Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY.
Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY.
Urol Oncol. 2021 Feb;39(2):109-120. doi: 10.1016/j.urolonc.2020.09.032. Epub 2020 Nov 19.
Radical cystectomy (RC) with urinary diversion is associated with significant perioperative morbidity and mortality, varying between 30% and 70% and between 0.3% and 10.6%, respectively. Risk calculators have been extensively studied in the general surgery literature to predict 30- and 90-day postoperative morbidity and mortality but have not been widely accepted in the RC literature.
We performed a search of MEDLINE and Embase databases during May 2020 to identify all relevant studies using the following keywords: radical cystectomy, surgical complication predictive model, surgical complication predictive equation, surgical complication predictive nomogram, surgical risk calculator, morbidity, and mortality. We determined the existing surgical predictive nomograms, calculators, and indices and their accuracy in predicting morbidity, mortality, and major complications after RC.
National Surgical Quality Improvement Program had poor accuracy at predicting 30-day morbidity at mortality (AUC 0.5-0.6). LACE index showed good discrimination at predicting 90-day mortality (AUC 0.7). The various frailty and sarcopenia indices have shown poor to fair accuracy at predicting (AUC 0.5-0.7). The Isbarn and Aziz nomograms have equivalent accuracy at predicting 90-day mortality (AUC 0.7) but are limited by inclusion of tumor histology and presence of metastatic disease as variables. POSSUM and P-POSSUM have poor ability at predicting morbidity and mortality (AUC 0.5) and are cumbersome calculators. The surgical Apgar score has been able to predict 30-day morbidity and mortality but can only be used in the postoperative setting.
The currently available surgical risk calculators have either poor accuracy at predicting post-RC morbidity and mortality or are limited by types of variables included. An ideal risk calculator would be comprised of preoperative factors only and have a high accuracy to serve as a tool for preoperative patient counseling prior to surgery.
There exists a strong need to develop a comprehensive and accurate preoperative risk calculator that predicts morbidity and mortality after RC.
根治性膀胱切除术（RC）伴尿路改道术相关的围手术期发病率和死亡率差异较大，分别为 30%-70%和 0.3%-10.6%。风险计算器已在普通外科文献中广泛研究，用于预测术后 30 天和 90 天的发病率和死亡率，但尚未被 RC 文献广泛接受。
我们于 2020 年 5 月在 MEDLINE 和 Embase 数据库中进行了检索，使用以下关键词查找所有相关研究：根治性膀胱切除术、手术并发症预测模型、手术并发症预测方程、手术并发症预测列线图、手术风险计算器、发病率和死亡率。我们确定了现有的手术预测列线图、计算器和指标，以及它们预测 RC 术后发病率、死亡率和主要并发症的准确性。
国家外科质量改进计划（National Surgical Quality Improvement Program，NSQIP）在预测 30 天发病率和死亡率方面的准确性较差（AUC 为 0.5-0.6）。LACE 指数在预测 90 天死亡率方面具有良好的区分度（AUC 为 0.7）。各种虚弱和肌肉减少症指数在预测方面的准确性较差或一般（AUC 为 0.5-0.7）。Isbarn 和 Aziz 列线图在预测 90 天死亡率方面具有相同的准确性（AUC 为 0.7），但受到纳入肿瘤组织学和转移性疾病作为变量的限制。POSSUM 和 P-POSSUM 在预测发病率和死亡率方面能力较差（AUC 为 0.5），且计算繁琐。手术 Apgar 评分能够预测 30 天的发病率和死亡率，但只能在术后使用。
目前可用的手术风险计算器在预测 RC 术后发病率和死亡率方面要么准确性较差，要么受到纳入变量类型的限制。理想的风险计算器将仅由术前因素组成，具有较高的准确性，作为手术前患者咨询的工具。
迫切需要开发一种全面且准确的术前风险计算器，以预测 RC 术后的发病率和死亡率。
