de Cássia Braga Ribeiro Karina, Kowalski Luiz Paulo
Hospital Cancer Registry and Department of Head and Neck Surgery and Otorhinolaryngology, Centro de Tratamento e Pesquisa Hospital do Câncer A. C. Camargo, São Paulo, Brazil.
Arch Otolaryngol Head Neck Surg. 2003 Jul;129(7):739-45. doi: 10.1001/archotol.129.7.739.
The indications for surgical treatment of patients with head and neck cancer can be limited by the risk of perioperative complications. Prediction of outcome is important in disease stratification and the subsequent decision-making process.
To assess the value of the APACHE II (Acute Physiology and Chronic Health Evaluation II) score, POSSUM (Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity), and ASA (American Society of Anesthesiologists) classification in the prediction of complications in patients with oral or oropharyngeal cancer.
Five hundred thirty patients with oral or oropharyngeal carcinomas who underwent surgical treatment were evaluated using ASA, POSSUM, and APACHE II scores. The outcome measure was morbidity within 30 days. Logistic regression and receiver operating characteristic curve analyses were used to estimate the predictive ability of the scoring systems.
The overall complication rate was 58.9%. Most of the patients had local complications. The mortality was 2.6%. The results showed that APACHE II (relative risk, 1.09; P =.001) and POSSUM (relative risk, 1.09; P<.001) equally predicted perioperative complications and were superior to the ASA system (relative risk, 0.98; P =.89) (area under the curve, 0.65 for APACHE II, 0.68 for POSSUM, and 0.56 for ASA).
The POSSUM and APACHE II scores were useful in predicting perioperative morbidity for patients with oral or oropharyngeal cancer, serving as objective methods to assist the surgeon in classifying patients into risk groups with different probabilities of perioperative complications. The poorer results achieved with the ASA classification are possibly because this system is primarily based on subjective clinical judgments.
头颈部癌患者的手术治疗指征可能会受到围手术期并发症风险的限制。结果预测在疾病分层及后续决策过程中至关重要。
评估急性生理与慢性健康状况评分系统II（APACHE II）、手术风险评分系统（POSSUM）及美国麻醉医师协会（ASA）分级在预测口腔或口咽癌患者并发症方面的价值。
采用ASA、POSSUM和APACHE II评分对530例接受手术治疗的口腔或口咽癌患者进行评估。观察指标为30天内的发病率。采用逻辑回归和受试者工作特征曲线分析来评估评分系统的预测能力。
总体并发症发生率为58.9%。大多数患者出现局部并发症。死亡率为2.6%。结果显示，APACHE II（相对风险，1.09；P = 0.001）和POSSUM（相对风险，1.09；P < 0.001）在预测围手术期并发症方面同样有效，且优于ASA系统（相对风险，0.98；P = 0.89）（曲线下面积，APACHE II为0.65，POSSUM为0.68，ASA为0.56）。
POSSUM和APACHE II评分在预测口腔或口咽癌患者围手术期发病率方面有用，可作为客观方法帮助外科医生将患者分为围手术期并发症概率不同的风险组。ASA分级结果较差可能是因为该系统主要基于主观临床判断。
