Risk prediction model of 90-day mortality after esophagectomy for cancer.
D'Journo, Xavier Benoit Boulate, David Fourdrain, Alex Loundou, Anderson van Berge Henegouwen, Mark I Gisbertz, Suzanne S O'Neill, J Robert Hoelscher, Arnulf Piessen, Guillaume van Lanschot, Jan
D'Journo, Xavier Benoit
Boulate, David
Fourdrain, Alex
Loundou, Anderson
van Berge Henegouwen, Mark I
Gisbertz, Suzanne S
O'Neill, J Robert
Hoelscher, Arnulf
Piessen, Guillaume
van Lanschot, Jan
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Affiliation
Aix-Marseille University; Assistance Publique des Hopitaux de Marseille; Amsterdam University Medical Center; University of Amsterdam; Addenbrookes Hospital; Elisabeth Hospital Essen; University Medicine Essen; Claude Huriez University Hospital; Erasmus Medical Center; Allegheny Health Network; Guy's & St Thomas' NHS Foundation Trust; Hirslanden Medical Center; Hospital Universitario del Mar; Karolinska Institutet; Karolinska University Hospital; Katholieke Universiteit Leuven; Keio University; Massachusetts General Hospital; MD Anderson Cancer Center; Memorial Sloan Kettering Cancer Center; National University Hospital, Singapore; Royal Victoria Infirmary; Nottingham University Hospitals NHS Trust; Odense University Hospital; Oregon Health and Science University; Oxford University Hospitals NHS Foundation Trust; Princess Alexandra Hospital, Brisbane; University of Queensland; University Hospitals Birmingham NHS Foundation Trust; Queen Mary Hospital, Hong Kong; The University of Hong Kong; Royal Victoria Hospital, Belfast; Sichuan Cancer Hospital & Institute; St James's Hospital Trinity College; Tata Memorial Centre; The University of Chicago Medicine; Toronto General Hospital; University Hospital of Cologne; University Hospital Southampton NHS Foundation Trust; University Medical Center, Utrecht; University of Michigan Health System; University of Sao Paulo School of Medicine; University of Verona; Vita-Salute San Raffaele University; Virginia Mason Medical Center
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Publication date
2021-06-23
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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 β 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.
Citation
D'Journo XB, Boulate D, Fourdrain A, Loundou A, van Berge Henegouwen MI, Gisbertz SS, O'Neill JR, Hoelscher A, Piessen G, van Lanschot J, Wijnhoven B, Jobe B, Davies A, Schneider PM, Pera M, Nilsson M, Nafteux P, Kitagawa Y, Morse CR, Hofstetter W, Molena D, So JB, Immanuel A, Parsons SL, Larsen MH, Dolan JP, Wood SG, Maynard N, Smithers M, Puig S, Law S, Wong I, Kennedy A, KangNing W, Reynolds JV, Pramesh CS, Ferguson M, Darling G, Schröder W, Bludau M, Underwood T, van Hillegersberg R, Chang A, Cecconello I, Ribeiro U Jr, de Manzoni G, Rosati R, Kuppusamy M, Thomas PA, Low DE; International Esodata Study Group. Risk Prediction Model of 90-Day Mortality After Esophagectomy for Cancer. JAMA Surg. 2021 Sep 1;156(9):836-845. doi: 10.1001/jamasurg.2021.2376. Erratum in: JAMA Surg. 2021 Sep 1;156(9):894. doi: 10.1001/jamasurg.2021.4340.
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Article