Abstract
ObjectiveThe potential risk of postoperative morbidity is important for gynecologic cancer patients because it leads to delays in adjunctive therapy and additional costs. We aimed to develop a preoperative nomogram to predict 30-day morbidity after gynecological cancer surgery.MethodsBetween 2005 and 2015, 533 consecutive patients with elective gynecological cancer surgery in our center were reviewed. Of those patients, 373 and 160 patients were assigned to the model development or validation cohort, respectively. To investigate independent predictors of 30-day morbidity, a multivariate Cox regression model with backward stepwise elimination was utilized. A nomogram based on this Cox model was developed and externally validated. Its performance was assessed using the concordance index and a calibration curve.ResultsNinety-seven (18.2%) patients had at least one postoperative complication within 30 days after surgery. After bootstrap resampling, the final model indicated age, operating time, and serum albumin level as statistically significant predictors of postoperative morbidity. The bootstrap-corrected concordance index of the nomogram incorporating these three predictors was 0.656 (95% CI, 0.608–0.723). In the validation cohort, the nomogram showed fair discrimination [concordance index: 0.674 (95% CI = 0.619–0.732] and good calibration (P = 0.614; Hosmer-Lemeshow test).ConclusionThe 30-day morbidity after gynecologic cancer surgery could be predicted according to age, operation time, and serum albumin level. After further validation using an independent dataset, the constructed nomogram could be valuable for predicting operative risk in individual patients.
Highlights
In 2014, an estimated 94,990 gynecologic cancer cases, including uterine corpus, ovarian, and cervix cancers, were diagnosed in the USA [1]
The bootstrap-corrected concordance index of the nomogram incorporating these three predictors was 0.656
The nomogram showed fair discrimination [concordance index: 0.674 (95% CI = 0.619–0.732] and good calibration (P = 0.614; Hosmer-Lemeshow test)
Summary
In 2014, an estimated 94,990 gynecologic cancer cases, including uterine corpus, ovarian, and cervix cancers, were diagnosed in the USA [1]. In Korea, the incidence of gynecological cancer was over 7,400 cases in 2010 [2]. For the vast majority of gynecological cancer patients, the primary treatment was surgery. Depending on the primary site and the extent of the surgical procedures, several studies have estimated morbidity rates after gynecologic cancer surgeries to range from 13% and 86% [3,4,5]. Postoperative morbidity is an undesirable but critical issue for both clinicians and gynecologic cancer patients. It may cause delays in subsequent chemotherapy or radiotherapy. It considerably escalates the cost of postoperative management [6]. It is important to preoperatively identify the subgroup that has a higher risk of morbidity after gynecologic cancer surgery
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