The EPOS-CC Score: An Integration of Independent, Tumor- and XXXX -Associated Risk Factors to Predict 5-years Overall Survival Following @entity14 .

@entity1 @entity4988 @entity5 @entity1372 @entity2802 @entity358 @entity14
BACKGROUND: Surgical audit is an essential task for the estimation of postoperative outcome and comparison of quality of care. Previous studies on surgical audits focused on short-term outcomes, such as postoperative mortality. We propose a surgical audit evaluating long-term outcome following @entity14 surgery. The predictive model for this audit is designated as 'Estimation of Postoperative Overall Survival for @entity14 (EPOS-CC)'. METHODS: Thirty-one @entity5 -related and physiological variables were prospectively collected in 889 @entity1 undergoing elective resection for @entity14 between April 2005 and April 2007 in 16 Japanese hospitals. Postoperative overall survival was assessed over a 5-years period. The EPOS-CC score was established by selecting significant variables in a uni- and multivariate analysis and allocating a risk-adjusted multiplication factor to each variable using Cox regression analysis. For validation, the EPOS-CC score was compared to the predictive power of UICC stage. Inter-hospital variability of the observed-to-estimated 5-years survival was assessed to estimate quality of care. RESULTS: Among the 889 @entity1 , 804 (90  %) completed the 5-years follow-up. Univariate analysis displayed a significant correlation with 5-years survival for 14 physiological and nine @entity5 -related variables (p  <  0.005). Highly significant p-values below 0.0001 were found for age, ASA score, severe @entity358 , respiratory history, performance status, @entity4988 , alteration of hemoglobin, serum @entity1372 level, and for all histological variables except @entity5 location. Age, @entity2802 stage, lymphatic invasion, performance status, and serum @entity1372 level were independent variables in the multivariate analysis and were entered the EPOS-CC model for the prediction of survival. Risk-adjusted multiplication factors between 1.5 (distant metastasis) and 0.16 (serum @entity1372 level) were accorded to the different variables. The predictive power of EPOS-CC was superior to the one of UICC stage; area under the curve 0.87, 95  % CI 0.85-0.90 for EPOS-CC, and 0.80, 0.76-0.83 for UICC stage, p  <  0.001. Quality of care did not differ between hospitals. CONCLUSIONS: The EPOS-CC score including the independent variables age, performance status, serum @entity1372 level, @entity2802 stage, and lymphatic invasion is superior to the UICC stage in the prediction of 5-years overall survival. This higher accuracy might be explained by the inclusion of physiological factors, thus also taking non- @entity5 -associated deaths into account. Furthermore, EPOS-CC score may compare quality of care among different institutions. Future studies are necessary to further evaluate this score and help improving the prediction of long-term survival following @entity14 surgery.
