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Development of an Integer-based Risk Score to Predict 90-Day Mortality After Hepatectomy in Patients With Hepatocellular Carcinoma.

开发基于整数的风险评分来预测肝细胞癌患者肝切除术后 90 天的死亡率。

  • 影响因子:2.46
  • DOI:10.1097/COC.0000000000000724
  • 作者列表:"Qi Y","LeVan TD","Haynatzki G","Are C","Farazi PA
  • 发表时间:2020-06-09
Abstract

BACKGROUND:The incidence of liver cancer has more than tripled since 1980. Hepatectomy represents the major curative treatment for liver cancer. The risk factors associated with 90-day mortality after hepatectomy are not well understood and there are currently no good prediction models for this outcome. The objectives of the current study were to identify risk factors of 90-day mortality after hepatectomy in patients with hepatocellular carcinoma and to develop an integer-based risk score using the National Cancer Database. METHODS:Hepatectomies recorded in the National Cancer Database during 2004-2012 were reviewed for 90-day mortality. Risk factors were identified by multivariate logistic regression models. An integer-based risk score was developed using the β coefficients derived from the logistic regression model and tested for discriminatory ability. According to the total risk score, patients were grouped into 4 risk groups. RESULTS:The overall 90-day mortality was 10.2%. Ten risk factors were identified, which included sex, age, race/ethnicity, insurance status, education, annual hospital volume, stage, tumor grade, Charlson-Deyo Score, and surgical procedure. The risk of 90-day mortality was stratified into 4 groups. The calculated 90-day mortality rates were 2.47%, 5.88%, 12.58%, and 24.67% for low-risk, medium-risk, high-risk, and excessive-risk groups, respectively. An area under the receiver operating characteristic curve of 0.69 was obtained for model discrimination. CONCLUSIONS:The integer-based risk score we developed could easily quantify each patient's risk level and predict 90-day mortality after hepatectomy. The stratified risk score could be a useful addition to perioperative risk management and a tool to improve 90-day mortality after hepatectomy.

摘要

背景: 自 1980 年以来,肝癌的发病率增加了两倍多。肝切除术是肝癌的主要治愈性治疗方法。与肝切除术后 90 天死亡率相关的危险因素尚不十分清楚,目前尚无良好的预测模型。本研究的目的是确定肝细胞癌患者肝切除术后 90 天死亡率的危险因素,并使用国家癌症数据库制定基于整数的风险评分。 方法: 回顾了 2004-2012 年间国家癌症数据库中记录的肝切除术的 90 天死亡率。通过多因素 logistic 回归模型确定危险因素。使用 logistic 回归模型得出的 β 系数制定基于整数的风险评分,并进行区分能力测试。根据总风险评分将患者分为 4 个风险组。 结果: 总的 90 天死亡率为 10.2%。确定了 10 个危险因素,包括性别、年龄、种族/民族、保险状况、教育程度、年住院量、分期、肿瘤分级、 Charlson-Deyo 评分和手术操作。将 90 天死亡率的风险分为 4 组。低危组、中危组、高危组和高危组的 90 天死亡率分别为 2.47% 、 5.88% 、 12.58% 和 24.67%。获得了 0.69 的受试者工作特征曲线下面积,用于模型判别。 结论: 我们开发的基于整数的风险评分可以很容易地量化每个患者的风险水平,并预测肝切除术后 90 天的死亡率。分层风险评分可能是围手术期风险管理的有用补充,也是改善肝切除术后 90 天死亡率的工具。

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