POSSUM、P-POSSUM和Cr-POSSUM及E-PASS评分系统对结直肠癌患者术后死亡风险的预测价值

摘要

Objective To evaluate the value of POSSUM,P-POSSUM,Cr-POSSUM and E-PASS scoring systems in predicting postoperative mortality risk of colorectal cancer patients.Methods The clinical data of 550 patients with colorectal cancer treated in Tianjin Medical University General Hospital from 2010 to 2015 were retrospectively analyzed.The relevant indicators were collected according to Physiological and Operative Severity Score for Enumeration of Mortality and morbidity(POSSUM),Portsmouth-POSSUM(P-POSSUM),Colorectal POSSUM(Cr-POSSUM)and Estimation of physiologic ability and surgical stress(E-PASS)scoring systems andresearchneeds.The POSSUM,P-POSSUM,Cr-POSSUM and E-PASS scoring systems were used to predict the postoperative mortality rate of 30 days in patients with colorectal cancer.The predictive value of the scoring system was evaluated by receiver operating characteristic(ROC) curve and observed to expected ratio(O/E).Results The best cutoff value of POSSUM,P-POSSUM,Cr-POSSUM and E-PASSscoring systems were 54.29%,55.39%,31.68% and 56.31%,respectively.The sensitivity of POSSUM,P-POSSUM,Cr-POSSUM and E-PASS scoring systems were 83.3%,83.3%,33.3% and 83.3%,respectively.The specificity of POSSUM,P-POSSUM,Cr-POSSUM and E-PASSscoring systems were 29.0%,27.9%,1.6% and 27.0%,respectively.The area under ROC curve of POSSUM,P-POSSUM,Cr-POSSUM and E-PASS scoring systems were 0.733〔95%CI(0.500,0.966)〕,0.713〔95%CI(0.479,0.948)〕,0.751〔95%CI(0.570,0.932)〕,and 0.781〔95%CI(0.607,0.955)〕,respectively.The O/E were 0.128,0.414,0.248,0.712,respectively.Conclusion POSSUM,P-POSSUM,Cr-POSSUM and E-PASS scoring systems all have an overestimation of the postoperative mortality of colorectal cancer.E-PASS scoring system has a good consistency in the predicting postoperative mortality and actual mortality.%目的 探讨POSSUM、P-POSSUM、Cr-POSSUM、E-PASS评分系统对结直肠癌患者术后死亡风险的预测价值.方法 回顾性分析2010-2015年天津医科大学总医院收治的550例结直肠癌患者的临床资料.按照POSSUM、P-POSSUM、Cr-POSSUM、E-PASS评分系统及研究需要,收集相关指标,并分别使用POSSUM、P-POSSUM、Cr-POSSUM、E-PASS评分系统预测结直肠癌患者术后30 d病死率.应用受试者工作特征(ROC)曲线和实际发生率/预测发生率(O/E)评价各评分系统对术后病死率的预测价值.结果 POSSUM、P-POSSUM、Cr-POSSUM、E-PASS评分系统预测结直肠癌患者术后死亡的最佳截断值分别为54.29%、55.39%、31.68%、56.31%,灵敏度分别为83.3%、83.3%、33.3%、83.3%,特异度分别为29.0%、27.9%、1.6%、27.0%,ROC曲线下面积分别为0.733〔95%CI(0.500,0.966)〕、0.713〔95%CI(0.479,0.948)〕、0.751〔95%CI(0.570,0.932)〕、0.781〔95%CI(0.607,0.955)〕,O/E分别为0.128、0.414、0.248、0.712.结论 POSSUM、P-POSSUM、Cr-POSSUM、E-PASS评分系统均存在高估结直肠癌患者术后病死率的情况,E-PASS评分系统预测结直肠癌患者术后病死率与实际病死率一致性较好.