改良POSSUM评分在预测老年非小细胞肺癌手术风险中的应用价值  

Value of Modified Possum Scoring System on Predicting Operation Risk in Elderly NSCLC Patients

作　　者：王蓉[1] 高德伟[1] 龚卫琴[1] 梁致如[1] 

机构地区：[1]解放军总医院南楼综合外科,北京100853

出　　处：《中国肺癌杂志》2014年第9期669-673,共5页Chinese Journal of Lung Cancer

摘　　要：背景与目的对于评价老年患者能否耐受肺癌手术,目前尚无明确标准。本研究旨在探讨改良POSSUM(Physiological and Operative Severity Score for the Umeration of Mortality and Morbidity)评分在预测老年非小细胞肺癌(non-small cell lung cancer,NSCLC)患者术后并发症发生率和病死率中的应用价值,为手术治疗的决策提供重要依据。方法 2007年12月-2013年12月在解放军总医院接受手术治疗的老年NSCLC患者138例,其中男性88例,女性50例,收集临床资料,各因素对术后实际并发症发生率和病死率的影响,采用二值多元Logistic回归分析。在有、无并发症两组中,采用成组t检验对标准及改良POSSUM评分值进行比较。绘制标准POSSUM和改良POSSUM的受试者工作特征曲线(receiver operating characteristic curve,ROC),计算曲线下面积(area under the curve,AUC),两组间AUC比较采用t检验。计算改良POSSUM评分预测值和实际并发症发生率和病死率的符合度。结果共有59例患者出现77例次术后并发症,手术死亡2例。Logistic回归分析,标准POSSUM的18项指标中17项及肺功能、肿瘤分期对术后并发症的发生有统计学意义(P<0.05),年龄对术后死亡有统计学意义(P<0.05)。在标准POSSUM评分中,并发症组与无并发症组的评分比较,差异有统计学意义(P<0.01)。在改良POSSUM评分中,并发症组与无并发症组的评分比较,差异有统计学意义(P<0.01)。改良POSSUM较标准POSSUM对术后并发症发生有更好的预测价值,两组AUC比较,差异有统计学意义(P<0.01)。但改良POSSUM对手术死亡的预测值过高。结论改良POSSUM评分对老年NSCLC术后并发症发生有较好的预测价值,可为决策手术治疗提供依据。Background and objective For the assessment of elderly patients can tolerate lung cancer operation, there is no clear standard. To evaluate the clinical validity of POSSUM （Physiological and Operative Severity Score for the Umeration of Mortality and Morbidity） in elderly non-small cell lung cancer （NSCLC） surgery patients, we want to provide an important basis for operation treatment decisions. Methods A total of 138 patients, with 88 males and 50 females, with elderly NSCLC surgery between December 2007 and December 2013, are included in PLA general hospital. Using the mul-tivariate Logistic regression analysis, we evaluate the value of each factor on the actual postoperative complications mortality and morbidity. hTe scorings on standard POSSUM and modiifed POSSUM in the complication group are compared with the non-complication group using the group t test. Drawing receiver operating characteristic （ROC） curve in standard POSSUM group and modiifed POSSUM group, calculating the area under the curve （AUC）, AUC in standard group is compared with modiifed group using t test. Judge if the modiifed POSSUM prediction is consistent with the actual mortality and morbidity. Results Among 138 patients, there were 77 postoperative complications in 59 patients, 2 cases of death. According to the Logistic regression analysis, 17 of 18 factors in standard POSSUM, pulmonary function, different TNM stage are predictors for postoperative complications （P〈0.05）. Age is a predictor for postoperative death （P〈0.05）. In the standard POSSUM scor-ing, actual complication group compared with non-complication group, the difference is statistically signiifcant （P〈0.01）. In the modiifed POSSUM scoring, complication group is compared with non-complication group, the difference is statistically signiifcant （P〈0.01）. Compared with the standard POSSUM, the modiifed POSSUM has better predictive value on postopera-tive morbidity, and the comparison of AUC between the two groups is statistically signiifca

关 键 词：肺肿瘤 老年人 手术风险 POSSUM评分 

分 类 号：R734.2[医药卫生—肿瘤]