Objective: The P-POSSUM scale is widely used in predicting perioperative morbidity and mortality. Evidence on the performance of P-POSSUM in predicting outcomes after cytoreductive surgery (CRS) for ovarian cancer (OC) is limited. In this study, we assess how well P-POSSUM predicts morbidity in OC CRS and explore whether incorporating additional clinical variables can enhance its predictive accuracy. We retrospectively collected data on consecutive patients undergoing OC CRS within a tertiary gynaecologic oncology network. The collected information included demographic characteristics, P-POSSUM morbidity and mortality scores, Edmonton Frail Scale (EFS) scores, preoperative serum albumin levels, and observed 30-day postoperative morbidity and mortality, classified using the Clavien–Dindo (CD) scale. The predictive performance of P-POSSUM was evaluated using receiver operating characteristic (ROC) curves to calculate sensitivity and specificity. A stepwise regression analysis was then applied to identify additional variables that could improve model performance, incorporating preoperative covariates. The final model incorporated parameters chosen through bootstrap investigation of the model variability (stepAIC). Predicted versus observed morbidity was calibrated and performance compared between P-POSSUM and the final model. Results: Of 161 sequential OC patients, 95 (59%) underwent primary, 45 (28%) interval, and 21 (13%) delayed CRS. The mean age was 66.4 (95%CI: 60–75) and duration of surgery was 223 mins (95%CI: 142–279). Sixty-five (40.3%) patients had ≥1 postoperative complication. Two deaths were reported. Among the observed complications, 4 patients (6.1%) experienced CD4, 10 patients (15.3%) CD3, 38 patients (58.5%) CD2, and 11 patients (16.9%) CD1 events. The mean P-POSSUM-predicted morbidity and mortality were 59.5% (95%CI: 56.7–62.3%) and 5.86% (95%CI: 5.02–6.70%), respectively. The area under the curve (AUC) for P-POSSUM in predicting morbidity and mortality was 0.539 (p= 0.401) and 0.569 (p= 0.137), respectively. Given the small number of deaths, no robust conclusions regarding mortality are possible. EFS and BMI emerged as significant predictors of observed morbidity using a stepwise-model selection process. The AIC of this final model was 211.44. Our final model of PPOSSUM + EFS + BMI had AUC = 0.6551 (Delong’s Z = 1.8845,p-value = 0.05949). Conclusions: The P-POSSUM scale shows poor performance for predicting morbidity in OC CRS. New validated and accurate model(s) are necessary for predicting surgical morbidity. Our proposed model incorporates additional variables to improve P-POSSUM’s performance. This requires further development and validation.
目的：P-POSSUM评分系统被广泛用于预测围手术期并发症发生率与死亡率，但其在卵巢癌肿瘤细胞减灭术预后预测方面的效能证据有限。本研究旨在评估P-POSSUM对卵巢癌肿瘤细胞减灭术并发症的预测能力，并探讨纳入额外临床变量能否提升其预测准确性。我们回顾性收集了三级妇科肿瘤诊疗网络中连续接受卵巢癌肿瘤细胞减灭术患者的临床资料，包括人口学特征、P-POSSUM并发症与死亡率评分、埃德蒙顿衰弱量表评分、术前血清白蛋白水平，以及采用Clavien-Dindo分级系统记录的术后30天实际并发症与死亡率。通过受试者工作特征曲线计算敏感度与特异度，评估P-POSSUM的预测效能。采用逐步回归分析筛选可提升模型性能的术前协变量，最终通过模型变异性的自助法研究确定参数构建新模型。对预测值与观测值进行校准，并比较P-POSSUM与最终模型的性能表现。 结果：在161例连续入组的卵巢癌患者中，95例（59%）接受初次肿瘤细胞减灭术，45例（28%）接受间歇性肿瘤细胞减灭术，21例（13%）接受延迟肿瘤细胞减灭术。患者平均年龄66.4岁（95%CI：60-75），手术时长223分钟（95%CI：142-279）。65例（40.3%）患者出现≥1种术后并发症，死亡病例2例。观察到的并发症中，4例（6.1%）为CD4级，10例（15.3%）为CD3级，38例（58.5%）为CD2级，11例（16.9%）为CD1级。P-POSSUM预测的并发症发生率与死亡率分别为59.5%（95%CI：56.7-62.3%）和5.86%（95%CI：5.02-6.70%）。P-POSSUM预测并发症与死亡率的曲线下面积分别为0.539（p=0.401）和0.569（p=0.137）。鉴于死亡病例数较少，无法得出关于死亡率预测的可靠结论。通过逐步模型筛选发现，埃德蒙顿衰弱量表评分与体重指数是实际并发症的显著预测因子。最终模型的赤池信息准则值为211.44。我们构建的P-POSSUM联合埃德蒙顿衰弱量表评分与体重指数新模型的曲线下面积为0.6551（Delong's Z=1.8845，p=0.05949）。 结论：P-POSSUM评分系统对卵巢癌肿瘤细胞减灭术并发症的预测效能欠佳。需要开发新型经过验证的精准模型用于预测手术并发症。本研究提出的模型通过纳入额外变量改善了P-POSSUM的预测性能，该模型尚需进一步开发与验证。
P-POSSUM Falls Short: Predicting Morbidity in Ovarian Cancer (OC) Cytoreductive Surgery
肿瘤(癌症)患者之家