Risk Prediction Model of 90-Day Mortality After Esophagectomy for Cancer
Risk Prediction Model of 90-Day Mortality After Esophagectomy for Cancer
复制标题
食管癌切除术后90天死亡风险预测模型
DOI：
10.1001/jamasurg.2021.2376
复制
发表时间：
2021-06-23
期刊：
影响因子：
16.9
通讯作者：
Low, Donald E.
中科院分区：
文献类型：
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作者：
D'Journo, Xavier Benoit;Boulate, David;Low, Donald E.
重要性 食管切除术后九十天的死亡率是肿瘤外科治疗质量的一个指标。基于大数据集的准确风险预测可以帮助患者和外科医生做出明智的决策。 目的 使用国际 Esodata 研究组 (IESG) 数据库（报告标准化术后结果的现有最大前瞻性、多中心队列）开发和验证癌症食管切除术后 90 天内死亡的风险预测模型。 设计、设置和参与者 在这项诊断/预后研究中，我们对来自 19 个国家 39 个机构的患者进行了回顾性分析2015年1月1日至2019年12月31日期间。食道癌患者被随机分配到开发组和验证组。建立了一个基于逻辑回归贝塔系数预测 90 天内死亡的评分系统。确定最终的预后评分并将其分为同质风险组，预测 90 天内死亡。对队列之间进行校准和区分测试进行评估。 暴露 食管癌和胃食管交界处的食管切除术。 主要结果和测量 全因术后 90 天死亡率。 结果 总共纳入 8403 名患者（平均 [SD] 年龄，63.6 [9.0] 岁；6641 名 [79.0%] 男性）。 30天死亡率为2.0%（n = 164），90天死亡率为4.2%（n = 353）。开发组 (n = 4172) 和验证组 (n = 4231) 被随机分配。多元逻辑回归模型确定了影响预后评分的 10 个加权点变量：年龄、性别、体重指数、体能状态、心肌梗死、结缔组织疾病、周围血管疾病、肝脏疾病、新辅助治疗和住院人数。预后评分分为 5 个风险组：极低风险（评分，>= 1；90 天死亡率，1.8%）、低风险（评分，0；90 天死亡率，3.0%）、中风险（评分，-1 至 -2；90 天死亡率，5.8%）、高风险（评分，-3 至 -4：90 天死亡率，8.9%）和极风险组。高风险（分数，
IMPORTANCE Ninety-day mortality rates after esophagectomy are an indicator of the quality of surgical oncologic management. Accurate risk prediction based on large data sets may aid patients and surgeons in making informed decisions.OBJECTIVE To develop and validate a risk prediction model of death within 90 days after esophagectomy for cancer using the International Esodata Study Group (IESG) database, the largest existing prospective, multicenter cohort reporting standardized postoperative outcomes.DESIGN, SETTING, AND PARTICIPANTS In this diagnostic/prognostic study, we performed a retrospective analysis of patients from 39 institutions in 19 countries between January 1, 2015, and December 31, 2019. Patients with esophageal cancer were randomly assigned to development and validation cohorts. A scoring system that predicted death within 90 days based on logistic regression beta coefficients was conducted. A final prognostic score was determined and categorized into homogeneous risk groups that predicted death within 90 days. Calibration and discrimination tests were assessed between cohorts.EXPOSURES Esophageal resection for cancer of the esophagus and gastroesophageal junction.MAIN OUTCOMES AND MEASURES All-cause postoperative 90-day mortality.RESULTS A total of 8403 patients (mean [SD] age, 63.6 [9.0] years; 6641 [79.0%] male) were included. The 30-day mortality rate was 2.0%(n = 164), and the 90-day mortality rate was 4.2%(n = 353). Development (n = 4172) and validation (n = 4231) cohorts were randomly assigned. The multiple logistic regression model identified 10 weighted point variables factored into the prognostic score: age, sex, body mass index, performance status, myocardial infarction, connective tissue disease, peripheral vascular disease, liver disease, neoadjuvant treatment, and hospital volume. The prognostic scores were categorized into 5 risk groups: very low risk (score, >= 1; 90-day mortality, 1.8%), low risk (score, 0; 90-day mortality, 3.0%), medium risk (score, -1 to -2; 90-day mortality, 5.8%), high risk (score, -3 to -4: 90-day mortality, 8.9%), and very high risk (score,