Martin-Roman Lorena, Kusamura Shigeki, Guaglio Marcello, Colletti Gaia, Cavalleri Tommaso, Deraco Marcello, Baratti Dario
Department of Surgery, Colorectal and Peritoneal Oncology Centre, Christie Foundation Trust, Manchester, UK.
Peritoneal Malignancy Program, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
BJS Open. 2025 Jul 1;9(4). doi: 10.1093/bjsopen/zraf064.
Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy is an effective but potentially highly morbid treatment option for peritoneal surface malignancies. Adequate risk assessment is fundamental for clinical decision-making and informed patient consent. The aim of this study was to construct a validated nomogram predicting the risk of severe postoperative complications based exclusively on preoperative variables.
A prospective database of patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in a single institution between February 1995 and April 2023 was reviewed. The cohort was divided randomly into derivation and validation cohorts (70 : 30). The primary outcome measure was postoperative complications (National Cancer Institute Common Terminology Criteria for Adverse Events grade ≥ 3). Binary logistic regression identified preoperative variables significantly associated with postoperative morbidity. A nomogram was constructed based on the results of the multivariable analysis. The model's performance was evaluated on the validation cohort by receiver operating characteristic curve analysis.
A total of 1039 patients were analysed. The majority of the patients were female (58.8%) and the median age was 56 (interquartile range 46-64) years. The postoperative complication rate was 37.7%, and the reoperation rate 12.7%. A nomogram was constructed based on the following predictive factors: age, body mass index, high-grade histology, disease identified in the left upper quadrant and surrounding the stomach and small bowel mesentery on preoperative imaging, preoperative white blood cell count, and Onodera nutritional index score. Receiver operating characteristic curve analysis showed an area under the curve of 0.707 with accurate calibration curves.
Preoperative variables were selected and included in a simple nomogram predicting the risk of postoperative complications. This nomogram could aid clinicians in decision-making and patients in making informed decisions.
细胞减灭术及腹腔内热灌注化疗是治疗腹膜表面恶性肿瘤的一种有效但潜在并发症发生率很高的治疗选择。充分的风险评估是临床决策和患者知情同意的基础。本研究的目的是构建一个仅基于术前变量预测术后严重并发症风险的有效列线图。
回顾了1995年2月至2023年4月在单一机构接受细胞减灭术及腹腔内热灌注化疗患者的前瞻性数据库。该队列被随机分为推导队列和验证队列（70:30）。主要结局指标为术后并发症（美国国立癌症研究所不良事件通用术语标准≥3级）。二元逻辑回归确定与术后发病显著相关的术前变量。基于多变量分析结果构建列线图。通过受试者工作特征曲线分析在验证队列中评估模型的性能。
共分析了1039例患者。大多数患者为女性（58.8%），中位年龄为56岁（四分位间距46 - 64岁）。术后并发症发生率为37.7%，再次手术率为12.7%。基于以下预测因素构建列线图：年龄、体重指数、高级别组织学类型、术前影像学检查中左上象限及胃和小肠系膜周围发现的疾病、术前白细胞计数和小野寺营养指数评分。受试者工作特征曲线分析显示曲线下面积为0.707，校准曲线准确。
选择术前变量并纳入一个简单的列线图来预测术后并发症风险。该列线图可帮助临床医生进行决策并帮助患者做出知情决策。
