Service d'urologie, CHU Grenoble-Alpes, CS 10217, 38043 Grenoble cedex 9, France.
Service d'urologie, hôpital Bichat-Claude-Bernard, Paris, France.
Fr J Urol. 2024 Jun;34(5):102610. doi: 10.1016/j.fjurol.2024.102610. Epub 2024 Mar 7.
Identifying patients at risk after cystectomy for cancer is essential. The POSPOM score is a non-specific urological surgery score for estimating postoperative hospital mortality. This study sought to validate the POSPOM score for predicting postoperative morbidity and mortality after cystectomy.
The study retrospectively included all patients undergoing cystectomy for muscle-invasive or locally advanced bladder cancer between 2010 and 2019 in one center. The primary objective was validation of the POSPOM score for calculating severe postoperative morbidity [Clavien-Dindo (CDC)≥3] and 90-day mortality after cystectomy. Secondary objectives were comparison to other predictive scores [Charlson (CCI), ASA].
At 90days, out of 167 patients, 26% (n=44) had a CDC≥3 complication and 8.4% (n=14) had died. POSPOM correlated with the risk of death at 90days (P<0.001) and postoperative transfusion (P<0.01). Patients with CDC≥3 complications had higher CCI and POSPOM (median 6.5 vs. 5, P<0.01 and 6.49% vs. 5.58%, P=0.029, respectively). Patients who died postoperatively had higher CCI and POSPOM (median 8 vs. 6, P<0.001 and 23.9% vs. 5.58%, P<0.001, respectively). The prognostic value of the POSPOM score for predicting mortality appears better [AUC=0.886 (0.798-0.973)] compared with CCI [AUC=0.812 (0.710-0.915)] and ASA [AUC=0.739 (0.630-0.849)], but not for predicting morbidity.
This study confirms the robustness of the POSPOM score for estimating mortality and its limitations for predicting postoperative morbidity.
识别膀胱癌根治术后风险患者至关重要。POSPOM 评分是一种用于估计术后院内死亡率的非特异性泌尿外科手术评分。本研究旨在验证 POSPOM 评分预测膀胱癌根治术后术后发病率和死亡率的能力。
本研究回顾性纳入了 2010 年至 2019 年期间在一家中心接受根治性膀胱切除术的肌层浸润性或局部晚期膀胱癌患者。主要目的是验证 POSPOM 评分用于计算根治性膀胱切除术后严重术后并发症（Clavien-Dindo [CDC]≥3）和 90 天死亡率的能力。次要目标是与其他预测评分（Charlson [CCI]、ASA）进行比较。
在 90 天内，167 例患者中有 26%（n=44）出现 CDC≥3 并发症，8.4%（n=14）死亡。POSPOM 与 90 天死亡率（P<0.001）和术后输血（P<0.01）相关。出现 CDC≥3 并发症的患者 CCI 和 POSPOM 更高（中位数 6.5 与 5，P<0.01 和 6.49%与 5.58%，P=0.029）。术后死亡的患者 CCI 和 POSPOM 更高（中位数 8 与 6，P<0.001 和 23.9%与 5.58%，P<0.001）。POSPOM 评分预测死亡率的预后价值似乎优于 CCI [AUC=0.886（0.798-0.973）]和 ASA [AUC=0.739（0.630-0.849）]，但预测发病率的价值有限。
本研究证实了 POSPOM 评分用于估计死亡率的稳健性及其预测术后发病率的局限性。
