结直肠癌术后死亡风险评估：使用荷兰结直肠癌审计数据开发并验证临床预测模型

Postoperative mortality risk assessment in colorectal cancer: development and validation of a clinical prediction model using data from the Dutch ColoRectal Audit.

作者信息

de Nes Lindsey C F, Hannink Gerjon, 't Lam-Boer Jorine, Hugen Niek, Verhoeven Rob H, de Wilt Johannes H W

机构信息

Department of Surgery, Maasziekenhuis Pantein, Beugen, The Netherlands.

Department of Surgery, Radboud Medical Center, University of Nijmegen, Nijmegen, The Netherlands.

出版信息

BJS Open. 2022 Mar 8;6(2). doi: 10.1093/bjsopen/zrac014.

DOI:10.1093/bjsopen/zrac014

PMID:35357416

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8969795/

Abstract

BACKGROUND

As the outcome of modern colorectal cancer (CRC) surgery has significantly improved over the years, however, renewed and adequate risk stratification for mortality is important to identify high-risk patients. This population-based study was conducted to analyse postoperative outcomes in patients with CRC and to create a risk model for 30-day mortality.

METHODS

Data from the Dutch Colorectal Audit were used to assess differences in postoperative outcomes (30-day mortality, hospital stay, blood transfusion, postoperative complications) in patients with CRC treated from 2009 to 2017. Time trends were analysed. Clinical variables were retrieved (including stage, age, sex, BMI, ASA grade, tumour location, timing, surgical approach) and a prediction model with multivariable regression was computed for 30-day mortality using data from 2009 to 2014. The predictive performance of the model was tested among a validation cohort of patients treated between 2015 and 2017.

RESULTS

The prediction model was obtained using data from 51 484 patients and the validation cohort consisted of 32 926 patients. Trends of decreased length of postoperative hospital stay and blood transfusions were found over the years. In stage I-III, postoperative complications declined from 34.3 per cent to 29.0 per cent (P < 0.001) over time, whereas in stage IV complications increased from 35.6 per cent to 39.5 per cent (P = 0.010). Mortality decreased in stage I-III from 3.0 per cent to 1.4 per cent (P < 0.001) and in stage IV from 7.6 per cent to 2.9 per cent (P < 0.001). Eight factors, including stage, age, sex, BMI, ASA grade, tumour location, timing, and surgical approach were included in a 30-day mortality prediction model. The results on the validation cohort documented a concordance C statistic of 0.82 (95 per cent c.i. 0.80 to 0.83) for the prediction model, indicating good discriminative ability.

CONCLUSION

Postoperative outcome improved in all stages of CRC surgery in the Netherlands. The developed model accurately predicts postoperative mortality risk and is clinically valuable for decision-making.

摘要

背景

近年来，现代结直肠癌（CRC）手术的疗效有了显著改善，然而，重新进行充分的死亡风险分层对于识别高危患者很重要。这项基于人群的研究旨在分析CRC患者的术后结局，并建立一个30天死亡率的风险模型。

方法

使用荷兰结直肠癌审计的数据来评估2009年至2017年接受治疗的CRC患者术后结局（30天死亡率、住院时间、输血、术后并发症）的差异。分析了时间趋势。检索了临床变量（包括分期、年龄、性别、BMI、ASA分级、肿瘤位置、时间、手术方式），并使用2009年至2014年的数据通过多变量回归计算了30天死亡率的预测模型。在2015年至2017年接受治疗的患者验证队列中测试了该模型的预测性能。

结果

预测模型使用了51484例患者的数据，验证队列包括32926例患者。多年来发现术后住院时间和输血次数呈下降趋势。在I-III期，术后并发症随时间从34.3%降至29.0%（P<0.001），而在IV期并发症从35.6%增至39.5%（P=0.010）。I-III期死亡率从3.0%降至1.4%（P<0.001），IV期从7.6%降至2.9%（P<0.001）。一个30天死亡率预测模型纳入了八个因素，包括分期、年龄、性别、BMI、ASA分级、肿瘤位置、时间和手术方式。验证队列的结果显示预测模型的一致性C统计量为0.82（95%置信区间0.80至0.83），表明具有良好的鉴别能力。