临床I期肺癌手术治疗后90天死亡率的VALCAN-M评分的开发和验证

SCI  26 October 2022

Development and validation of the VA Lung Cancer Mortality (VALCAN-M) score for 90-day mortality following surgical treatment of clinical stage I lung cancer

(Annals of Surgery, IF: 13.787)

Heiden BT, Eaton DB, Jr., Brandt WS, et al. Development and Validation of the VA Lung Cancer Mortality (VALCAN-M) Score for 90-day Mortality Following Surgical Treatment of Clinical Stage I Lung Cancer. Ann Surg 2022. DOI: 10.1097/SLA.0000000000005725.

Corresponding Author: Brendan T. Heiden, MD, MPHS; 660 S. Euclid Ave, Campus Box 8234; St Louis, MO 63110; E-mail: bheiden@wustl.edu

Objective 目的

To develop and validate the Veterans Administration (VA) Lung Cancer Mortality (VALCAN-M) score, a risk prediction model for 90-day mortality following surgical treatment of clinical stage I non-small cell lung cancer (NSCLC). 

建立并验证退伍军人管理局（VA）肺癌死亡率（VALCAN-M）评分，这是一种临床I期非小细胞肺癌（NSCLC）手术后90天死亡率的风险预测模型。

Background 背景

While surgery remains the preferred treatment for functionally fit patients with early-stage NSCLC, less invasive, non-surgical treatments have emerged for high-risk patients. Accurate risk prediction models for post-operative mortality may aid surgeons and other providers in optimizing patient-centered treatment plans. 

虽然手术仍然是功能正常的早期NSCLC患者的首选治疗方法，但对高危患者出现了侵袭性较小的非手术治疗。准确的术后死亡率风险预测模型可以帮助外科医生和其他治疗提供者优化以患者为中心的治疗方案。

Methods 方法

We performed a retrospective cohort study using a uniquely compiled VA dataset including all Veterans with clinical stage I NSCLC undergoing surgical treatment between 2006 and 2016. Patients were randomly split into derivation and validation cohorts. We derived the VALCAN-M score based on multivariable logistic regression modeling of patient-and treatment-variables and 90-day mortality. 

我们使用唯一编译的VA数据集进行回顾性队列研究，包括所有在2006年至2016年期间接受手术治疗的临床I期NSCLC退伍军人。患者被随机分为推导组和验证组。基于患者和治疗变量及90天死亡率的多变量逻辑回归模型，我们推导了VALCAN-M评分。

Results 结果

A total of 9749 patients were included (derivation cohort: n=6825, 70.0%; validation cohort: n=2924, 30.0%). The 90-day mortality rate was 4.0% (n=390). The final multivariable model included 11 factors that were associated with 90-day mortality: age, body mass index, history of heart failure, forced expiratory volume (FEV1, % predicted), history of peripheral vascular disease, functional status, delayed surgery, American Society of Anesthesiology performance status, tumor histology, extent of resection (lobectomy, wedge, segmentectomy, or pneumonectomy), and surgical approach (minimally invasive or open). The c-statistic was 0.739 (95% CI=0.708-0.771) in the derivation cohort. 

共纳入9749例患者（推导队列：n=6825, 70.0%；验证队列：n=2924, 30.0%）。90天死亡率为4.0%（n=390）。最终的多变量模型包括与90天死亡率相关的11个因素：年龄、BMI、心衰史、用力呼气量（FEV1， %预测）、周围血管疾病史、功能状态、延迟手术、美国麻醉学会PS评分、肿瘤组织学、切除程度（肺叶切除术、楔形切除术、节段切除术或全肺切除术）和手术入路（微创或开放）。推导队列的c统计量为0.739（95% CI=0.708-0.771）。

Conclusions 结论

The VALCAN-M score uses readily available treatment-related variables to reliably predict 90-day operative mortality. This score can aid surgeons and other providers in objectively discussing operative risk among high-risk patients with clinical stage I NSCLC considering surgery versus other definitive therapies. 

VALCAN-M评分使用现成的治疗相关变量可靠地预测90天手术死亡率。该评分可以帮助外科医生和其他提供者客观地讨论临床I期NSCLC高危患者的手术风险，考虑手术与其他的根治方法。

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