Abstract
Malignant bowel obstruction (MBO) is a common and complex condition in clinical practice, which seriously affects the quality of life and prognosis of patients. However, the current lack of effective prognostic models for MBO has greatly limited clinical precision treatment and patient management. Focusing on this issue, this study aims to construct and validate a prognostic model for the overall survival (OS) of MBO patients, providing crucial support for clinical decision - making and improving the prognosis of patients. In this study, 41 items of real - world data from 192 patients in the Affiliated Hospital of Nantong University from January 2022 to January 2024 were collected, including 39 independent variables, survival time, and survival status. Subsequently, the patients were randomly divided into groups at a ratio of 7:3. Predictor variables were screened using the Least Absolute Shrinkage and Selection Operator (LASSO) and multivariate Cox regression, and then a Cox model was constructed. The model was validated using the Concordance index (C - index), time - dependent Receiver Operating Characteristic (ROC) curve, and Decision Curve Analysis (DCA). Finally, a nomogram of the model was created. The study found that significant risk factors affecting patient mortality included chemoradiotherapy (β = - 1.24; HR = 0.29;95%CI, 0.14-0.59), conservative treatment (β = 1.34; HR = 3.81; 95%CI, 1.69-8.55), new cases (β = - 0.96; HR = 0.38; 95%CI, 0.19-0.77), AJCC T stage 4 (β = 2.16; HR = 8.64; 95%CI, 1.47-50.76), red blood cell count (RBC, β = - 0.63; HR = 0.53; ; 95%CI, 0.38-0.80), prothrombin time (PT, β = 0.37; HR = 1.45; ; 95%CI, 1.07-1.97), aspartate aminotransferase (AST, β = 0.01; HR = 1.01; 95%CI, 1.00-1.02), and intestinal necrosis (β = 1.73; HR = 5.62; 95%CI, 1.11-28.27). In the development set, the AUC and C - index values of the prognostic models for 30 - day, 90 - day, and 180 - day are 0.87, 0.94, and 0.92 respectively. In the validation set, the corresponding values are 0.83, 0.96, and 0.89. The results of DCA analysis indicated that the model was reliable and could effectively predict the 30 - day, 90 - day, and 180 - day survival periods of MBO patients. This study successfully constructed and validated a prognostic model for the overall survival of MBO patients. This model identified multiple key prognostic factors and exhibited good predictive performance. It provides important reference for clinicians to predict the survival period of MBO patients and develop personalized treatment plans, and is expected to improve the clinical outcomes of MBO patients.