Scarpa M, Filip B, Cavallin F, Alfieri R, Saadeh L, Cagol M, Castoro C
Surgical Oncology Unit, Veneto Institute of Oncology (IOV-IRCCS), Padova, Italy.
Department of Surgery, University of Medicine of Iasi, Iasi, Romania.
Dis Esophagus. 2016 Aug;29(6):589-97. doi: 10.1111/dote.12358. Epub 2015 Apr 15.
Our study aimed to identify the best prognostic score for fitness for surgery and postoperative morbidity in elderly patients. A prospectively collected database of a consecutive series of patients with esophageal cancer evaluated for possible esophagectomy at our unit was analyzed. Fitness for surgery and postoperative morbidity were used as measures of outcome. The performances of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) score, the Charlson Comorbidity Index, the age-related Charlson Comorbidity Index (ACCI), the American Society of Anesthesiologists scale and the prognostic nutritional index (PNI) were evaluated in elderly patients. Discrimination was measured with receiver operating characteristics curve analysis; calibration was assessed by the Hosmer-Lemeshow goodness-of-fit test. Age did not result a significant predictor for postoperative complications. In elderly patients, ACCI predicted the judgment of the multidisciplinary team about fitness for surgery with the best discrimination (C-index = 0.94). PNI had the best discrimination for postoperative complications (C-index = 0.71) in the elderly group. ACCI best predicted the fitness for surgery in elderly patients. In elderly patients, the most discriminative prognostic score for postoperative complication was PNI, which could be used at admission for surgery to correctly inform patients about their risk and, possibly, to take extra precaution in case of high risk.
我们的研究旨在确定老年患者手术适宜性和术后发病率的最佳预后评分。对我们科室前瞻性收集的一系列连续食管癌患者数据库进行分析，这些患者均接受了食管癌切除术可能性评估。手术适宜性和术后发病率用作结局指标。在老年患者中评估了生理和手术严重程度评分系统（POSSUM）评分、查尔森合并症指数、年龄相关查尔森合并症指数（ACCI）、美国麻醉医师协会分级以及预后营养指数（PNI）的表现。通过受试者工作特征曲线分析测量辨别力；通过Hosmer-Lemeshow拟合优度检验评估校准情况。年龄并非术后并发症的显著预测因素。在老年患者中，ACCI对多学科团队关于手术适宜性的判断具有最佳辨别力（C指数 = 0.94）。PNI对老年组术后并发症具有最佳辨别力（C指数 = 0.71）。ACCI最能预测老年患者的手术适宜性。在老年患者中，对术后并发症最具辨别力的预后评分是PNI，其可在手术入院时使用，以便正确告知患者其风险，并可能在高风险情况下采取额外预防措施。
