POSSUM评分预测高龄胃癌患者术后并发症和死亡风险的价值

Assessment of POSSUM in predicting postoperative mortality and morbidity in very elderly gastric cancer patients

目的评价POSSUM评分在预测高龄胃癌患者术后并发症和死亡风险中的价值。方法回顾性分析2010年1月-2014年12月收治的76例接受胃癌根治术的80岁及以上的高龄患者,以POSSUM评分预测术后并发症和死亡的发生率,并与实际情况相比较。结果以POSSUM评分预测术后并发症发生率(R1)为(61.2±19.8)%,实际发生率为59.2%,O/E值(观测值/预测值)为0.97。根据R1值高低分成4组,各组间并发症发生率无明显差异(P=0.676),低危组(<40%)O/E值为1.8,而极高危组(≥80%)O/E值为0.54。随着Rl值的升高,术后住院时间和住院费用均有上升的趋势,差异无统计学意义。POSSUM评分预测死亡率(R2)为(17.4±9.9)%,P-POSSUM评分预测死亡率(R3)为(7.6±6.0)%,而实际死亡率为2.6%,O/E值分别是0.15和0.34。结论 POSSUM评分适用于预测高龄胃癌患者术后并发症的风险,但同时存在低估和高估风险的可能。POSSUM评分和P-POSSUM评分都存在高估死亡率的风险。

Objective The aim of the present study was to assess the value of the POSSUM scoring system in predicting mortality and morbidity in very elderly patients with gastric cancer treated with gastrectomy. Methods From Jan. 2010 to Dec. 2014,76 patients over 80 years old with gastric cancer undergoing gastrectomy were analyzed in this study. The risk of morbidity and mortality was predicted using the POSSUM. Results The predicted morbidity （R1） was （61.2 ± 19.8） %, while the actual morbidity was 59.2 %. The Observed/Expected （O/E） ratio of morbidity was 0.97. The R1 based subgroup analysis showed the actual morbidity of four subgroups was similar （P=0.676）. O/E ratio was 1.8 in the low R1 group （〈40%） and 0.54 in the high R1 group （≥80%）. With the increase of R1, the post-operative hospital stay and the hos- pitalization expenses increased, but there was no significant statistical difference among subgroups. The predicted mortality using the POSSUM （R2） and the P-POSSUM （R3） were （17.4±9.9%） and （7.6±6.0） %, respectively. The actual mortality was 2.6 %. The O/E ratio of mortality was 0. 15 and 0.34, respectively. Conclusion The POSSUM system may be useful for the morbidity assessment of the very elderly patients with gastric cancer undergoing gastrectomy. However, there exists possibility of underestimating and overestimating the morbidity. Both the POSSUM and the P-POSSUM bear risk of overestimating the mortality.