Risk Prediction Model of 90-Day Mortality after Esophagectom
The International Esodata Study Group risk prediction model allowed for stratification of an individual patient’s risk of death within 90 days after esophagectomy and may aid decision-making and the consent process between patients and surgeons.

The aim was 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, investigators performed a retrospective analysis of patients from 39 institutions in 19 countries. 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. 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 nonsignificance 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.

JAMA Surgery
Source: https://jamanetwork.com/journals/jamasurgery/article-abstract/2781222