Giovanni Catalano, Laura Alaimo, Yutaka Endo, Odysseas P. Chatzipanagiotou, Andrea Ruzzenente, Luca Aldrighetti, Matthew Weiss, Todd W. Bauer, Sorin Alexandrescu, George A. Poultsides, Shishir K. Maithel, Hugo P. Marques, Guillaume Martel, Carlo Pulitano, Feng Shen, François Cauchy, Bas G. Koerkamp, Itaru Endo, Minoru Kitago, Timothy M. Pawlik
{"title":"肝内胆管癌治愈性即时手术患者输血风险预测评分的开发与验证","authors":"Giovanni Catalano, Laura Alaimo, Yutaka Endo, Odysseas P. Chatzipanagiotou, Andrea Ruzzenente, Luca Aldrighetti, Matthew Weiss, Todd W. Bauer, Sorin Alexandrescu, George A. Poultsides, Shishir K. Maithel, Hugo P. Marques, Guillaume Martel, Carlo Pulitano, Feng Shen, François Cauchy, Bas G. Koerkamp, Itaru Endo, Minoru Kitago, Timothy M. Pawlik","doi":"10.1002/jso.27903","DOIUrl":null,"url":null,"abstract":"Background and ObjectivesAmong patients undergoing liver resection for intrahepatic cholangiocarcinoma (ICC), perioperative bleeding requiring blood transfusion is a common complication, yet preoperative identification of patients at risk for transfusion remains challenging. The objective of this study was to develop a preoperative risk score for blood transfusion requirement during surgery for ICC.MethodsPatients undergoing curative‐intent liver surgery for ICC (1990–2020) were identified from a multi‐institutional database. A predictive model was developed and validated. An easy‐to‐use risk calculator was made available online.ResultsAmong 1420 patients, 300 (21.1%) received an intraoperative transfusion. Independent predictors of transfusion included severe preoperative anemia (OR = 1.65, 95% CI 1.10–2.47), T2 category or higher (OR = 2.00, 95% CI 1.36–3.02), positive lymph nodes (OR = 1.75, 95% CI 1.32–2.32) and major resection (OR = 2.56, 95%CI 1.85–3.58). Receipt of blood transfusion significantly correlated with worse outcomes. The model showed good discriminative ability in both training (AUC = 0.68, 95% CI 0.66–0.72) and bootstrapping validation (C‐index = 0.67, 95% CI 0.65–0.70) cohorts. An online risk calculator of blood transfusion requirement was developed (<jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" xlink:href=\"https://catalano-giovanni.shinyapps.io/TransfusionRisk\">https://catalano-giovanni.shinyapps.io/TransfusionRisk</jats:ext-link>).ConclusionsIntraoperative blood transfusion was significantly associated with poor postoperative outcomes among patients undergoing surgery for ICC. The identification of patients at high risk of transfusion could improve perioperative patient care and blood resources allocation.","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":null,"pages":null},"PeriodicalIF":2.0000,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Development and Validation of a Predictive Risk Score for Blood Transfusion in Patients Undergoing Curative‐Intent Surgery for Intrahepatic Cholangiocarcinoma\",\"authors\":\"Giovanni Catalano, Laura Alaimo, Yutaka Endo, Odysseas P. Chatzipanagiotou, Andrea Ruzzenente, Luca Aldrighetti, Matthew Weiss, Todd W. Bauer, Sorin Alexandrescu, George A. Poultsides, Shishir K. Maithel, Hugo P. Marques, Guillaume Martel, Carlo Pulitano, Feng Shen, François Cauchy, Bas G. Koerkamp, Itaru Endo, Minoru Kitago, Timothy M. Pawlik\",\"doi\":\"10.1002/jso.27903\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Background and ObjectivesAmong patients undergoing liver resection for intrahepatic cholangiocarcinoma (ICC), perioperative bleeding requiring blood transfusion is a common complication, yet preoperative identification of patients at risk for transfusion remains challenging. The objective of this study was to develop a preoperative risk score for blood transfusion requirement during surgery for ICC.MethodsPatients undergoing curative‐intent liver surgery for ICC (1990–2020) were identified from a multi‐institutional database. A predictive model was developed and validated. An easy‐to‐use risk calculator was made available online.ResultsAmong 1420 patients, 300 (21.1%) received an intraoperative transfusion. Independent predictors of transfusion included severe preoperative anemia (OR = 1.65, 95% CI 1.10–2.47), T2 category or higher (OR = 2.00, 95% CI 1.36–3.02), positive lymph nodes (OR = 1.75, 95% CI 1.32–2.32) and major resection (OR = 2.56, 95%CI 1.85–3.58). Receipt of blood transfusion significantly correlated with worse outcomes. The model showed good discriminative ability in both training (AUC = 0.68, 95% CI 0.66–0.72) and bootstrapping validation (C‐index = 0.67, 95% CI 0.65–0.70) cohorts. An online risk calculator of blood transfusion requirement was developed (<jats:ext-link xmlns:xlink=\\\"http://www.w3.org/1999/xlink\\\" xlink:href=\\\"https://catalano-giovanni.shinyapps.io/TransfusionRisk\\\">https://catalano-giovanni.shinyapps.io/TransfusionRisk</jats:ext-link>).ConclusionsIntraoperative blood transfusion was significantly associated with poor postoperative outcomes among patients undergoing surgery for ICC. The identification of patients at high risk of transfusion could improve perioperative patient care and blood resources allocation.\",\"PeriodicalId\":17111,\"journal\":{\"name\":\"Journal of Surgical Oncology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.0000,\"publicationDate\":\"2024-09-17\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Surgical Oncology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1002/jso.27903\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Surgical Oncology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/jso.27903","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景和目的在接受肝内胆管癌(ICC)肝切除术的患者中,需要输血的围手术期出血是一种常见的并发症,但术前识别有输血风险的患者仍具有挑战性。本研究的目的是为 ICC 手术中需要输血的患者制定术前风险评分。方法从一个多机构数据库中确定了因 ICC 而接受治愈性肝脏手术的患者(1990-2020 年)。开发并验证了一个预测模型。结果在1420名患者中,有300人(21.1%)接受了术中输血。输血的独立预测因素包括术前严重贫血(OR = 1.65,95% CI 1.10-2.47)、T2 类或以上(OR = 2.00,95% CI 1.36-3.02)、淋巴结阳性(OR = 1.75,95% CI 1.32-2.32)和大部切除(OR = 2.56,95% CI 1.85-3.58)。接受输血与较差的预后明显相关。该模型在训练(AUC = 0.68,95% CI 0.66-0.72)和引导验证(C-指数 = 0.67,95% CI 0.65-0.70)队列中均显示出良好的判别能力。结论在接受 ICC 手术的患者中,术中输血与术后不良预后显著相关。识别输血高风险患者可改善围术期患者护理和血液资源分配。
Development and Validation of a Predictive Risk Score for Blood Transfusion in Patients Undergoing Curative‐Intent Surgery for Intrahepatic Cholangiocarcinoma
Background and ObjectivesAmong patients undergoing liver resection for intrahepatic cholangiocarcinoma (ICC), perioperative bleeding requiring blood transfusion is a common complication, yet preoperative identification of patients at risk for transfusion remains challenging. The objective of this study was to develop a preoperative risk score for blood transfusion requirement during surgery for ICC.MethodsPatients undergoing curative‐intent liver surgery for ICC (1990–2020) were identified from a multi‐institutional database. A predictive model was developed and validated. An easy‐to‐use risk calculator was made available online.ResultsAmong 1420 patients, 300 (21.1%) received an intraoperative transfusion. Independent predictors of transfusion included severe preoperative anemia (OR = 1.65, 95% CI 1.10–2.47), T2 category or higher (OR = 2.00, 95% CI 1.36–3.02), positive lymph nodes (OR = 1.75, 95% CI 1.32–2.32) and major resection (OR = 2.56, 95%CI 1.85–3.58). Receipt of blood transfusion significantly correlated with worse outcomes. The model showed good discriminative ability in both training (AUC = 0.68, 95% CI 0.66–0.72) and bootstrapping validation (C‐index = 0.67, 95% CI 0.65–0.70) cohorts. An online risk calculator of blood transfusion requirement was developed (https://catalano-giovanni.shinyapps.io/TransfusionRisk).ConclusionsIntraoperative blood transfusion was significantly associated with poor postoperative outcomes among patients undergoing surgery for ICC. The identification of patients at high risk of transfusion could improve perioperative patient care and blood resources allocation.
期刊介绍:
The Journal of Surgical Oncology offers peer-reviewed, original papers in the field of surgical oncology and broadly related surgical sciences, including reports on experimental and laboratory studies. As an international journal, the editors encourage participation from leading surgeons around the world. The JSO is the representative journal for the World Federation of Surgical Oncology Societies. Publishing 16 issues in 2 volumes each year, the journal accepts Research Articles, in-depth Reviews of timely interest, Letters to the Editor, and invited Editorials. Guest Editors from the JSO Editorial Board oversee multiple special Seminars issues each year. These Seminars include multifaceted Reviews on a particular topic or current issue in surgical oncology, which are invited from experts in the field.