Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
Gastrointest Endosc. 2020 Jan;91(1):33-40.e1. doi: 10.1016/j.gie.2019.07.036. Epub 2019 Aug 14.
We aimed to establish a predictive model and develop a simple risk-scoring system (Zhongshan POEM Score) to help clinicians to characterize high-risk patients for clinical failure after peroral endoscopic myotomy (POEM).
A total of 1538 patients with achalasia treated with POEM with available follow-up data were included in this study and were randomly classified to the training cohort (n = 769) or internal validation cohort (n = 769). A risk-scoring system was developed using multivariate Cox regression analysis in the training cohort. The system was then internally validated by survival analysis in the validation cohort.
During a median follow-up time of 42 months, 109 patients had clinical failure. In the training stage, 3 risk factors for clinical failure were weighted with point values: previous treatment (2 points), intraprocedural mucosal injury (2 points for type I and 6 points for type II), and clinical reflux (3 points). The patients were categorized into low-risk and high-risk groups. In the validation stage, Kaplan-Meier curves differed significantly between the 2 groups. Patients in the high-risk group had a significantly higher risk of clinical failure than those in the low-risk group (hazard ratio, 3.99; 95% confidence interval, 2.31-6.91; P < .001). Satisfactory discrimination and calibration were shown.
This risk-scoring system demonstrated good performance in predicting clinical failure in patients who underwent POEM.
我们旨在建立一个预测模型，并开发一个简单的风险评分系统（中山 POEM 评分），以帮助临床医生识别 POEM 术后临床失败的高危患者。
本研究共纳入 1538 例接受 POEM 治疗的贲门失弛缓症患者，且均有随访资料。患者被随机分为训练队列（n=769）或内部验证队列（n=769）。采用多变量 Cox 回归分析在训练队列中建立风险评分系统。然后，通过验证队列中的生存分析对该系统进行内部验证。
在中位随访时间 42 个月期间，有 109 例患者发生临床失败。在训练阶段，有 3 个临床失败的风险因素被赋予了分值：既往治疗（2 分）、术中黏膜损伤（I 型 2 分，II 型 6 分）和临床反流（3 分）。患者被分为低危组和高危组。在验证阶段，两组之间的 Kaplan-Meier 曲线差异有统计学意义。高危组患者的临床失败风险明显高于低危组（危险比，3.99；95%置信区间，2.31-6.91；P<0.001）。该评分系统显示出良好的区分度和校准度。
该风险评分系统在预测 POEM 术后患者临床失败方面表现良好。
