In a retrospective analysis reported by researchers from the International Esodata Study Group (IESG) in JAMA Surgery, D’Journo et al developed a model for predicting risk of 90-day mortality following esophagectomy for patients with esophageal or gastroesophageal junction cancer.
As stated by the investigators, “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.”
Study Details
The study involved data from the IESG database including patients from sites in 19 countries treated between January 2015 and December 2019. A total of 8,403 patients were randomly assigned to a development cohort (n = 4,172) and a validation cohort (n = 4,231). The primary outcome measure was all-cause postoperative 90-day mortality.
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.— D’Journo et al
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Key Findings
Among all patients, the 30-day mortality rate was 2.0% (n = 164) and the 90-day mortality rate was 4.2% (n = 353). Mortality rates at 30 and 90 days in the development and validation cohorts were 2.1% and 1.8% (P = .23) and 4.4% and 4.0% (P = .34), respectively.
In the development cohort, multivariate analysis identified 10 weighted point variables contributing to prognostic score: age, sex, body mass index, performance status, myocardial infarction, connective tissue disease, peripheral vascular disease, liver disease, neoadjuvant treatment, and hospital volume. Risk scores ranged from –10 to +5, with a positive score indicating a lower risk of 90-day mortality (points assigned to variables to generate the risk score are presented in the article).
In the development cohort, risk scores identified five 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 distribution of deaths within 90 days according to risk score stratification in the validation cohort was similar to that in the development cohorts. Compared with patients with a very low–risk score, those with a very high–risk score had an 11-fold increased risk of 90-day mortality in the development cohort (1.8% vs 18.2%) and a 7-fold increased risk in the validation cohort (2.1% vs 14.1%).
Model discrimination was similar in the two cohorts, with receiver operating characteristic area under the curve values of 0.68 (95% confidence interval [CI] = 0.64–0.72) in the development cohort and 0.64 (95% CI = 0.60–0.69) in the validation cohort.
The investigators concluded, “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.”
Xavier Benoit D’Journo, MD, PhD, of the Department of Thoracic Surgery, Aix-Marseille University, North Hospital, Marseille, is the corresponding author for the JAMA Surgery article.
Disclosure: The study was supported by the Marseille Research Thoracic Oncology Foundation. For full disclosures of the study authors, visit jamanetwork.com.
