Comparative Study of Predictive Mortality Scores in Esophagectomy with Three-Field Lymph Node Dissection in Patients with Esophageal Cancer.
Aged
Area Under Curve
Body Mass Index
Comorbidity
Esophageal Neoplasms
/ mortality
Esophagectomy
/ adverse effects
Female
Forecasting
/ methods
Hemoglobins
/ metabolism
Humans
Lymph Node Excision
/ methods
Male
Middle Aged
Neoplasm Staging
Postoperative Complications
/ etiology
Prognosis
ROC Curve
Retrospective Studies
Risk Factors
Survival Rate
Esophageal cancer
Esophagectomy
Mortality score
Prognosis score
Journal
Digestive surgery
ISSN: 1421-9883
Titre abrégé: Dig Surg
Pays: Switzerland
ID NLM: 8501808
Informations de publication
Date de publication:
2019
2019
Historique:
received:
09
03
2017
accepted:
30
12
2017
pubmed:
3
2
2018
medline:
4
4
2019
entrez:
3
2
2018
Statut:
ppublish
Résumé
Esophagectomy is still the best therapeutic option for curing resectable esophageal cancer (EC). Radical surgical resection with three-field lymphadenectomy (3FLD) is a potentially curative treatment option. We compared the predictive accuracy of 5 different scores in patients with EC who underwent 3FLD. Five years' worth of medical records in a single institution were analyzed (January 2010 to January 2015) from 311 patients who underwent esophagectomy for EC. We selected 191 in whom 3FLD was performed. Mortality was calculated based on 5 predictive scores. Outcomes measures were intraoperative mortality, 30-day mortality, and 1- and 2-year mortality after surgery. Intraoperative mortality and 30-day mortality after surgery was 0%; 1 and 2-year mortality were 19.8 and 31.4%, respectively. The area under the curve showed poor discriminatory power for all 5 scores (<0.7). In one-way analysis of variance, for 1 year mortality, Portsmouth-Physiological and Operative Severity Score for mortality (P-Possum) was significant (p = 0.0424); in a multivariable analysis for 2-year mortality, P-Possum (p < 0.0001) remained significant. There is no accurate prognosis score for esophagectomy in patients who undergo high-risk procedures like 3FLD. New scores are needed to predict the mortality after 3FLD with good discriminatory power. Independent factors affect survival and may function as the baseline for obtaining a new accurate mortality score.
Sections du résumé
BACKGROUND/AIM
OBJECTIVE
Esophagectomy is still the best therapeutic option for curing resectable esophageal cancer (EC). Radical surgical resection with three-field lymphadenectomy (3FLD) is a potentially curative treatment option. We compared the predictive accuracy of 5 different scores in patients with EC who underwent 3FLD.
METHODS
METHODS
Five years' worth of medical records in a single institution were analyzed (January 2010 to January 2015) from 311 patients who underwent esophagectomy for EC. We selected 191 in whom 3FLD was performed. Mortality was calculated based on 5 predictive scores. Outcomes measures were intraoperative mortality, 30-day mortality, and 1- and 2-year mortality after surgery.
RESULTS
RESULTS
Intraoperative mortality and 30-day mortality after surgery was 0%; 1 and 2-year mortality were 19.8 and 31.4%, respectively. The area under the curve showed poor discriminatory power for all 5 scores (<0.7). In one-way analysis of variance, for 1 year mortality, Portsmouth-Physiological and Operative Severity Score for mortality (P-Possum) was significant (p = 0.0424); in a multivariable analysis for 2-year mortality, P-Possum (p < 0.0001) remained significant.
CONCLUSION
CONCLUSIONS
There is no accurate prognosis score for esophagectomy in patients who undergo high-risk procedures like 3FLD. New scores are needed to predict the mortality after 3FLD with good discriminatory power. Independent factors affect survival and may function as the baseline for obtaining a new accurate mortality score.
Identifiants
pubmed: 29393197
pii: 000486551
doi: 10.1159/000486551
doi:
Substances chimiques
Hemoglobins
0
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
67-75Informations de copyright
© 2018 S. Karger AG, Basel.