(4): 330-333.
30. Yu Z, Li S, Liu D, et al. Society for Translational Medicine expert consensus on the prevention and treatment of postoperative pulmonary infection in esophageal cancer patients. J Thorac Dis, 2018, 10(2): 1050-1057.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Risk factors for postoperative respiratory failure in patients with esophageal cancer and the prediction model establishment

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