肝癌患者术后恶心呕吐风险评分的外部验证：一项单中心前瞻性队列研究。

Department of Nursing, Zhongshan Hospital of Fudan University, Shanghai, 200032, People's Republic of China.

Department of Biostatistics, Zhongshan Hospital of Fudan University, Shanghai, 200032, People's Republic of China.

Eur J Oncol Nurs. 2023 Aug;65:102350. doi: 10.1016/j.ejon.2023.102350. Epub 2023 Jun 2.

OBJECTIVES

This study aimed to test the external validity of postoperative nausea and vomiting (PONV) risk assessment tools in patients undergoing hepatectomy, and to guide healthcare professionals' assessment of postoperative patients.

BACKGROUND

The identification of PONV risk is particularly important in the context of prevention. However, the predictive performance of the current PONV risk scores has not been confirmed in patients with liver cancer, and its applicability is still unknown. These uncertainties pose difficulties in performing routine risk assessment of PONV for patients with liver cancer in a clinical practice setting.

METHODS

Patients diagnosed with liver cancer and undergoing hepatectomy were prospectively consecutively recruited. All enrolled patients received PONV assessments and PONV risk assessments via the Apfel risk score and the Koivuranta risk score. Receiver operating characteristic curves (ROC curves) and calibration curves were used to assess the external validity. This study was reported according to the TRIPOD Checklist.

RESULTS

Among 214 PONV-assessed patients, 114 patients (53.3%) developed PONV. For the Apfel simplified risk score, the ROC area was 0.612 (95% confidence interval [CI]: 0.543-0.678) in the validation dataset, which demonstrated imperfect discrimination; the calibration curve showed poor calibration with a slope of 0.49. For the Koivuranta score, the ROC area was 0.628 (CI: 0.559-0.693) in the validation dataset, which showed limited discrimination; the calibration curve indicated an unsatisfactory calibration with a slope of 0.71.

CONCLUSIONS

The Apfel risk score and the Koivuranta risk score were not well validated in our study and disease-specific risk factors should be taken into account when updating or developing PONV risk stratification instruments.

目的

本研究旨在检验术后恶心呕吐（PONV）风险评估工具在肝切除术患者中的外部有效性，并为医护人员评估术后患者提供指导。

背景

在预防方面，识别 PONV 风险尤为重要。然而，目前的 PONV 风险评分在肝癌患者中的预测性能尚未得到证实，其适用性仍不清楚。这些不确定性给肝癌患者在临床实践中进行常规 PONV 风险评估带来了困难。

方法

前瞻性连续招募诊断为肝癌并接受肝切除术的患者。所有入组患者均接受 PONV 评估和 Apfel 风险评分和 Koivuranta 风险评分的 PONV 风险评估。采用受试者工作特征曲线（ROC 曲线）和校准曲线评估外部有效性。本研究按照 TRIPOD 清单进行报告。

结果

在 214 例接受 PONV 评估的患者中，有 114 例（53.3%）发生了 PONV。对于 Apfel 简化风险评分，验证数据集中的 ROC 曲线下面积为 0.612（95%置信区间[CI]：0.543-0.678），表明存在一定程度的区分能力不足；校准曲线显示校准效果不佳，斜率为 0.49。对于 Koivuranta 评分，验证数据集中的 ROC 曲线下面积为 0.628（CI：0.559-0.693），表明区分能力有限；校准曲线表明校准效果不理想，斜率为 0.71。