Jiang Caixia, Liu Yingwei, Tang Junying, Li Zhengyu, Min Wenjiao
Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.
Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Front Oncol. 2022 Nov 23;12:1052628. doi: 10.3389/fonc.2022.1052628. eCollection 2022.
To establish nomograms to predict the risk of postoperative complications following cytoreductive surgery in patients with advanced epithelial ovarian cancer (AEOC).
A multicenter retrospective cohort study that included patients with FIGO stage IIIC-IV epithelial ovarian cancer who underwent cytoreductive surgery was designed. By using univariate and multivariate analyses, patient preoperative characteristics were used to predict the risk of postoperative complications. Multivariate modeling was used to develop Nomograms.
Overall, 585 AEOC patients were included for analysis (training cohort = 426, extrapolation cohort = 159). According to the findings, the training cohort observed an incidence of postoperative overall and severe complications of 28.87% and 6.10%, respectively. Modified frailty index (mFI) (OR 1.96 and 2.18), FIGO stage (OR 2.31 and 3.22), and Surgical Complexity Score (SCS) (OR 1.16 and 1.23) were the clinical factors that were most substantially associated to the incidence of overall and severe complications, respectively. The resulting nomograms demonstrated great internal discrimination, good consistency, and stable calibration, with C-index of 0.74 and 0.78 for overall and severe complications prediction, respectively. A satisfactory external discrimination was also indicated by the extrapolation cohort, with the C-index for predicting overall and severe complications being 0.92 and 0.91, respectively.
The risk of considerable postoperative morbidity exists after cytoreductive surgery for AEOC. These two nomograms with good discrimination and calibration might be useful to guide clinical decision-making and help doctors assess the probability of postoperative complications for AEOC patients.
建立列线图以预测晚期上皮性卵巢癌（AEOC）患者减瘤手术后的术后并发症风险。
设计了一项多中心回顾性队列研究，纳入接受减瘤手术的国际妇产科联盟（FIGO）IIIC-IV期上皮性卵巢癌患者。通过单因素和多因素分析，利用患者术前特征预测术后并发症风险。采用多因素建模开发列线图。
总体而言，纳入585例AEOC患者进行分析（训练队列=426例，外推队列=159例）。根据研究结果，训练队列中术后总体并发症和严重并发症的发生率分别为28.87%和6.10%。改良虚弱指数（mFI）（比值比[OR]为1.96和2.18）、FIGO分期（OR为2.31和3.22）以及手术复杂性评分（SCS）（OR为1.16和1.23）分别是与总体并发症和严重并发症发生率最密切相关的临床因素。生成的列线图显示出良好的内部区分度、一致性和校准稳定性，总体并发症预测和严重并发症预测的C指数分别为0.74和0.78。外推队列也显示出令人满意的外部区分度，预测总体并发症和严重并发症的C指数分别为0.92和0.91。
AEOC患者减瘤手术后存在相当高术后发病率的风险。这两个具有良好区分度和校准性的列线图可能有助于指导临床决策，并帮助医生评估AEOC患者术后并发症的概率。
