Alternative Fistula Risk Score for Pancreatoduodenectomy (a-FRS): Design and International External Validation.
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Mungroop Timothy H, van Rijssen L Bengt, van Klaveren David, Smits F Jasmijn, van Woerden Victor, Linnemann Ralph J, de Pastena Matteo, Klompmaker Sjors, Marchegiani Giovanni, Ecker Brett L, van Dieren Susan, Bonsing Bert, Busch Olivier R, van Dam Ronald M, Erdmann Joris, van Eijck Casper H, Gerhards Michael F, van Goor Harry, van der Harst Erwin, de Hingh Ignace H, de Jong Koert P, Kazemier Geert, Luyer Misha, Shamali Awad, Barbaro Salvatore, Armstrong Thomas, Takhar Arjun, Hamady Zaed, Klaase Joost, Lips Daan J, Molenaar I Quintus, Nieuwenhuijs Vincent B, Rupert Coen, van Santvoort Hjalmar C, Scheepers Joris J, van der Schelling George P, Bassi Claudio, Vollmer Charles M, Steyerberg Ewout W, Abu Hilal Mohammed, Groot Koerkamp Bas, Besselink Marc G, Dutch Pancreatic Cancer Group
Аннотация
BACKGROUND: Blood loss, one of the predictors of the original-FRS, was not a significant factor during 2 recent external validations.
METHODS: The a-FRS was developed in 2 databases: the Dutch Pancreatic Cancer Audit (18 centers) and the University Hospital Southampton NHS. Primary outcome was grade B/C POPF according to the 2005 International Study Group on Pancreatic Surgery (ISGPS) definition. The score was externally validated in 2 independent databases (University Hospital of Verona and University Hospital of Pennsylvania), using both 2005 and 2016 ISGPS definitions. The a-FRS was also compared with the original-FRS.
RESULTS: For model design, 1924 patients were included of whom 12% developed POPF. Three predictors were strongly associated with POPF: soft pancreatic texture [odds ratio (OR) 2.58, 95% confidence interval (95% CI) 1.80-3.69], small pancreatic duct diameter (per mm increase, OR: 0.68, 95% CI: 0.61-0.76), and high body mass index (BMI) (per kg/m increase, OR: 1.07, 95% CI: 1.04-1.11). Discrimination was adequate with an area under curve (AUC) of 0.75 (95% CI: 0.71-0.78) after internal validation, and 0.78 (0.74-0.82) after external validation. The predictive capacity of a-FRS was comparable with the original-FRS, both for the 2005 definition (AUC 0.78 vs 0.75, P = 0.03), and 2016 definition (AUC 0.72 vs 0.70, P = 0.05).
CONCLUSION: The a-FRS predicts POPF after pancreatoduodenectomy based on 3 easily available variables (pancreatic texture, duct diameter, BMI) without blood loss and pathology, and was successfully validated for both the 2005 and 2016 POPF definition. The online calculator is available at www.pancreascalculator.com.