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Randomized Controlled Trial
. 2021 Sep 1;156(9):836-845.
doi: 10.1001/jamasurg.2021.2376.

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

Xavier Benoit D'Journo  1 , David Boulate  1 , Alex Fourdrain  1 , Anderson Loundou  1 , Mark I van Berge Henegouwen  2 , Suzanne S Gisbertz  2 , J Robert O'Neill  3 , Arnulf Hoelscher  4 , Guillaume Piessen  5 , Jan van Lanschot  6 , Bas Wijnhoven  6 , Blair Jobe  7 , Andrew Davies  8 , Paul M Schneider  9 , Manuel Pera  10 , Magnus Nilsson  11 , Philippe Nafteux  12 , Yuko Kitagawa  13 , Christopher R Morse  14 , Wayne Hofstetter  15 , Daniela Molena  16 , Jimmy Bok-Yan So  17 , Arul Immanuel  18 , Simon L Parsons  19 , Michael Hareskov Larsen  20 , James P Dolan  21 , Stephanie G Wood  21 , Nick Maynard  22 , Mark Smithers  23 , Sonia Puig  24 , Simon Law  25 , Ian Wong  25 , Andrew Kennedy  26 , Wang KangNing  27 , John V Reynolds  28 , C S Pramesh  29 , Mark Ferguson  30 , Gail Darling  31 , Wolfgang Schröder  32 , Marc Bludau  32 , Tim Underwood  33 , Richard van Hillegersberg  34 , Andrew Chang  35 , Ivan Cecconello  36 , Ulysses Ribeiro Jr  36 , Giovanni de Manzoni  37 , Riccardo Rosati  38 , MadhanKumar Kuppusamy  39 , Pascal Alexandre Thomas  1 , Donald E Low  39 ; International Esodata Study Group
Collaborators, Affiliations
Randomized Controlled Trial

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

Xavier Benoit D'Journo et al. JAMA Surg. .

Erratum in

  • Error in a Supplement.
    [No authors listed] [No authors listed] JAMA Surg. 2021 Sep 1;156(9):894. doi: 10.1001/jamasurg.2021.4340. JAMA Surg. 2021. PMID: 34495318 Free PMC article. No abstract available.

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.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr D’Journo reported receiving grants from the Marseille Research Thoracic Oncology Foundation during the conduct of the study. Dr van Berge Henegouwen reported receiving grants from Olympus and Stryker and personal fees from Medtronic, Mylan, Alesi Surgical, and Johnson & Johnson outside the submitted work. Dr Piessen reported receiving nonfinancial support from Medtronic and personal fees from BMS, Amgen, Roche, Stryker, Nestle, and MSD outside the submitted work. Dr Kitagawa reported receiving grants from Chugai Pharmaceutical Co Ltd, Taiho Pharmaceutical Co Ltd, Yakult Honsha Co Ltd, Asahi Kasei Pharma Corporation, Otsuka Pharmaceutical Co Ltd, and Nippon Covidien Inc outside the submitted work. Dr Molena reported receiving travel reimbursement from Intuitive, Johnson & Johnson, Urogen, Boston Scientific, and AstraZeneca outside the submitted work. Dr Thomas reported receiving personal fees from Ethicon and AstraZeneca outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Predicted Surgical 90-Day Mortality According to International Esodata Study Group (IESG) Risk Score Associated With the Sum Score
See the Methods section for the formula used to calculate the predicted probability of surgical 90-day mortality (P for mortality).
Figure 2.
Figure 2.. Surgical 90-Day Mortality According to Risk Group Score in the Development and Validation Cohorts
The best cutoff was reached to collapse the cohort into 5 different homogeneous groups of risk according to their score: very low risk (score, ≥1), low risk (score, 0), medium risk (score, −1 to −2), high risk (score, −3 to −4), and very high risk (score, ≤−5).
See this image and copyright information in PMC

Comment in

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