Annals of medicine · 2025
Identification of risk factors and development of predictive models for chronic postsurgical pain after modified radical mastectomy.
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Gong Ninger, Yuan Qinyue, Li Pengyan, Zhao Zhen, Zhao Yi, Li Bing, Zhang Luyao, Yang Yitian, Zhang Jiaqiang, Zhang Wei
Аннотация
OBJECTIVE: To investigate the risk factors for chronic postsurgical pain (CPSP) following modified radical mastectomy (MRM) for breast cancer and to establish a clinical prediction model.
METHODS: A prospective cohort study was conducted, enrolling patients who underwent MRM for breast cancer. Comprehensive data were systematically collected at three time points: preoperatively, intraoperatively, and postoperatively. Follow-up assessments were performed at 3 and 6 months postoperatively. Separate prediction models were constructed for CPSP at 3 months and 6 months postoperatively. A comprehensive clinical prediction model was developed through a systematic approach.
RESULTS: A total of 235 patients were enrolled in this study. Postoperative insomnia and follicle-stimulating hormone (FSH) levels were independent risk factors for CPSP at both 3 and 6-month postoperatively, while a higher body mass index (BMI) was a protective factor for CPSP at 3-month postoperatively. The AUC values of the model at 3 and 6-month postoperatively were 0.767 (0.706-0.829) and 0.733 (0.666-0.799), respectively. Model performance and stability were further confirmed by receiver operating characteristic (ROC) curves, decision curve analysis (DCA), calibration curves, and a nomogram, indicating good discrimination and clinical applicability.
CONCLUSION: Postoperative insomnia and FSH levels are independent risk factors for CPSP at 3 and 6-month postoperatively, and a higher BMI is a protective factor for CPSP at 3-month postoperatively. Early identification and management of postoperative insomnia, as well as preoperative screening of FSH levels, may help reduce the risk of CPSP.
METHODS: A prospective cohort study was conducted, enrolling patients who underwent MRM for breast cancer. Comprehensive data were systematically collected at three time points: preoperatively, intraoperatively, and postoperatively. Follow-up assessments were performed at 3 and 6 months postoperatively. Separate prediction models were constructed for CPSP at 3 months and 6 months postoperatively. A comprehensive clinical prediction model was developed through a systematic approach.
RESULTS: A total of 235 patients were enrolled in this study. Postoperative insomnia and follicle-stimulating hormone (FSH) levels were independent risk factors for CPSP at both 3 and 6-month postoperatively, while a higher body mass index (BMI) was a protective factor for CPSP at 3-month postoperatively. The AUC values of the model at 3 and 6-month postoperatively were 0.767 (0.706-0.829) and 0.733 (0.666-0.799), respectively. Model performance and stability were further confirmed by receiver operating characteristic (ROC) curves, decision curve analysis (DCA), calibration curves, and a nomogram, indicating good discrimination and clinical applicability.
CONCLUSION: Postoperative insomnia and FSH levels are independent risk factors for CPSP at 3 and 6-month postoperatively, and a higher BMI is a protective factor for CPSP at 3-month postoperatively. Early identification and management of postoperative insomnia, as well as preoperative screening of FSH levels, may help reduce the risk of CPSP.