A Prediction Model for Severe Complications after Elective Colorectal Cancer Surgery in Patients of 70 Years and Older.

Autor: Souwer ETD; Department of Internal Medicine, Haga Hospital, 2545 AA Den Haag, The Netherlands.; Department of Medical Oncology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands., Bastiaannet E; Department of Medical Oncology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands., Steyerberg EW; Department of Medical Statistics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands., Dekker JWT; Department of Surgery, Reinier De Graaf Gasthuis, 2625 AD Delft, The Netherlands., Steup WH; Department of Surgery, Haga Hospital, 2545 AA Den Haag, The Netherlands., Hamaker MM; Department of Geriatric Medicine, Diakonessenhuis, 3582 KE Utrecht, The Netherlands., Sonneveld DJA; Department of Surgery, Dijklander Ziekenhuis, 1624 NP Hoorn, The Netherlands., Burghgraef TA; Department of Surgery, Meander Medisch Centrum, 3813 TZ Amersfoort, The Netherlands., van den Bos F; Department of Geriatric Medicine, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands., Portielje JEA; Department of Medical Oncology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
Jazyk: angličtina
Zdroj: Cancers [Cancers (Basel)] 2021 Jun 22; Vol. 13 (13). Date of Electronic Publication: 2021 Jun 22.
DOI: 10.3390/cancers13133110
Abstrakt: Introduction Older patients have an increased risk of morbidity and mortality after colorectal cancer (CRC) surgery. Existing CRC surgical prediction models have not incorporated geriatric predictors, limiting applicability for preoperative decision-making. The objective was to develop and internally validate a predictive model based on preoperative predictors, including geriatric characteristics, for severe postoperative complications after elective surgery for stage I-III CRC in patients ≥70 years.
Patients and Methods: A prospectively collected database contained 1088 consecutive patients from five Dutch hospitals (2014-2017) with 171 severe complications (16%). The least absolute shrinkage and selection operator (LASSO) method was used for predictor selection and prediction model building. Internal validation was done using bootstrapping.
Results: A geriatric model that included gender, previous DVT or pulmonary embolism, COPD/asthma/emphysema, rectal cancer, the use of a mobility aid, ADL assistance, previous delirium and polypharmacy showed satisfactory discrimination with an AUC of 0.69 (95% CI 0.73-0.64); the AUC for the optimism corrected model was 0.65. Based on these predictors, the eight-item colorectal geriatric model (GerCRC) was developed.
Conclusion: The GerCRC is the first prediction model specifically developed for older patients expected to undergo CRC surgery. Combining tumour- and patient-specific predictors, including geriatric predictors, improves outcome prediction in the heterogeneous older population.
Databáze: MEDLINE
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