Valdatta Luigi, Perletti Gianpaolo, Maggiulli Francesca, Tamborini Federico, Pellegatta Igor, Cherubino Mario
Department of Biotechnology and Life Sciences, Section of Medical and Surgical Sciences, University of Insubria, I-21100 Varese, Italy.
Department of Human Structure and Repair, Faculty of Medicine and Medical Sciences, Ghent University, B-9000 Ghent, Belgium.
Oncol Lett. 2019 Jan;17(1):263-269. doi: 10.3892/ol.2018.9568. Epub 2018 Oct 11.
The aim of the present study was to determine the association between preoperative frailty and the onset of surgical complications in patients diagnosed with massive non-melanoma skin cancer subjected to plastic and reconstructive surgery. A retrospective analysis was performed on a cohort of 587 patients with non-melanoma skin cancer, selected on the basis of specific inclusion criteria, who were subjected to plastic and reconstructive surgery between 2005 and 2014. Frailty was scored using the FRAIL index, whereas postoperative complications were classified according to Clavien-Dindo criteria. By binary logistic regression, the odds and probabilities of complications were calculated as a function of increasing values of the FRAIL index. Two different logistic models were created, comparing absent/mild (Clavien grades 1st and 2nd) vs. moderate/severe complications or mortality (Clavien grades 3rd-5th; model A), or absent/mild/moderate complications (Clavien grades 1st-3rd) vs. severe complications or mortality (Clavien grades 4th and 5th; model B). The FRAIL index was an accurate predictor of surgical complications or mortality, with significant odds ratios and goodness of fit. In model A, FRAIL scores 4 and 5 were the most critical predictors of moderate/severe complications or mortality (37 and 94% probability, 0.6 and 17.3 odds, respectively), compared to score 3 (2% probability, 0.02 odds) or lower. In model B, FRAIL score 5 was the most critical predictor of severe complications or mortality, as it was associated with a 74.6% probability and 2.93 odds for these events. In conclusion, increasing FRAIL scores were associated with worsening surgical outcomes for patients with non-melanoma skin cancer undergoing plastic/reconstructive surgery. A low rate of surgical complications was observed in pre-frail and frail patients up to FRAIL score 3.
本研究的目的是确定诊断为大面积非黑色素瘤皮肤癌并接受整形和重建手术的患者术前虚弱与手术并发症发生之间的关联。对587例非黑色素瘤皮肤癌患者进行了回顾性分析，这些患者根据特定纳入标准选取，于2005年至2014年间接受了整形和重建手术。使用FRAIL指数对虚弱进行评分，而术后并发症则根据Clavien-Dindo标准进行分类。通过二元逻辑回归，计算并发症的比值比和概率作为FRAIL指数增加值的函数。创建了两个不同的逻辑模型，比较无/轻度（Clavien 1级和2级）与中度/重度并发症或死亡率（Clavien 3级 - 5级；模型A），或无/轻度/中度并发症（Clavien 1级 - 3级）与重度并发症或死亡率（Clavien 4级和5级；模型B）。FRAIL指数是手术并发症或死亡率的准确预测指标，具有显著的比值比和拟合优度。在模型A中，与FRAIL评分为3（概率为2%，比值为0.02）或更低相比，FRAIL评分为4和5是中度/重度并发症或死亡率的最关键预测指标（概率分别为37%和94%，比值分别为0.6和17.3）。在模型B中，FRAIL评分为5是重度并发症或死亡率的最关键预测指标，因为这些事件的概率为74.6%，比值为2.93。总之，对于接受整形/重建手术的非黑色素瘤皮肤癌患者，FRAIL评分增加与手术结果恶化相关。在FRAIL评分达到3之前的虚弱前期和虚弱患者中，手术并发症发生率较低。
