Awad Mahmoud I, Palmer Frank L, Kou Lei, Yu Changhong, Montero Pablo H, Shuman Andrew G, Ganly Ian, Shah Jatin P, Kattan Michael W, Patel Snehal G
Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.
JAMA Otolaryngol Head Neck Surg. 2015 Nov;141(11):960-8. doi: 10.1001/jamaoto.2015.2200.
Postoperative complications after head and neck surgery carry the potential for significant morbidity. Estimating the risk of complications in an individual patient is challenging.
To develop a statistical tool capable of predicting an individual patient's risk of developing a major complication after surgery for oral cavity squamous cell carcinoma.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective case series derived from an institutional clinical oncologic database, augmented by medical record abstraction, at an academic tertiary care cancer center. Participants were 506 previously untreated adult patients with biopsy-proven oral cavity squamous cell carcinoma who underwent surgery between January 1, 2007, and December 31, 2012.
The primary end point was a major postoperative complication requiring invasive intervention (Clavien-Dindo classification grades III-V). Patients treated between January 1, 2007, and December 31, 2008 (354 of 506 [70.0%]) comprised the modeling cohort and were used to develop a nomogram to predict the risk of developing the primary end point. Univariable analysis and correlation analysis were used to prescreen 36 potential predictors for incorporation in the subsequent multivariable logistic regression analysis. The variables with the highest predictive value were identified with the step-down model reduction method and included in the nomogram. Patients treated between January 1, 2007, and December 31, 2008 (152 of 506 [30.0%]) were used to validate the nomogram.
Clinical characteristics were similar between the 2 cohorts for most comparisons. Thirty-six patients in the modeling cohort (10.2%) and 16 patients in the validation cohort (10.5%) developed a major postoperative complication. The 6 preoperative variables with the highest individual predictive value were incorporated within the nomogram, including body mass index, comorbidity status, preoperative white blood cell count, preoperative hematocrit, planned neck dissection, and planned tracheotomy. The nomogram predicted a major complication with a validated concordance index of 0.79. Inclusion of surgical operative variables in the nomogram maintained predictive accuracy (concordance index, 0.77).
A statistical tool was developed that accurately estimates an individual patient's risk of developing a major complication after surgery for oral cavity squamous cell carcinoma.
头颈外科手术后的并发症有可能导致严重的发病情况。评估个体患者发生并发症的风险具有挑战性。
开发一种能够预测个体患者口腔鳞状细胞癌手术后发生主要并发症风险的统计工具。
设计、地点和参与者：来自机构临床肿瘤数据库的回顾性病例系列，通过病历摘要进行补充，该数据库来自一家学术性三级护理癌症中心。参与者为506例先前未经治疗的成年患者，经活检证实患有口腔鳞状细胞癌，于2007年1月1日至2012年12月31日期间接受了手术。
主要终点是需要进行侵入性干预的主要术后并发症（Clavien-Dindo分类III-V级）。2007年1月1日至2008年12月31日期间接受治疗的患者（506例中的354例[70.0%]）组成建模队列，用于开发列线图以预测发生主要终点的风险。单变量分析和相关性分析用于预先筛选36个潜在预测因素，以纳入随后的多变量逻辑回归分析。采用逐步模型简化方法确定预测价值最高的变量，并将其纳入列线图。2007年1月1日至2008年12月31日期间接受治疗的患者（506例中的152例[30.0%]）用于验证列线图。
在大多数比较中，两个队列的临床特征相似。建模队列中有36例患者（10.2%），验证队列中有16例患者（10.5%）发生了主要术后并发症。列线图纳入了6个个体预测价值最高的术前变量，包括体重指数、合并症状态、术前白细胞计数、术前血细胞比容、计划的颈部清扫和计划的气管切开术。列线图预测主要并发症的验证一致性指数为0.79。在列线图中纳入手术操作变量可保持预测准确性（一致性指数，0.77）。
开发了一种统计工具，可准确估计个体患者口腔鳞状细胞癌手术后发生主要并发症的风险。
