Okamoto Tatsuya, Takamizawa Shigeru, Arai Hiroshi, Bitoh Yuko, Nakao Makoto, Yokoi Akiko, Nishijima Eiji
Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Japan.
Surgery. 2009 Jun;145(6):675-81. doi: 10.1016/j.surg.2009.01.017. Epub 2009 Apr 11.
Although the Spitz classification is the most widely used prognostic classification for esophageal atresia and/or tracheoesophageal fistula (EA), its discrimination ability remains unclear. We sought to develop a more accurate prognostic classification for EA.
The records of 121 consecutive infants with EA (1980-2005) were reviewed. The independent variables included 6 clinical characteristics, and the dependent variables were survival and mortality. Stepwise logistic regression analysis was used to construct models predicting mortality and create a revised prognostic classification. The discrimination abilities of the revised classification and the Spitz classification were compared using receiver-operating characteristic (ROC) curves.
Birth weight and the presence of major cardiac anomalies were significant prognostic factors for mortality, and major cardiac anomalies affected mortality more than birth weight. The ROC curve for birth weight suggested that 2,000 g was an appropriate cutoff point. The Spitz classification was revised as follows: the revised class I (low-risk group) consisted of patients without major cardiac anomalies and birth weight >2,000 g; class II (moderate-risk group) consisted of patients without major cardiac abnormalities and birth weight <2,000 g; class III (relatively high-risk group) consisted of patients with major cardiac anomalies and birth weight >2,000 g; and class IV (high-risk group) consisted of patients with major cardiac anomalies and birth weight <2,000 g. The ROC comparisons showed that the revised classification provided a significant improvement (P = .049).
This revised classification can improve the stratification of EA patients and be a useful predictor of survival.
尽管斯皮茨分类是食管闭锁和/或气管食管瘘（EA）最广泛使用的预后分类，但它的判别能力仍不明确。我们试图开发一种更准确的EA预后分类。
回顾了121例连续的EA婴儿（1980 - 2005年）的记录。自变量包括6项临床特征，因变量是生存和死亡。采用逐步逻辑回归分析构建预测死亡率的模型并创建修订后的预后分类。使用受试者操作特征（ROC）曲线比较修订分类和斯皮茨分类的判别能力。
出生体重和主要心脏畸形的存在是死亡率的重要预后因素，主要心脏畸形对死亡率的影响大于出生体重。出生体重的ROC曲线表明2000g是一个合适的截断点。斯皮茨分类修订如下：修订后的I类（低风险组）由无主要心脏畸形且出生体重>2000g的患者组成；II类（中度风险组）由无主要心脏异常且出生体重<2000g的患者组成；III类（相对高风险组）由有主要心脏畸形且出生体重>2000g的患者组成；IV类（高风险组）由有主要心脏畸形且出生体重<2000g的患者组成。ROC比较显示修订后的分类有显著改善（P = 0.049）。
这种修订后的分类可以改善EA患者的分层，是生存的有用预测指标。
