Evaluation and validation of Physiological and Operative Severity Score for the enumeration of mortality and morbidity and Portsmouth-POSSUM scores in predicting morbidity and mortality in patients undergoing head and neck cancer surgeries

Association of Age and Overall Survival in Surgically Resected Colorectal Cancer Patients

INTRODUCTION

Incidence of colorectal cancer (CRC) among young patients has increased in the last 20 y often with more aggressive tumor biology. It is unclear if age < 50 y is an independent factor for shorter overall survival in CRC patients. Our objective was to determine if younger age at diagnosis was associated with worse overall survival.

METHODS

This study used the National Cancer Data Base (2004-2016), retrospectively reviewing patients who underwent surgical resection for CRC. Patients were limited to only those without comorbidities and primary outcome was overall survival for all patients.

RESULTS

Older patients have worse overall survival as compared to younger patients at a lower stage of disease (I and II) after adjusting for tumor location, gender, histology, stage, and systemic chemotherapy (< 36 y old versus 36-55 y old hazard ratio [HR] 1.16, confidence interval [CI] 1.03-1.29). This survival benefit is eliminated at a higher stage of disease, stage III in 36-55 y old versus < 36 y old (HR 0.96 [CI 0.90-1.03.99]) and stage IV (HR 0.94 [CI 0.89-0.99]).

CONCLUSIONS

Older patients (aged > 36 y) have worse overall survival at a lower stage of disease, but the survival among all age groups was similar for stage III or IV disease in CRC.

Mining Pre-Surgical Patterns Able to Discriminate Post-Surgical Outcomes in the Oncological Domain

Understanding the individualized risks of undertaking surgical procedures is essential to personalize preparatory, intervention and post-care protocols for minimizing post-surgical complications. This knowledge is key in oncology given the nature of interventions, the fragile profile of patients with comorbidities and cytotoxic drug exposure, and the possible cancer recurrence. Despite its relevance, the discovery of discriminative patterns of post-surgical risk is hampered by major challenges: i) the unique physiological and demographic profile of individuals, as well as their differentiated post-surgical care; ii) the high-dimensionality and heterogeneous nature of available biomedical data, combining non-identically distributed risk factors, clinical and molecular variables; iii) the need to generalize tumors have significant histopathological differences and individuals undertake unique surgical procedures; iv) the need to focus on non-trivial patterns of post-surgical risk, while guaranteeing their statistical significance and discriminative power; and v) the lack of interpretability and actionability of current approaches. Biclustering, the discovery of groups of individuals correlated on subsets of variables, has unique properties of interest, being positioned to satisfy the aforementioned challenges. In this context, this work proposes a structured view on why, when and how to apply biclustering to mine discriminative patterns of post-surgical risk with guarantees of usability, a subject remaining unexplored up to date. These patterns offer a comprehensive view on how the patient profile, cancer histopathology and entailed surgical procedures determine: i) post-surgical complications, ii) survival, and iii) hospitalization needs. The gathered results confirm the role of biclustering in comprehensively finding interpretable, actionable and statistically significant patterns of post-surgical risk. The found patterns are already assisting healthcare professionals at IPO-Porto to establish specialized pre-habilitation protocols and bedside care.

Prediction of Mortality in Patients After Oncologic Gastrointestinal Surgery: Comparison of the ASA, APACHE II, and POSSUM Scoring Systems

Scoring systems have been developed to predict the expected mortality and morbidity in surgical procedures. In this study, our aim was to compare the ASA (American Society of Anesthesiologists), APACHE (Acute Physiology and Chronic Health Evaluation) II, POSSUM (Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity) scoring systems as predictors of mortality in patients who underwent gastrointestinal oncologic surgery, followed, and were admitted to the intensive care unit during the postoperative period. We examined the files of 82 patients who underwent oncologic gastrointestinal surgery and followed up in the intensive care units (ICUs). The patients’ APACHE II scores and predicted mortality rates (PMR) according to the APACHE II, POSSUM, and ASA scores were ​​calculated. The receiver operator characteristic (ROC) curve analysis was used when evaluating the performances of the ASA, APACHE, and POSSUM scoring systems in terms of accurate assessment of mortality. Accordingly, the area under the curve (AUC) = 0.5 no distinction, 0.5 <AUC <0.7 discriminative power of the test is statistically not significant, 0.7 <AUC <0.8 acceptable, 0.8 <AUC <0.9 very good and 0.9 <AUC <1 perfect. The evaluations showed that APACHE II had the best performance with 0.81, followed by POSSUM, which had an acceptable level at 0.78. On the other hand, the ASA score was 0.63 and its discriminative power was identified as statistically insignificant. Our results show that the POSSUM and APACHE II scoring systems were better at predicting mortality than the ASA scoring system for the prediction of mortality in the postoperative period. Both the POSSUM and APACHE II scoring systems can be confidently used for the prediction of mortality in patients undergoing operations due to oncologic gastrointestinal diseases.