Fuchs H F, Harnsberger C R, Broderick R C, Chang D C, Sandler B J, Jacobsen G R, Bouvet M, Horgan S
Department of Surgery, Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California, San Diego, USA.
Department of General Surgery, University of Cologne, Cologne, Germany.
Dis Esophagus. 2017 Jan 1;30(1):1-6. doi: 10.1111/dote.12451.
Surgery remains one of the major treatment options available to patients with esophageal cancer, with high mortality in certain cohorts. The aim of this study was to develop a simple preoperative risk scale based on patient factors, hospital factors, and tumor pathology to predict the risk of perioperative mortality following esophagectomy for malignancy. The Nationwide Inpatient Sample database was used to create the risk scale. Patients who underwent open or laparoscopic transhiatal and transthoracic esophageal resection were identified using International Classification of Diseases, 9th edition codes. Patients <18 years and those with peritoneal disease were excluded. Multivariate logistic regressions were used to define a predictive model of perioperative mortality and to create a simple risk scale. From 1998 to 2011, a total of 23 751 patients underwent esophagectomy. The observed overall perioperative mortality rate for this cohort was 7.7%. Minimally invasive techniques, and operations performed in higher volume centers were protective, whereas increasing age, comorbidities and diagnosis of squamous cell carcinoma were independent predictors of mortality. Based on this population, a risk scale from 0-16 was created. The calibration revealed a good agreement between the observed and risk scale-predicted probabilities. A set of sensitivity/specificity analyses was then performed to define normal (score 0-7) and high risk (score 8-16) patients for clinical practice. Mortality in patients with a score of 0-7 ranged from 1.3-7.6%, compared with 10.5-34.5% in patients with a score of 8-16. This simple preoperative risk scale may accurately predict the risk of perioperative mortality following esophagectomy for malignancy and can be used as a clinical tool for preoperative counseling.
手术仍然是食管癌患者可采用的主要治疗选择之一，在某些队列中死亡率较高。本研究的目的是基于患者因素、医院因素和肿瘤病理制定一个简单的术前风险量表，以预测恶性肿瘤食管切除术后围手术期死亡风险。使用全国住院患者样本数据库创建风险量表。通过国际疾病分类第9版编码识别接受开放或腹腔镜经裂孔和经胸食管切除术的患者。排除年龄<18岁和患有腹膜疾病的患者。采用多因素逻辑回归来定义围手术期死亡的预测模型并创建一个简单的风险量表。1998年至2011年，共有23751例患者接受了食管切除术。该队列观察到的总体围手术期死亡率为7.7%。微创技术以及在手术量较大的中心进行的手术具有保护作用，而年龄增加、合并症和鳞状细胞癌诊断是死亡的独立预测因素。基于该人群，创建了一个0至16的风险量表。校准显示观察到的概率与风险量表预测的概率之间具有良好的一致性。然后进行了一组敏感性/特异性分析，以确定临床实践中的正常（评分0至7）和高风险（评分8至16）患者。评分0至7的患者死亡率为1.3%至7.6%，而评分8至16的患者死亡率为10.5%至34.5%。这个简单的术前风险量表可以准确预测恶性肿瘤食管切除术后围手术期死亡风险，并可作为术前咨询的临床工具。
