This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Steyerberg, E. W. Articles by Earle, C. C. Search for Related Content PubMed PubMed Citation Articles by Steyerberg, E. W. Articles by Earle, C. C.

Surgical Mortality in Patients With Esophageal Cancer: Development and Validation of a Simple Risk Score

Ewout W. Steyerberg, Bridget A. Neville, Linetta B. Koppert, Valery E.P.P. Lemmens, Hugo W. Tilanus, Jan-Willem W. Coebergh, Jane C. Weeks, Craig C. Earle

From the Departments of Public Health and Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam; Eindhoven Cancer Registry, Comprehensive Cancer Center South, Eindhoven, the Netherlands; and the Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA

Address reprint requests to Ewout W. Steyerberg, PhD, Department of Public Health, AE-236, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, Rotterdam, the Netherlands 3000 CA; e-mail: e.steyerberg{at}erasmusmc.nl

Purpose: Surgery has curative potential in a proportion of patients with esophageal cancer, but is associated with considerable perioperative risks. We aimed to develop and validate a simple risk score for surgical mortality that could be applied to administrative data.

Patients and Methods: We analyzed 3,592 esophagectomy patients from four cohorts. We applied logistic regression analysis to predict mortality occurring within 30 days after esophagectomy for 1,327 esophageal cancer patients older than 65 years of age, diagnosed between 1991 and 1996 in the linked Surveillance, Epidemiology and End Results (SEER) - Medicare database. A simple score chart for preoperative risk assessment of surgical mortality was developed and validated on three other cohorts, including 714 SEER-Medicare patients diagnosed between 1997 and 1999, 349 patients from a population-based registry in the Netherlands diagnosed between 1993 and 2001, and 1,202 patients from a referral hospital in the Netherlands diagnosed between 1980 and 2002.

Results: Surgical mortality in the four cohorts was 11% (147 of 1,327), 10% (74 of 714), 7% (25 of 349), and 4% (45 of 1,202), respectively. Predictive patient characteristics included age, comorbidity (cardiac, pulmonary, renal, hepatic, and diabetes), preoperative radiotherapy or combined chemoradiotherapy, and a relatively low hospital volume. At validation, the simple score showed good agreement of predicted risks with observed mortality rates (calibration), but low discrimination (area under the receiver operating characteristic curve 0.58 to 0.66).

Conclusion: A simple risk score combining clinical characteristics along with hospital volume to predict surgical mortality after esophagectomy from administrative data may form a basis for risk adjustment in quality of care assessment.

Terms in blue are defined in the glossary, found at the end of this article and online at www.jco.org.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

This article has been cited by other articles:

				J. Ra, E. C. Paulson, J. Kucharczuk, K. Armstrong, C. Wirtalla, R. Rapaport-Kelz, L. R. Kaiser, and F. R. Spitz Postoperative Mortality After Esophagectomy for Cancer: Development of a Preoperative Risk Prediction Model Ann. Surg. Oncol., June 1, 2008; 15(6): 1577 - 1584. [Abstract] [Full Text] [PDF]

				S. M. Lagarde, J. B. Reitsma, A.-K. D. Maris, M. I. van Berge Henegouwen, O. R.C. Busch, H. Obertop, A. H. Zwinderman, and J. J. B. van Lanschot Preoperative prediction of the occurrence and severity of complications after esophagectomy for cancer with use of a nomogram. Ann. Thorac. Surg., June 1, 2008; 85(6): 1938 - 1945. [Abstract] [Full Text] [PDF]

				E. Internullo, J. Moons, P. Nafteux, W. Coosemans, G. Decker, P. De Leyn, D. Van Raemdonck, and T. Lerut Outcome after esophagectomy for cancer of the esophagus and GEJ in patients aged over 75 years Eur. J. Cardiothorac. Surg., June 1, 2008; 33(6): 1096 - 1104. [Abstract] [Full Text] [PDF]

				E. W. Steyerberg, B. Neville, J. C. Weeks, and C. C. Earle Referral Patterns, Treatment Choices, and Outcomes in Locoregional Esophageal Cancer: A Population-Based Analysis of Elderly Patients J. Clin. Oncol., June 10, 2007; 25(17): 2389 - 2396. [Abstract] [Full Text] [PDF]

				M. Extermann and A. Hurria Comprehensive Geriatric Assessment for Older Patients With Cancer J. Clin. Oncol., May 10, 2007; 25(14): 1824 - 1831. [Abstract] [Full Text] [PDF]