POSSUM评分预测食管癌患者手术风险价值的探讨

Evaluation of POSSUM in predicting postoperative morbidity and mortality in patients with esophageal carcinoma

目的 为辅助临床医师判断食管癌手术风险,本研究探讨生理学和手术侵袭度评分（physiological and operative severity score for the enumeration of mortality and morbidity,POSSUM）在预测食管癌患者术后并发症发生率及死亡率中的价值。方法 回顾性分析2012-01-01-2012-10-31四川省肿瘤医院457例接受食管癌手术患者的POSSUM评分,预测术后出现并发症和死亡的危险性,与实际值比较,采用Logistic回归分析影响并发症及死亡发生的独立危险因素,ROC曲线及实际例数/预测例数（O/E值）评估POSSUM评分预测能力。结果 POSSUM评分预测并发症发生率为52.3%（239/457）,与实际并发症发生率为57.3%（262/457）比较,差异无统计学意义,χ~2=2.337,P=0.126;年龄（P=0.002）、手术持续时间（P=0.043）及吻合方式（P=0.037）是术后并发症发生的独立危险因素;ROC曲线下面积（area under curve,AUC）为0.627,P〈0.001,O/E=1.10。POSSUM评分预测死亡率为14.2%（65/457）,与实际死亡率为3.3%（15/457）比较,差异有统计学意义,χ~2=34.248,P〈0.001;年龄（P=0.038）及手术持续时间（P=0.040）是术后死亡发生的独立危险因素;AUC为0.707,P=0.006,O/E=0.23。结论 POSSUM评分对食管癌术后并发症的发生具有一定的预测能力,但对死亡率的预测过高。

OBJECTIVE To help surgeons to assess the risk of postoperative complications in oesophagectorry the present study was designed to evaluate the ability of the physiological and operative severity score for the enumeration of mortality and morbidity （POSSUM） to predict morbidity and mortality in patients undergoing oesophagectomy. METH- ODS POSSUM predictor equations for morbidity and mortality were applied retrospectively to 457 patients who had un- dergone oesophagectomy due to cancer from 1st January to 31st October 2012 in Sichuan Cancer Hospital and Institute. Observed morbidity and mortality rates were compared with expected rates by POSSUM. Logistic regression was used to evaluate the independent risk factors associated with postoperative morbidity and mortality. ROC curve and observe/ex- pect （O/E） were applied to assess the ability of scoring system. RESULTS The predicted and observed morbidity rates were 52.3% （239 cases） and 57.3% （262 cases） respectively （χ2 =2. 337,P=0. 126）. Age （P=0. 002）, the duration of operation （P=0. 043） and the position of anastomosis （P=0. 037） were independent risk factors associated with the post- operative morbidity. AUC of ROC was 0. 627 （P〈0. 001） and O/E was 1. 10. However, the predicted and observed mortality rates were 14.2% （65 cases） and 3.3% （15 cases） respectively （χ 2 =34. 248, P〈0. 001）. Age （P=0.038） and the duration of operation （P= 0. 040） were independent risk factors associated with the postoperative mortality. AUC of ROC was 0. 707 （P=0. 006） and O/E was 0.23. CONCLUSIONS It suggests that POSSUM has value for predicting the risk of morbidity but is not accurate in predicting mortality in patients undergoing oesophagectomy.