ARISCAT评分对食管鳞状细胞癌术后肺炎的预后价值:一项回顾性队列研究

IF 3.4 3区 医学 Q2 MEDICINE, RESEARCH & EXPERIMENTAL
Peng Zhang, Yunyun Chen, Zhiyun Xu, Tingting Qin, Yueqin Yang, Changying Liu, Jianqiang Zhao, Hui Xia
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引用次数: 0

摘要

背景:术后肺炎仍然是食管鳞状细胞癌切除术后最常见和最严重的并发症之一,严重影响恢复和生存结果。准确的术前风险分层是至关重要的,但目前尚无广泛验证的escc特异性手术队列评分系统。ARISCAT评分是一种术前风险指数,用于评估普通手术中肺部并发症的风险,但此前并未在ESCC患者中进行评估。本研究旨在评估ARISCAT评分及其与其他围手术期指标的结合对预测术后肺炎的预后价值。方法:本回顾性队列研究包括366例组织学证实可切除的ESCC患者,这些患者于2019年1月至2022年12月在一家大容量胸外科中心接受了治疗性胸腹腔镜McKeown食管切除术。术前收集ARISCAT评分及其他临床参数,包括肿瘤长度、住院时间、PNI、LMR。术后肺炎在术后30天内根据放射学、临床和实验室标准诊断。进行单因素和多因素logistic回归分析以确定肺炎的独立预测因素。限制三次样条建模用于评估非线性关联。结果:366例患者术后发生肺炎99例(27.0%)。肺炎患者ARISCAT评分较高(59.6±8.9比44.4±7.6),肿瘤长度较长(4.5±0.7 cm比3.8±0.6 cm),住院时间较长(17.6±2.8比13.6±2.3天),PNI和LMR值较低(均为p)结论:ARISCAT评分是行McKeown食管切除术的ESCC患者术后肺炎的独立且可靠的预测因子。该研究首次在escc特异性手术队列中对ARISCAT评分进行了全面评估,并独特地证明了其与炎症(LMR)和营养(PNI)标志物的结合显著增强了术前风险分层。这些发现为个性化围手术期管理提供了宝贵的临床见解。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Prognostic value of the ARISCAT score for postoperative pneumonia in patients with esophageal squamous cell carcinoma: a retrospective cohort study.

Background: Postoperative pneumonia remains one of the most common and serious complications after esophagectomy for esophageal squamous cell carcinoma, significantly impairing recovery and survival outcomes. Accurate preoperative risk stratification is critical, yet no widely validated scoring system currently exists for ESCC-specific surgical cohorts. The ARISCAT score, a preoperative risk index developed to estimate pulmonary complication risk in general surgery, has not been previously assessed in ESCC patients. This study aimed to evaluate the prognostic value of the ARISCAT score and its integration with other perioperative indicators for predicting postoperative pneumonia.

Methods: This retrospective cohort study included 366 patients with histologically confirmed resectable ESCC who underwent curative thoraco-laparoscopic McKeown esophagectomy at a high-volume thoracic surgery center between January 2019 and December 2022. The ARISCAT score and other clinical parameters, including tumor length, length of hospital stay, PNI, and LMR, were collected preoperatively. Postoperative pneumonia was diagnosed based on radiologic, clinical, and laboratory criteria within 30 days after surgery. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of pneumonia. Restricted cubic spline modeling was used to assess non-linear associations.

Results: Postoperative pneumonia occurred in 99 of 366 patients (27.0%). Patients with pneumonia had significantly higher ARISCAT scores (59.6 ± 8.9 vs. 44.4 ± 7.6), longer tumor lengths (4.5 ± 0.7 cm vs. 3.8 ± 0.6 cm), and prolonged hospital stays (17.6 ± 2.8 vs. 13.6 ± 2.3 days), along with lower PNI and LMR values (all p < 0.001). In multivariate analysis, the ARISCAT score was independently associated with postoperative pneumonia (adjusted OR = 1.40, 95% CI 1.22-1.60, p < 0.001). Other independent predictors included tumor length (adjusted OR = 12.44), length of hospital stay (adjusted OR = 2.64), PNI (adjusted OR = 0.79), and LMR (adjusted OR = 0.18). RCS analysis revealed linear dose-response relationships for ARISCAT and tumor length, while LMR and hospital stay showed non-linear associations with pneumonia risk. No significant interaction effects were observed across subgroups.

Conclusions: The ARISCAT score is an independent and robust predictor of postoperative pneumonia in ESCC patients undergoing McKeown esophagectomy. This study represents the first comprehensive evaluation of the ARISCAT score in an ESCC-specific surgical cohort, and uniquely demonstrates that its integration with inflammatory (LMR) and nutritional (PNI) markers significantly enhances preoperative risk stratification. These findings offer valuable clinical insights for personalized perioperative management.

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来源期刊
European Journal of Medical Research
European Journal of Medical Research 医学-医学:研究与实验
CiteScore
3.20
自引率
0.00%
发文量
247
审稿时长
>12 weeks
期刊介绍: European Journal of Medical Research publishes translational and clinical research of international interest across all medical disciplines, enabling clinicians and other researchers to learn about developments and innovations within these disciplines and across the boundaries between disciplines. The journal publishes high quality research and reviews and aims to ensure that the results of all well-conducted research are published, regardless of their outcome.
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