Xavier Benoit D'Journo1, David Boulate1, Alex Fourdrain1, Anderson Loundou1, Mark I van Berge Henegouwen2, Suzanne S Gisbertz2, J Robert O'Neill3, Arnulf Hoelscher4, Guillaume Piessen5, Jan van Lanschot6, Bas Wijnhoven6, Blair Jobe7, Andrew Davies8, Paul M Schneider9, Manuel Pera10, Magnus Nilsson11, Philippe Nafteux12, Yuko Kitagawa13, Christopher R Morse14, Wayne Hofstetter15, Daniela Molena16, Jimmy Bok-Yan So17, Arul Immanuel18, Simon L Parsons19, Michael Hareskov Larsen20, James P Dolan21, Stephanie G Wood21, Nick Maynard22, Mark Smithers23, Sonia Puig24, Simon Law25, Ian Wong25, Andrew Kennedy26, Wang KangNing27, John V Reynolds28, C S Pramesh29, Mark Ferguson30, Gail Darling31, Wolfgang Schröder32, Marc Bludau32, Tim Underwood33, Richard van Hillegersberg34, Andrew Chang35, Ivan Cecconello36, Ulysses Ribeiro36, Giovanni de Manzoni37, Riccardo Rosati38, MadhanKumar Kuppusamy39, Pascal Alexandre Thomas1, Donald E Low39. 1. Department of Thoracic Surgery, Aix-Marseille University, North Hospital, Marseille, France. 2. Department of Gastrointestinal Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands. 3. Department of Oesophago-Gastric Cancer Surgery, Cambridge Oesophago-Gastric Centre, Addenbrookes Hospital, Cambridge, United Kingdom. 4. Center for Esophageal Diseases, Elisabeth Hospital Essen, University Medicine Essen, Essen, Germany. 5. Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France. 6. Department of Digestive Surgery, Erasmus Medical Center, Rotterdam, the Netherlands. 7. Esophageal and Lung Institute, Allegheny Health Network, Pittsburgh, Pennsylvania. 8. Department of Digestive Surgery, Guy's & St Thomas' National Health Service Foundation Trust, London, United Kingdom. 9. Department of Digestive and Oncological Surgery, Hirslanden Medical Center, Zurich, Switzerland. 10. Department of Digestive Surgery, Hospital Universitario del Mar, Barcelona, Spain. 11. Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden. 12. Department of Digestive Surgery, Katholieke Universiteit Leuven, Leuven, Belgium. 13. Department of Thoracic Surgery, Keio University, Tokyo, Japan. 14. Department of Surgery, Massachusetts General Hospital, Boston. 15. Department of Thoracic Surgery, MD Anderson Cancer Center, Houston, Texas. 16. Department of Thoracic and Cardiovascular Surgery, Memorial Sloan Kettering Cancer Center, New York City, New York. 17. Department of Thoracic Surgery, National University Hospital, Singapore, Singapore. 18. Department of Surgery, Northern Oesophagogastric Cancer Unit, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom. 19. Department of Upper Gastrointestinal Surgery, Nottingham University Hospitals National Health Service Trust, Nottingham, United Kingdom. 20. Department of Surgery, Odense University Hospital, Odense, Denmark. 21. Digestive Health Center, Oregon Health and Science University, Portland. 22. Oesophagogastric Cancer Multidisciplinary Team, Oxford University Hospitals National Health Service Foundation Trust, Oxford, United Kingdom. 23. Department of Surgery, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia. 24. Department of Gastrointestinal Surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham Foundation Trust, Birmingham, United Kingdom. 25. Department of Gastrointestinal Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, China. 26. Department of Gastrointestinal Surgery, Royal Victoria Hospital, Belfast, Northern Ireland. 27. Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Chengdu, China. 28. Department of Surgery, St James's Hospital Trinity College, Dublin, Ireland. 29. Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India. 30. Department of Thoracic Surgery, The University of Chicago Medicine, Chicago, Illinois. 31. Department of Thoracic Surgery, Toronto General Hospital, Toronto, Ontario, Canada. 32. Department of Digestive Surgery, University Hospital of Cologne, Cologne, Germany. 33. Department of Gastrointestinal Surgery, University Hospital Southampton National Health Service Foundation Trust, Southampton, United Kingdom. 34. Department of Surgery, University Medical Center, Utrecht, the Netherlands. 35. Department of Thoracic Surgery, University of Michigan Health System, Ann Arbor. 36. Department of Digestive Surgery, University of Sao Paulo School of Medicine, Sao Paulo, Brazil. 37. Department of Upper Gastrointestinal Surgery, University of Verona, Verona, Italy. 38. Department of Upper Gastrointestinal Surgery, Vita-Salute San Raffaele University, Milan, Italy. 39. Department of Thoracic Surgery, Virginia Mason Medical Center, Seattle, Washington.
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.
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.