左半胰切除术胰瘘预测模型的国际多中心验证以及联合DISPAIR-FRS预测模型的开发与验证。

International multicentre validation of the left pancreatectomy pancreatic fistula prediction models and development and validation of the combined DISPAIR-FRS prediction model.

作者信息

Bonsdorff Akseli, Kjeseth Trond, Kirkegård Jakob, de Ponthaud Charles, Ghorbani Poya, Wennerblom Johanna, Williamson Caroline, Acher Alexandra W, Thillai Manoj, Tarvainen Timo, Helanterä Ilkka, Uutela Aki, Sirén Jukka, Kokkola Arto, Sahakyan Mushegh, Kleive Dyre, Hagen Rolf, Lund Andrea, Nielsen Mette F, Vaillant Jean-Christophe, Fristedt Richard, Biörserud Christina, Bratlie Svein O, Tingstedt Bobby, Labori Knut J, Gaujoux Sébastien, Wigmore Stephen J, Hallet Julie, Sparrelid Ernesto, Sallinen Ville

机构信息

Department of Gastroenterological Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.

Department of Hepato-Pancreato-Biliary Surgery, Rikshospitalet, Oslo University Hospital, Oslo, Norway.

出版信息

Br J Surg. 2025 Mar 4;112(3). doi: 10.1093/bjs/znae313.

DOI:10.1093/bjs/znae313

PMID:40114539

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11926329/

Abstract

BACKGROUND

Every fifth patient undergoing left pancreatectomy develops a postoperative pancreatic fistula (POPF). Accurate POPF risk prediction could help. Two independent preoperative prediction models have been developed and externally validated: DISPAIR and D-FRS. The aim of this study was to validate, compare, and possibly update the models.

METHODS

Patients from nine high-volume pancreatic surgery centres (8 in Europe and 1 in North America) were included in this retrospective cohort study. Inclusion criteria were age over 18 years and open or minimally invasive left pancreatectomy since 2010. Model performance was assessed with discrimination (receiver operating characteristic (ROC) curves) and calibration (calibration plots). The updated model was developed with logistic regression and internally-externally validated.

RESULTS

Of 2284 patients included, 497 (21.8%) developed POPF. Both DISPAIR (area under the ROC curve (AUC) 0.62) and D-FRS (AUC 0.62) performed suboptimally, both in the pooled validation cohort combining every centre's data and centre-wise. An updated model, named DISPAIR-FRS, was constructed by combining the most stable predictors from the existing models and incorporating other readily available patient demographics, such as age, sex, transection site, pancreatic thickness at the transection site, and main pancreatic duct diameter at the transection site. Internal-external validation demonstrated an AUC of 0.72, a calibration slope of 0.93, and an intercept of -0.02 for the updated model.

CONCLUSION

The combined updated model of DISPAIR and D-FRS named DISPAIR-FRS demonstrated better performance and can be accessed at www.tinyurl.com/the-dispair-frs.

摘要

背景

每五名接受左半胰切除术的患者中就有一名会发生术后胰瘘（POPF）。准确的POPF风险预测可能会有所帮助。已经开发并进行了外部验证的两种独立术前预测模型：DISPAIR和D-FRS。本研究的目的是验证、比较并可能更新这些模型。

方法

本回顾性队列研究纳入了来自九个高容量胰腺手术中心（欧洲8个，北美1个）的患者。纳入标准为年龄超过18岁且自2010年以来接受开放或微创左半胰切除术。通过区分度（受试者操作特征（ROC）曲线）和校准（校准图）评估模型性能。使用逻辑回归开发更新模型并进行内部-外部验证。

结果

在纳入的2284例患者中，497例（21.8%）发生了POPF。DISPAIR（ROC曲线下面积（AUC）为0.62）和D-FRS（AUC为0.62）在合并每个中心数据的汇总验证队列以及按中心分析时表现均欠佳。通过结合现有模型中最稳定的预测因素并纳入其他易于获取的患者人口统计学信息，如年龄、性别、横断部位、横断部位的胰腺厚度以及横断部位的主胰管直径，构建了一个名为DISPAIR-FRS的更新模型。内部-外部验证显示更新模型的AUC为0.72，校准斜率为0.93，截距为-0.02。