CAJ | 학술논문

目的建立预测术后病死率的改良P-POSSUM和改良Cr-POSSUM评分系统并与POSSUM比较,评价其对结直肠癌患者住院期间病死率的预测能力.方法调查北京大学第三医院1992-2005年间结直肠癌经手术切除的903例患者资料.按70:30把本组病例分成建立模型样本和预测模型样本,用Logistic回归分析建立改良P-POSSUM和改良Cr-POSSUM,用ROC曲线分析判断改良P-POSSUM和改良Cr-POSSUM评分的判别能力,用Hosmer-Lemeshow检验判断评分的拟合优度,用不同危险因素群的O:E值判断评分的预测能力.结果本组患者住院期间的病死率为1.0%(9/903).POSSUM、P-POSSUM和Cr-POSSUM评分预测的病死率明显高于实际病死率,O:E值分别为0.18、0.35和0.20.改良P-POSSUM除在急诊手术和姑息手术中判别能力较差外,在其他手术中都具有较好的判别能力,在所有手术中预测的死亡率与实际死亡率接近(O:E值为0.91);改良Cr-POSSUM除在姑息手术中有很好的判别能力外,在评价模型样本和急诊手术预测的死亡率高于实际死亡率,但仍在实际死亡率95%的可信区间内(O:E值为0.78).两者的预测能力都好于POSSUM.结论 POSSUM、P-POSSUM和Cr-POSSUM在中国结直肠癌手术中预测的病死率高于实际病死率,改良P-POSSUM和改良Cr-POSSUM可较准确地预测中国结直肠癌患者手术住院期间病死率.
목적 건립예측술후병사솔적개량P-POSSUM화개량Cr-POSSUM평분계통병여POSSUM비교,평개기대결직장암환자주원기간병사솔적예측능력.방법 조사북경대학제삼의원1992-2005년간결직장암경수술절제적903례환자자료.안70:30파본조병례분성건립모형양본화예측모형양본,용Logistic회귀분석건립개량P-POSSUM화개량Cr-POSSUM,용ROC곡선분석판단개량P-POSSUM화개량Cr-POSSUM평분적판별능력,용Hosmer-Lemeshow검험판단평분적의합우도,용불동위험인소군적O:E치판단평분적예측능력.결과 본조환자주원기간적병사솔위1.0%(9/903).POSSUM、P-POSSUM화Cr-POSSUM평분예측적병사솔명현고우실제병사솔,O:E치분별위0.18、0.35화0.20.개량P-POSSUM제재급진수술화고식수술중판별능력교차외,재기타수술중도구유교호적판별능력,재소유수술중예측적사망솔여실제사망솔접근(O:E치위0.91);개량Cr-POSSUM제재고식수술중유흔호적판별능력외,재평개모형양본화급진수술예측적사망솔고우실제사망솔,단잉재실제사망솔95%적가신구간내(O:E치위0.78).량자적예측능력도호우POSSUM.결론 POSSUM、P-POSSUM화Cr-POSSUM재중국결직장암수술중예측적병사솔고우실제병사솔,개량P-POSSUM화개량Cr-POSSUM가교준학지예측중국결직장암환자수술주원기간병사솔.
Objective To develop the modified P-POSSUM equation and the modified Cr-POSSUM equation and compare their performances with POSSUM in forecasting in-hospital morbidity and mortality of colorectal cancer. Methods Data of 903 patients undergone operation of colon and rectal cancers from 1992 to 2005 in our department were enrolled in this study. ROC curve was applied to judge the differentiation ability of each score. Model goodness-or-fit was tested by the Hosmer-Lemeshow statistic and subgroup analysis was performed by the ratio of observed to expected deaths (O:E ratio). A 70:30 percent split-sample validation technique was adopted for model development and testing. Stepwise logistic regression was used to develop the modified P-POSSUM and the modified Cr-POSSUM. Their performance in validating sample, colonic cancer sample, rectal cancer sample,elective surgery sample, emergency surgery sample, curative surgery sample and palliative surgery sample was tested by ROC curve, Hosmer-Lemeshow statistic and O:E ratio. Results The modified P-POSSUM showed good discrimination in all samples except the emergency surgery and palliative surgery. The predicted mortality of modified P-POSSUM was very close to the observed mortality.However, the modified Cr-POSSUM showed good discrimination in ,all samples except the palliative surgery.The predicted moaality was higher than the observed mortality, but still within the 95% confidence interval(CI)of the observed mortality.Both the modified models offered better accuracy than the P-POSSUM. Conclusion The modified P.POSSUM and the modified Cr-POSSUM model provide an accurate prediction of inpatient moaality in Chinese colorectal cancer patients.