New prediction model helps stratify death risk after esophagectomy for cancer: Study

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.

D'Journo X et. al conducted a study 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.

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.

The results of the study are as follows:

· A total of 8403 patients were included.

· The 30-day mortality rate was 2.0%, and the 90-day mortality rate was 4.2%

· 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, low risk, medium risk, high risk, and very high risk.

· The model was supported by non-significance in the Hosmer-Lemeshow test. The discrimination was 0.68 in the development cohort and 0.64 in the validation cohort.

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.

Reference:

Risk Prediction Model of 90-Day Mortality After Esophagectomy for Cancer

doi:10.1001/jamasurg.2021.2376