用于胰十二指肠切除术的替代瘘管风险评分（a-FRS）：设计和国际外部验证。

Alternative Fistula Risk Score for Pancreatoduodenectomy (a-FRS): Design and International External Validation.

机构信息

Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, the Netherlands.

Department of Public Health, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands.

出版信息

Ann Surg. 2019 May;269(5):937-943. doi: 10.1097/SLA.0000000000002620.

DOI:10.1097/SLA.0000000000002620

PMID:29240007

Abstract

OBJECTIVE

The aim of this study was to develop an alternative fistula risk score (a-FRS) for postoperative pancreatic fistula (POPF) after pancreatoduodenectomy, without blood loss as a predictor.

BACKGROUND

Blood loss, one of the predictors of the original-FRS, was not a significant factor during 2 recent external validations.

METHODS

The a-FRS was developed in 2 databases: the Dutch Pancreatic Cancer Audit (18 centers) and the University Hospital Southampton NHS. Primary outcome was grade B/C POPF according to the 2005 International Study Group on Pancreatic Surgery (ISGPS) definition. The score was externally validated in 2 independent databases (University Hospital of Verona and University Hospital of Pennsylvania), using both 2005 and 2016 ISGPS definitions. The a-FRS was also compared with the original-FRS.

RESULTS

For model design, 1924 patients were included of whom 12% developed POPF. Three predictors were strongly associated with POPF: soft pancreatic texture [odds ratio (OR) 2.58, 95% confidence interval (95% CI) 1.80-3.69], small pancreatic duct diameter (per mm increase, OR: 0.68, 95% CI: 0.61-0.76), and high body mass index (BMI) (per kg/m increase, OR: 1.07, 95% CI: 1.04-1.11). Discrimination was adequate with an area under curve (AUC) of 0.75 (95% CI: 0.71-0.78) after internal validation, and 0.78 (0.74-0.82) after external validation. The predictive capacity of a-FRS was comparable with the original-FRS, both for the 2005 definition (AUC 0.78 vs 0.75, P = 0.03), and 2016 definition (AUC 0.72 vs 0.70, P = 0.05).

CONCLUSION

The a-FRS predicts POPF after pancreatoduodenectomy based on 3 easily available variables (pancreatic texture, duct diameter, BMI) without blood loss and pathology, and was successfully validated for both the 2005 and 2016 POPF definition. The online calculator is available at www.pancreascalculator.com.

摘要

目的

本研究旨在开发一种新的胰十二指肠切除术后胰瘘（POPF）风险评分（a-FRS），不包括失血作为预测因子。

背景

在最近的两项外部验证中，作为原始-FRS 预测因子之一的失血量并不是一个显著因素。

方法

a-FRS 在两个数据库中开发：荷兰胰腺癌症审计（18 个中心）和南安普顿大学医院 NHS。主要结果是根据 2005 年国际胰腺外科学研究组（ISGPS）定义的 B/C 级 POPF。该评分在两个独立的数据库（维罗纳大学医院和宾夕法尼亚大学医院）中进行了外部验证，使用了 2005 年和 2016 年 ISGPS 定义。a-FRS 还与原始-FRS 进行了比较。

结果

在模型设计中，纳入了 1924 名患者，其中 12%发生了 POPF。三个预测因子与 POPF 密切相关：胰腺质地柔软（比值比 [OR] 2.58，95%置信区间 [95%CI] 1.80-3.69）、胰管直径小（每增加 1mm，OR：0.68，95%CI：0.61-0.76）和高体重指数（BMI）（每增加 1kg/m，OR：1.07，95%CI：1.04-1.11）。内部验证后，该评分具有较好的区分度，曲线下面积（AUC）为 0.75（95%CI：0.71-0.78），外部验证后 AUC 为 0.78（0.74-0.82）。a-FRS 的预测能力与原始-FRS 相当，对于 2005 年的定义（AUC 0.78 与 0.75，P=0.03）和 2016 年的定义（AUC 0.72 与 0.70，P=0.05）都是如此。