Multivariate Analysis Of Prognosis Of Malignant Bowel Obstruction And Comparative Analysis Of Curative Effect Of Surgical And Non-surgical Treatment Of Malignant Bowel Obstruction

Objective: To analyze the prognostic factors of malignant bowel obstruction,and establish the Nomogram model for predicting the prognosis of patients with malignant bowel obstruction.And to compare the short-term and long-term effects of surgical and non-surgical treatment of malignant bowel obstruction.Methods: The clinical data of 203 patients diagnosed with malignant bowel obstruction from June 2013 to June 2019 were retrospectively analyzed and followed up at the Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine.Results: From June 2013 to June 2019,there were a total of 203 patients,and 143 patients(70.4%)among those could be followed up.Univariate analysis results showed that age,gender,platelet levels,C-reactive protein,total protein,number of comorbidities,somatostatin,enteral nutrition,parenteral nutrition use,length of hospitalization,etc.were not related to the survival rate of patients with malignant bowel obstruction,anemia(P =0.001),low albumin level(P = 0.000),high white blood cell level(P = 0.023),late TNM staging of tumor(P <0.001),secondary tumor metastasis(P<0.001),non-surgical treatment(P =0.013)were significantly related to the prognosis in patients with malignant bowel obstruction.Multivariate analysis showed that tumor stage(P = 0.001)and albumin level(P = 0.001)were independent risk factors affecting the prognosis of patients with malignant bowel obstruction.There was no significant difference in obstruction relief time,hospital stay,and quality of life scores between surgical and non-surgical patients(all P> 0.05).However,the TNM stage was stage IV(P= 0.032),the primary tumor(P = 0.0004),and the patients with secondary tumor(P = 0.0011)had longer survival time than non-surgical treatment.The impact of the three surgical methods on survival was also statistically different(P = 0.006).Patients with radical resection had longer survival than those with simple enterostomy or short-circuit surgery,while the latter had longer survival than patients with palliative resection.Conclusion: Malignant bowel obstruction has a poor prognosis.Many factors can predict the survival of patients,and we can establish the Nomogram model to for predicting the prognosis of patients with malignant bowel obstruction.Surgical and non-surgical patients with malignant bowel obstruction have no significant effect on short-term efficacy but surgical treatment can improve patients’ survival period.The choice of treatment for malignant bowel obstruction should follow the principle of individualization,and strive for radical tumor surgery when the patient’s circumstances permit.