Ren Li-Huan, Fu Wei, Wang Dong, Wang Liang, Li Lei, Zhang Chun, Lv Jing-Qiao, Zhang Tong-Lin
Department of General Surgery, Peking University Third Hospital, Beijing 100083, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2008 May;11(3):213-8.
To develop the modified P-POSSUM equation and the modified Cr-POSSUM equation and compare their performances with POSSUM in forecasting in-hospital morbidity and mortality of colorectal cancer.
Data of 903 patients undergone operation of colon and rectal cancers from 1992 to 2005 in our department were enrolled in this study. ROC curve was applied to judge the differentiation ability of each score. Model goodness-or-fit was tested by the Hosmer-Lemeshow statistic and subgroup analysis was performed by the ratio of observed to expected deaths (O:E ratio). A 70:30 percent split-sample validation technique was adopted for model development and testing. Stepwise logistic regression was used to develop the modified P-POSSUM and the modified Cr-POSSUM. Their performance in validating sample, colonic cancer sample, rectal cancer sample, elective surgery sample, emergency surgery sample, curative surgery sample and palliative surgery sample was tested by ROC curve, Hosmer-Lemeshow statistic and O:E ratio.
The modified P-POSSUM showed good discrimination in all samples except the emergency surgery and palliative surgery. The predicted mortality of modified P-POSSUM was very close to the observed mortality. However, the modified Cr-POSSUM showed good discrimination in all samples except the palliative surgery. The predicted mortality was higher than the observed mortality, but still within the 95% confidence interval (CI) of the observed mortality. Both the modified models offered better accuracy than the P-POSSUM.
The modified P-POSSUM and the modified Cr-POSSUM model provide an accurate prediction of inpatient mortality in Chinese colorectal cancer patients.
开发改良的P-POSSUM方程和改良的Cr-POSSUM方程，并将它们与POSSUM在预测结直肠癌患者住院发病率和死亡率方面的表现进行比较。
纳入1992年至2005年在我科接受结肠和直肠癌手术的903例患者的数据。应用ROC曲线判断各评分的区分能力。采用Hosmer-Lemeshow统计量检验模型拟合优度，并通过观察死亡与预期死亡之比（O:E比）进行亚组分析。采用70:30的样本拆分验证技术进行模型开发和测试。采用逐步逻辑回归法开发改良的P-POSSUM和改良的Cr-POSSUM。通过ROC曲线、Hosmer-Lemeshow统计量和O:E比测试它们在验证样本、结肠癌样本、直肠癌样本、择期手术样本、急诊手术样本、根治性手术样本和姑息性手术样本中的表现。
改良的P-POSSUM在除急诊手术和姑息性手术外的所有样本中均表现出良好的区分能力。改良的P-POSSUM预测死亡率与观察到的死亡率非常接近。然而，改良的Cr-POSSUM在除姑息性手术外的所有样本中均表现出良好的区分能力。预测死亡率高于观察到的死亡率，但仍在观察到的死亡率的95%置信区间（CI）内。两种改良模型的准确性均优于P-POSSUM。
改良的P-POSSUM和改良的Cr-POSSUM模型能准确预测中国结直肠癌患者的住院死亡率。
