Degett Thea Helene, Christensen Jane, Dalton Susanne Oksbjerg, Bossen Kristine, Frederiksen Kirsten, Iversen Lene Hjerrild, Gögenur Ismail
Center for Surgical Science (CSS), Department of Surgery, Zealand University Hospital, Lykkebækvej 1, 4600, Koge, Denmark.
Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark.
Int J Colorectal Dis. 2021 Sep;36(9):1873-1883. doi: 10.1007/s00384-021-03950-6. Epub 2021 May 12.
The aim of this study was to develop and validate a model to predict 90-day mortality after acute colorectal cancer surgery.
The model was developed in all patients undergoing acute colorectal cancer surgery in 2014-2016 and validated in a patient group operated in 2017 in Denmark. The outcome was 90-day mortality. Tested predictor variables were age, sex, performance status, BMI, smoking, alcohol, education level, cohabitation status, tumour localization and primary surgical procedure. Variables were selected according to the smallest Akaike information criterion. The model was shrunken by bootstrapping. Discrimination was evaluated with a receiver operated characteristic curve, calibration with a calibration slope and the accuracy with a Brier score.
A total of 1450 patients were included for development of the model and 451 patients for validation. The 90-day mortality rate was 19% and 20%, respectively. Age, performance status, alcohol, smoking and primary surgical procedure were the final variables included in the model. Discrimination (AUC = 0.79), calibration (slope = 1.04, intercept = 0.04) and accuracy (brier score = 0.13) were good in the developed model. In the temporal validation, discrimination (AUC = 0.80) and accuracy (brier score = 0.13) were good, and calibration was acceptable (slope = 1.19, intercept = 0.52).
We developed prediction model for 90-day mortality after acute colorectal cancer surgery that may be a promising tool for surgeons to identify patients at risk of postoperative mortality.
本研究旨在开发并验证一个预测急性结直肠癌手术后90天死亡率的模型。
该模型在2014 - 2016年接受急性结直肠癌手术的所有患者中开发，并在2017年丹麦手术的一组患者中进行验证。结局指标为90天死亡率。测试的预测变量包括年龄、性别、体能状态、体重指数、吸烟、饮酒、教育水平、同居状况、肿瘤定位和初次手术方式。根据最小赤池信息准则选择变量。通过自抽样法对模型进行收缩。用受试者操作特征曲线评估区分度，用校准斜率评估校准情况，用Brier评分评估准确性。
共纳入1450例患者用于模型开发，451例患者用于验证。90天死亡率分别为19%和20%。年龄、体能状态、饮酒、吸烟和初次手术方式是模型中包含的最终变量。开发的模型在区分度（AUC = 0.79）、校准（斜率 = 1.04，截距 = 0.04）和准确性（Brier评分 = 0.13）方面表现良好。在时间验证中，区分度（AUC = 0.80）和准确性（Brier评分 = 0.13）良好，校准情况可接受（斜率 = 1.19，截距 = 0.52）。
我们开发了急性结直肠癌手术后90天死亡率的预测模型，这可能是外科医生识别术后死亡风险患者的一个有前景的工具。
