计算机断层扫描调整的瘘管风险评分预测胰十二指肠切除术后临床相关术后胰瘘：模型升级的培训和外部验证。

Computed tomography-adjusted fistula risk score for predicting clinically relevant postoperative pancreatic fistula after pancreatoduodenectomy: Training and external validation of model upgrade.

机构信息

Department of Radiology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang 110004, China.

Department of Pancreato-thyroidic Surgery, Shengjing Hospital of China Medical University, Shenyang, China.

出版信息

EBioMedicine. 2020 Dec;62:103096. doi: 10.1016/j.ebiom.2020.103096. Epub 2020 Nov 5.

DOI:10.1016/j.ebiom.2020.103096

PMID:33161232

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7648191/

Abstract

BACKGROUND

To develop a modified Fistula Risk Score (FRS) for predicting clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreatoduodenectomy (PD) based on both FRS and contrast-enhanced computed tomography (CE-CT).

METHODS

In this multicenter retrospective analysis, we focused on 990 consecutive patients with pancreatoduodenectomy performed at four institutions between 2009 and 2019. The enhanced CT-FRS model initially targeted 26 pre- and intraoperative factors, including CT descriptors, FRS elements and clinical factors, using LASSO-penalized multivariable logistic regression for predicting CR-POPF events in discovery (n = 718) and externally validated (n = 272) datasets. Probabilities generated were further correlated with histologic features of pancreatic stumps in 356 patients. C-indices were analyzed to compare the predictive potential between the original FRS and the CT-FRS.

FINDINGS

CR-POPF developed in 112 (15.6%) and 36 (13.2%) patients in discovery and validation datasets, respectively. The final CT-FRS construct, incorporating remnant pancreatic volume (RPV), stump area, fat and atrophy scores by CT, and main pancreatic duct size, offered significantly greater overall predictability than the original FRS in discovery (C-index: 0.825 vs 0.794; p = 0.04) and validation (0.807 vs 0.741; p = 0.05) cohorts. Importantly, it outperformed the FRS in patients at moderate risk levels (FRS: 3-6), showing remarkably improved C-indices (discovery: 0.729 vs 0.626 [p<0.001], validation: 0.722 vs 0.573 [p = 0.006]). CT-FRS probabilities increased in conjunction with less extensive pancreatic fibrosis (p<0.001), ample glandular acini (p<0.001), and advanced lipomatosis (p<0.001).

INTERPRETATION

The enhanced CT-FRS performed significantly better than the original FRS in predicting CR-POPF occurrences after PD, especially at moderate FRS levels.

摘要

背景

基于 Fistula Risk Score（FRS）和增强型计算机断层扫描（CE-CT），开发一种改良的 Fistula Risk Score（FRS），用于预测胰十二指肠切除术（PD）后具有临床意义的术后胰腺瘘（CR-POPF）。

方法

在这项多中心回顾性分析中，我们重点关注了 2009 年至 2019 年期间在四家机构接受 PD 的 990 例连续患者。使用 LASSO 惩罚多变量逻辑回归对初始靶向 26 个术前和术中因素（包括 CT 描述符、FRS 元素和临床因素）的增强 CT-FRS 模型进行分析，以预测发现（n=718）和外部验证（n=272）数据集中的 CR-POPF 事件。在 356 例患者中，进一步将生成的概率与胰腺残端的组织学特征相关联。分析 C 指数以比较原始 FRS 和 CT-FRS 的预测潜力。

结果

在发现和验证数据集中，分别有 112（15.6%）和 36（13.2%）例患者发生 CR-POPF。最终的 CT-FRS 构建体，通过 CT 合并胰腺残端体积（RPV）、残端面积、脂肪和萎缩评分，以及主胰管大小，与原始 FRS 相比，在发现（C 指数：0.825 与 0.794；p=0.04）和验证（0.807 与 0.741；p=0.05）队列中提供了显著更高的总体预测能力。重要的是，它在中危风险水平（FRS：3-6）的患者中优于 FRS，显示出显著提高的 C 指数（发现：0.729 与 0.626[ p<0.001]，验证：0.722 与 0.573 [p=0.006]）。CT-FRS 概率随着胰腺纤维化程度降低（p<0.001）、腺泡增多（p<0.001）和脂肪增生程度加重（p<0.001）而增加。