Department of Urologic Sciences, University of British Columbia, Level 6, 2775 Laurel St, Vancouver, BC, V6N 2W6, Canada.
Vancouver Prostate Centre, Vancouver, BC, Canada.
World J Urol. 2020 May;38(5):1215-1220. doi: 10.1007/s00345-019-02915-3. Epub 2019 Aug 27.
Radical cystectomy (RC) is a challenging procedure with significant morbidity, though remains the standard of care treatment for many patients with bladder cancer. There has been debate regarding the utility of universal risk calculators to aid in point-of-care prediction of complications in individual patients preoperatively. We retrospectively evaluated the predictive value of the ACS NSQIP universal surgical risk calculator in our patients who underwent RC.
A prospective cohort of patients undergoing RC was retrospectively reviewed between October 2014 and August 2017. Only patients who underwent a RC for genitourinary cancer without significant deviation from NSQIP surgery codes 51590, 51595, and 51596 (n = 29) were included. The accuracy of the risk calculator was assessed by ROC AUC and Brier scores for both NSQIP and Clavien-Dindo defined complications. Additionally, each NSQIP risk factor was individually assessed for association with postoperative complications.
223 patients who underwent open or robotic RC (n = 18) were included for analysis. Determined by AUC C-stat and Brier scores, prediction was good for cardiac complications (0.80 and 0.021), fair for pneumonia (0.75 and 0.017), poor for UTI (0.64 and 0.078), 30-day mortality (0.62 and 0.013), any complication (0.60 and 0.19) and serious complication (0.60 and 0.17). There was a significant discordance between the rate of NSQIP predicted vs. Clavien-Dindo observed any and serious complications: 28.8% vs. 67.3%, and 25.3% vs. 11.7%, respectively.
The NSQIP universal surgical risk calculator did not perform with enough accuracy to consider adoption into clinical practice.
根治性膀胱切除术（RC）是一种具有挑战性的手术，其发病率较高，但仍是许多膀胱癌患者的标准治疗方法。关于是否使用通用风险计算器在术前为个别患者提供并发症发生的即时预测，存在一定的争议。我们回顾性评估了 ACS NSQIP 通用手术风险计算器在接受 RC 治疗的患者中的预测价值。
对 2014 年 10 月至 2017 年 8 月期间接受 RC 的患者进行了前瞻性队列研究。仅纳入接受 RC 治疗泌尿生殖系统癌症且与 NSQIP 手术代码 51590、51595 和 51596 无明显差异的患者（n=29）。通过 ROC AUC 和 Brier 评分评估风险计算器对 NSQIP 和 Clavien-Dindo 定义的并发症的准确性。此外，还单独评估了每个 NSQIP 风险因素与术后并发症的相关性。
纳入了 223 例接受开腹或机器人 RC（n=18）的患者进行分析。通过 AUC C-统计量和 Brier 评分判断，预测心脏并发症的准确性较高（0.80 和 0.021），预测肺炎的准确性为中等（0.75 和 0.017），预测尿路感染的准确性较差（0.64 和 0.078），30 天死亡率（0.62 和 0.013）、任何并发症（0.60 和 0.19）和严重并发症（0.60 和 0.17）。NSQIP 预测的与 Clavien-Dindo 观察到的任何并发症和严重并发症的发生率之间存在显著差异：分别为 28.8% vs. 67.3%和 25.3% vs. 11.7%。
NSQIP 通用手术风险计算器的准确性不足，无法考虑将其应用于临床实践。
