Departments of Epidemiology.
Biostatistics.
Am J Clin Oncol. 2020 Sep;43(9):640-647. doi: 10.1097/COC.0000000000000724.
The incidence of liver cancer has more than tripled since 1980. Hepatectomy represents the major curative treatment for liver cancer. The risk factors associated with 90-day mortality after hepatectomy are not well understood and there are currently no good prediction models for this outcome. The objectives of the current study were to identify risk factors of 90-day mortality after hepatectomy in patients with hepatocellular carcinoma and to develop an integer-based risk score using the National Cancer Database.
Hepatectomies recorded in the National Cancer Database during 2004-2012 were reviewed for 90-day mortality. Risk factors were identified by multivariate logistic regression models. An integer-based risk score was developed using the β coefficients derived from the logistic regression model and tested for discriminatory ability. According to the total risk score, patients were grouped into 4 risk groups.
The overall 90-day mortality was 10.2%. Ten risk factors were identified, which included sex, age, race/ethnicity, insurance status, education, annual hospital volume, stage, tumor grade, Charlson-Deyo Score, and surgical procedure. The risk of 90-day mortality was stratified into 4 groups. The calculated 90-day mortality rates were 2.47%, 5.88%, 12.58%, and 24.67% for low-risk, medium-risk, high-risk, and excessive-risk groups, respectively. An area under the receiver operating characteristic curve of 0.69 was obtained for model discrimination.
The integer-based risk score we developed could easily quantify each patient's risk level and predict 90-day mortality after hepatectomy. The stratified risk score could be a useful addition to perioperative risk management and a tool to improve 90-day mortality after hepatectomy.
自 1980 年以来，肝癌的发病率增长了两倍多。肝切除术是肝癌的主要治疗方法。肝切除术后 90 天死亡率的相关危险因素尚不清楚，目前尚无针对该结果的良好预测模型。本研究的目的是确定肝细胞癌患者肝切除术后 90 天死亡率的危险因素，并使用国家癌症数据库开发基于整数的风险评分。
回顾了 2004 年至 2012 年期间国家癌症数据库中记录的肝切除术，以评估 90 天死亡率。通过多变量逻辑回归模型确定危险因素。使用从逻辑回归模型中得出的β系数开发基于整数的风险评分，并测试其判别能力。根据总风险评分，将患者分为 4 个风险组。
总体 90 天死亡率为 10.2%。确定了 10 个危险因素，包括性别、年龄、种族/民族、保险状况、教育程度、医院年手术量、分期、肿瘤分级、Charlson-Deyo 评分和手术方式。90 天死亡风险分层为 4 组。计算出的低危、中危、高危和高危组的 90 天死亡率分别为 2.47%、5.88%、12.58%和 24.67%。模型判别获得的受试者工作特征曲线下面积为 0.69。
我们开发的基于整数的风险评分可以简单地量化每个患者的风险水平，并预测肝切除术后 90 天的死亡率。分层风险评分可作为围手术期风险管理的有用补充，也是提高肝切除术后 90 天死亡率的工具。
