D'Journo, Xavier Benoit, Boulate, David ORCID: 0000-0003-4757-4565, Fourdrain, Alex, Loundou, Anderson, Henegouwen, Mark I. van Berge, Gisbertz, Suzanne S., O'Neill, J. Robert, Hoelscher, Arnulf, Piessen, Guillaume, van Lanschot, Jan, Wijnhoven, Bas, Jobe, Blair, Davies, Andrew, Schneider, Paul M., Pera, Manuel, Nilsson, Magnus, Nafteux, Philippe, Kitagawa, Yuko, Morse, Christopher R., Hofstetter, Wayne, Molena, Daniela, So, Jimmy Bok-Yan, Immanuel, Arul, Parsons, Simon L., Larsen, Michael Hareskov, Dolan, James P., Wood, Stephanie G., Maynard, Nick, Smithers, Mark, Puig, Sonia, Law, Simon, Wong, Ian, Kennedy, Andrew, KangNing, Wang, Reynolds, John V., Pramesh, C. S., Ferguson, Mark, Darling, Gail, Schroder, Wolfgang, Bludau, Marc, Underwood, Tim ORCID: 0000-0001-9455-2188, van Hillegersberg, Richard, Chang, Andrew, Cecconello, Ivan, Ribeiro, Ulysses, Jr., de Manzoni, Giovanni, Rosati, Riccardo, Kuppusamy, MadhanKumar, Thomas, Pascal Alexandre and Low, Donald E. (2021). Risk Prediction Model of 90-Day Mortality After Esophagectomy for Cancer. JAMA Surg., 156 (9). S. 836 - 846. CHICAGO: AMER MEDICAL ASSOC. ISSN 2168-6262

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Abstract

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, <=-5; 90-day mortality, 18.2%). The model was supported by nonsignificance in the Hosmer-Lemeshow test. The discrimination (area under the receiver operating characteristic curve) was 0.68 (95% CI, 0.64-0.72) in the development cohort and 0.64 (95% CI, 0.60-0.69) in the validation cohort. CONCLUSIONS AND RELEVANCE In this study, on the basis of preoperative variables, the IESG risk prediction model allowed stratification of an individual patient's risk of death within 90 days after esophagectomy. These data suggest that this model can help in the decision-making process when esophageal cancer surgery is being considered and in informed consent.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
D'Journo, Xavier BenoitUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Boulate, DavidUNSPECIFIEDorcid.org/0000-0003-4757-4565UNSPECIFIED
Fourdrain, AlexUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Loundou, AndersonUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Henegouwen, Mark I. van BergeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gisbertz, Suzanne S.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
O'Neill, J. RobertUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hoelscher, ArnulfUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Piessen, GuillaumeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
van Lanschot, JanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Wijnhoven, BasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Jobe, BlairUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Davies, AndrewUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schneider, Paul M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Pera, ManuelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Nilsson, MagnusUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Nafteux, PhilippeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kitagawa, YukoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Morse, Christopher R.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hofstetter, WayneUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Molena, DanielaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
So, Jimmy Bok-YanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Immanuel, ArulUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Parsons, Simon L.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Larsen, Michael HareskovUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Dolan, James P.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Wood, Stephanie G.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Maynard, NickUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Smithers, MarkUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Puig, SoniaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Law, SimonUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Wong, IanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kennedy, AndrewUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
KangNing, WangUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Reynolds, John V.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Pramesh, C. S.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ferguson, MarkUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Darling, GailUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schroder, WolfgangUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bludau, MarcUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Underwood, TimUNSPECIFIEDorcid.org/0000-0001-9455-2188UNSPECIFIED
van Hillegersberg, RichardUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Chang, AndrewUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Cecconello, IvanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ribeiro, Ulysses, Jr.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
de Manzoni, GiovanniUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rosati, RiccardoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kuppusamy, MadhanKumarUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Thomas, Pascal AlexandreUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Low, Donald E.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-607907
DOI: 10.1001/jamasurg.2021.2376
Journal or Publication Title: JAMA Surg.
Volume: 156
Number: 9
Page Range: S. 836 - 846
Date: 2021
Publisher: AMER MEDICAL ASSOC
Place of Publication: CHICAGO
ISSN: 2168-6262
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
NEOADJUVANT THERAPY; SURGERY; OUTCOMES; CHEMORADIOTHERAPY; MORBIDITY; SURVIVAL; ESOPHAGUS; CIRRHOSIS; IMPACT; 30-DAYMultiple languages
SurgeryMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/60790

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