Department of Surgery/Surgical Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30001, 9700 RB Groningen, The Netherlands.
Am J Surg. 2011 Sep;202(3):303-9. doi: 10.1016/j.amjsurg.2011.04.003.
Different risk-prediction models have been developed, but none is generally accepted in selecting patients for esophagectomy. This study evaluated 5 most frequently used risk-prediction models, including the American Society of Anesthesiologists, Portsmouth-modified Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM), and the adjusted version for Oesophagogastric surgery (O-POSSUM), Charlson and the Age adjusted Charlson score to assess postoperative mortality after transthoracic esophagectomy.
Data were obtained from 278 consecutive esophageal cancer patients between 1991 and 2007. Performance in predicting postoperative mortality (in-hospital and 90-day mortality) were analyzed regarding calibration (Hosmer and Lemeshow goodness-of-fit test) and discrimination (area under the receiver operator curve).
The Hosmer and Lemeshow goodness-of-fit test was applied to each model and showed a significant outcome for only the P-POSSUM score (P = .035). The receiver operator curve indicated discriminatory power for P-POSSUM (.766) and for O-POSSUM (.756), other models did not exceed the minimal surface of .7.
Postoperative mortality after esophagectomy was best predicted by O-POSSUM. However, it still overpredicted postoperative mortality.
已经开发了不同的风险预测模型，但没有一个模型被普遍接受用于选择接受食管切除术的患者。本研究评估了 5 种最常用的风险预测模型，包括美国麻醉医师协会、朴茨茅斯改良生理和手术严重程度评分用于死亡率和发病率的枚举（P-POSSUM），以及用于食管胃手术的调整版本（O-POSSUM）、Charlson 和年龄调整 Charlson 评分，以评估经胸食管切除术的术后死亡率。
数据来自 1991 年至 2007 年期间的 278 例连续食管癌症患者。关于校准（Hosmer 和 Lemeshow 拟合优度检验）和判别力（接收者操作特征曲线下的面积），分析了预测术后死亡率（住院和 90 天死亡率）的表现。
对每个模型应用了 Hosmer 和 Lemeshow 拟合优度检验，仅 P-POSSUM 评分显示出显著结果（P =.035）。接收者操作特征曲线表明 P-POSSUM（.766）和 O-POSSUM（.756）具有判别能力，其他模型未超过.7 的最小表面。
O-POSSUM 可最好地预测食管切除术后的死亡率。然而，它仍然高估了术后死亡率。
