Kengsakul Malika, Nieuwenhuyzen-de Boer Gatske M, Udomkarnjananun Suwasin, Kerr Stephen J, van Doorn Helena C, van Beekhuizen Heleen J
Department of Gynecologic Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
Department of Obstetrics and Gynecology, Srinakharinwirot University Panyananthaphikkhu Chonprathan Medical Center, Nonthaburi, Thailand.
Int J Gynecol Cancer. 2023 Feb 6;33(2):263-270. doi: 10.1136/ijgc-2022-003998.
The Comprehensive Complication Index (CCI) is an instrument used to measure cumulative post-operative complications. Our study aimed to validate the CCI after cytoreductive surgery for primary advanced-stage epithelial ovarian cancer, and to compare its diagnostic performance with the Clavien-Dindo classification.
This prospective cohort study classified post-operative complications according to the Clavien-Dindo classification and the CCI. Logistic regression was used to determine the association between both classifications with intensive care unit admission, prolonged length of hospital stay (defined as stays longer than the 75th percentile of all stays in this study), 30-day readmission, and time to initiating chemotherapy after surgery >42 days. Area under the receiver operating characteristic curves (AUC) were used to assess the discriminative performance of each classification.
A total of 300 patients were included in the analysis. Most patients (n=255, 85%) underwent interval cytoreductive surgery. Complete cytoreduction was achieved in 235 (78%) patients. Overall, 30-day post-operative complications classified by the Clavien-Dindo classification occurred in 147 (49%) patients. Severe complications (grade ≥3a) occurred in 51 (17%) patients. Approximately 30% (n=82) had multiple complications. The CCI showed an excellent correlation with the Clavien-Dindo classification (=0.906, p<0.001). In comparison with the Clavien-Dindo classification, the proportion of patients classified with severe complications increased from 17% to 30% when stratified with the CCI, and 20% of patients were diagnosed with a CCI score that correlated with a higher Clavien-Dindo classification grade. On regression analysis, both Clavien-Dindo classification and CCI had associations with intensive care unit admission, prolonged length of hospital stay, 30-day readmission, and time to chemotherapy >42 days (all p<0.05). AUC demonstrated that CCI (0.842, 95% CI 0.792 to 0.893) and Clavien-Dindo classification (0.813, 95% CI 0.762 to 0.864, p<0.001) had a good diagnostic performance for prolonged length of hospital stay.
Both the Clavien-Dindo classification and CCI showed significant associations with all surgical outcomes. However, the cumulative complications score of the CCI demonstrated a more superior discriminative performance than the Clavien-Dindo classification for prolonged length of hospital stay in advanced-stage epithelial ovarian cancer.
综合并发症指数（CCI）是一种用于衡量术后累积并发症的工具。我们的研究旨在验证原发性晚期上皮性卵巢癌肿瘤细胞减灭术后的CCI，并将其诊断性能与Clavien-Dindo分类法进行比较。
这项前瞻性队列研究根据Clavien-Dindo分类法和CCI对术后并发症进行分类。采用逻辑回归分析来确定这两种分类法与重症监护病房入院、住院时间延长（定义为本研究中所有住院时间超过第75百分位数）、30天再入院以及术后开始化疗时间>42天之间的关联。受试者工作特征曲线下面积（AUC）用于评估每种分类法的判别性能。
共有300例患者纳入分析。大多数患者（n = 255，85%）接受了间歇性肿瘤细胞减灭术。235例（78%）患者实现了完全肿瘤细胞减灭。总体而言，根据Clavien-Dindo分类法，147例（49%）患者发生了术后30天并发症。51例（17%）患者发生了严重并发症（≥3a级）。约30%（n = 82）的患者有多种并发症。CCI与Clavien-Dindo分类法显示出极好的相关性（= 0.906，p < 0.001）。与Clavien-Dindo分类法相比，当按CCI分层时，严重并发症患者的比例从17%增加到30%，并且20%的患者被诊断为CCI评分与更高的Clavien-Dindo分类等级相关。回归分析显示，Clavien-Dindo分类法和CCI均与重症监护病房入院、住院时间延长、30天再入院以及化疗时间>42天相关（所有p < 0.05）。AUC表明，CCI（0.842，95%CI 0.792至0.893）和Clavien-Dindo分类法（0.813，95%CI 0.762至0.864，p < 0.001）对住院时间延长具有良好的诊断性能。
Clavien-Dindo分类法和CCI均与所有手术结局显著相关。然而，对于晚期上皮性卵巢癌患者住院时间延长的情况，CCI的累积并发症评分显示出比Clavien-Dindo分类法更优越的判别性能。
