Abstract Background A permanent stoma after anterior resection for rectal cancer is common. Preoperative counselling could be improved by providing individualized accurate prediction modelling. Methods Patients who underwent anterior resection between 2007 and 2015 were identified from the Swedish Colorectal Cancer Registry. National Patient Registry data were added to determine presence of a stoma 2 years after surgery. A training set based on the years 2007–2013 was employed in an ensemble of prediction models. Judged by the area under the receiving operating characteristic curve (AUROC), data from the years 2014–2015 were used to evaluate the predictive ability of all models. The best performing model was subsequently implemented in typical clinical scenarios and in an online calculator to predict the permanent stoma risk. Results Patients in the training set (n = 3512) and the test set (n = 1136) had similar permanent stoma rates (13.6 and 15.2 per cent). The logistic regression model with a forward/backward procedure was the most parsimonious among several similarly performing models (AUROC 0.67, 95 per cent c.i. 0.63 to 0.72). Key predictors included co-morbidity, local tumour category, presence of metastasis, neoadjuvant therapy, defunctioning stoma use, tumour height, and hospital volume; the interaction between age and metastasis was also predictive. Conclusion Using routinely available preoperative data, the stoma outcome at 2 years after anterior resection for rectal cancer can be predicted fairly accurately.

中文翻译：

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直肠癌前切除术后永久造口率：使用术前变量进行风险预测评分

摘要 背景直肠癌前切除术后永久性造口很常见。通过提供个性化的准确预测模型可以改善术前咨询。 方法2007 年至 2015 年间接受前切除术的患者是从瑞典结直肠癌登记处确定的。添加国家患者登记数据以确定手术后 2 年后是否存在造口。预测模型集合中采用了基于 2007-2013 年的训练集。根据接收操作特征曲线下面积（AUROC）来判断，使用2014-2015年的数据来评估所有模型的预测能力。随后在典型的临床场景和在线计算器中实施了性能最佳的模型，以预测永久性造口风险。 结果训练组 (n = 3512) 和测试组 (n = 1136) 中的患者具有相似的永久造口率（13.6% 和 15.2%）。在几个性能相似的模型中，具有前向/后向过程的逻辑回归模型是最简约的（AUROC 0.67，95% CI 0.63 至 0.72）。关键预测因素包括合并症、局部肿瘤类别、是否存在转移、新辅助治疗、造口功能丧失、肿瘤高度和医院容量；年龄和转移之间的相互作用也具有预测性。 结论使用常规可用的术前数据，可以相当准确地预测直肠癌前切除术后 2 年的造口结果。