目的:开发一种术前工具来评估原发性减瘤手术围手术期红细胞输注的风险。
方法:我们回顾性回顾了一个机构数据库,以确定在2001年1月1日至2019年5月31日期间在单个中心接受卵巢癌原发性减瘤手术的患者。计算接收器工作特征曲线和接收器工作特征曲线下面积(AUC)。将五折交叉验证应用于多变量模型。如果存在,则将重要变量分配为“血液”(卵巢癌膨胀手术的血液输血)评分为+1。计算每位患者的总血液评分,并对每个评分确定接受输血的几率.
结果:总体而言,1566例患者符合资格标准;800例(51%)接受了围手术期输血。美国麻醉医师协会评分为3分和4分的赔率比(OR)具有统计学意义(OR1.34,95%置信区间(95%CI)1.09至1.63),术前癌症抗原125(CA125)水平(OR2.43,95%CI1.98至2.99),血小板(OR1.59,95%CI1.45至1.74),肥胖(OR0.76,95%CI0.60至0.96),存在癌病(OR2.45,95%CI1.93至3.11),上腹部大部疾病(OR2.86,95%CI2.32至3.54),术前血清白蛋白水平(OR0.31,95%CI0.24至0.40),术前血红蛋白水平(OR0.56,95%CI0.51至0.61)。校正的AUC为0.748(95%CI0.693至0.804)。血液得分为0分和5分,分别对应11%和73%的赔率,分别,接受围手术期输血.
结论:我们开发了一种通用的术前评分系统,血液分数,以帮助识别卵巢癌患者谁将受益于手术计划和血液节约技术。血液评分与美国麻醉医师协会的评分成正比,上腹部疾病的存在,癌,CA125水平,和血小板水平。我们相信该模型可以帮助医生制定手术计划,并有利于患者的预后。
OBJECTIVE: To develop a pre-operative tool to estimate the risk of peri-operative packed red blood cell transfusion in primary debulking surgery.
METHODS: We retrospectively reviewed an institutional database to identify patients who underwent primary debulking surgery for ovarian cancer at a single center between January 1, 2001 and May 31, 2019. Receiver operating characteristic curve and area under the receiver operating characteristic curve (AUC) were calculated. Five-fold cross-validation was applied to the multivariate model. Significant variables were assigned a \'BLOODS\' (BLood transfusion Over an Ovarian cancer Debulking Surgery) score of +1 if present. A total BLOODS score was calculated for each patient, and the odds of receiving a transfusion was determined for each score.
RESULTS: Overall, 1566 patients met eligibility criteria; 800 (51%) underwent a peri-operative blood transfusion. Odds ratios (OR) were statistically significant for American Society of Anesthesiologists scores of 3 and 4 (OR 1.34, 95% confidence interval (95% CI) 1.09 to 1.63), pre-operative levels of cancer antigen 125 (CA125) (OR 2.43, 95% CI 1.98 to 2.99), platelets (OR 1.59, 95% CI 1.45 to 1.74), obesity (OR 0.76, 95% CI 0.60 to 0.96), presence of carcinomatosis (OR 2.45, 95% CI 1.93 to 3.11), bulky upper abdominal disease (OR 2.86, 95% CI 2.32 to 3.54), pre-operative serum albumin level (OR 0.31, 95% CI 0.24 to 0.40), and pre-operative hemoglobin level (OR 0.56, 95% CI 0.51 to 0.61). The corrected AUC was 0.748 (95% CI 0.693 to 0.804). BLOODS scores of 0 and 5 corresponded to 11% and 73% odds, respectively, of receiving a peri-operative blood transfusion.
CONCLUSIONS: We developed a universal pre-operative scoring system, the BLOODS score, to help identify patients with ovarian cancer who would benefit from surgical planning and blood-saving techniques. The BLOODS score was directly proportional to the American Society of Anesthesiologists score, presence of upper abdominal disease, carcinomatosis, CA125 level, and platelets level. We believe this model can help physicians with surgical planning and can benefit patient outcomes.