title: Evaluation of the POSSUM, p-POSSUM, o-POSSUM, and APACHE II scoring systems in predicting postoperative mortality and morbidity in gastric cancer patients.
abstract: OBJECTIVE
  Gastric cancer is the fourth most prevalent cancer worldwide. The ability to accurately predict surgery-related morbidity and mortality is critical in deciding both the timing of surgery and choice of surgical procedure. The aim of this study is to compare the POSSUM, p-POSSUM, o-POSSUM, and APACHE II scoring systems for predicting surgical morbidity and mortality in Chinese gastric cancer patients, as well as to create new scoring systems to achieve better prediction.
  
  
  METHODS
  Data from 612 gastric cancer patients undergoing gastrectomy between January 2007 and December 2011 were included in this study. The predictive abilities of the four scoring systems were compared by examining observed-to-expected (O/E) ratios, the receiver operating characteristic curve, Student t test, and χ2test results.
  
  
  RESULTS
  The observed complication rate of 34% (n = 208) did not differ significantly from the rate of 36.6% (n = 208) predicted by the POSSUM scoring system (O/E ratio = 0.93). The observed mortality rate was 2.9% (n = 18). For predicting mortality, POSSUM had an O/E ratio of 0.34 as compared with p-POSSUM (O/E ratio = 0.91), o-POSSUM (O/E ratio = 1.26), and APACHE II (O/E ratio = 0.28).
  
  
  CONCLUSIONS
  The POSSUM scoring system performed well with respect to predicting morbidity risk following gastric cancer resection. For predicting postoperative mortality, p-POSSUM and o-POSSUM exhibited superior performance relative to POSSUM and APACHE II.
authors.affiliation: Department of Oncology Surgery, Anhui Provincial Cancer Hospital, Anhui Medical University, Anhui, China. Electronic address: ahhans2050@126.com.
authors.forename: Shikai
authors.initials: S
authors.lastname: Hong
authors.affiliation: Department of Oncology Surgery, Anhui Provincial Cancer Hospital, Anhui Medical University, Anhui, China.
authors.forename: Shengying
authors.initials: S
authors.lastname: Wang
authors.affiliation: Department of Radiation Oncology, Guangxi Zhuang Autonomous Region Tumor Hospital, Nanning, China.
authors.forename: Guozeng
authors.initials: G
authors.lastname: Xu
authors.affiliation: Department of Gastrointestinal, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
authors.forename: JinLu
authors.initials: J
authors.lastname: Liu
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D019540:Area Under Curve; D002423:Cause of Death; D002681:China; D015331:Cohort Studies; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods / Q000401:mortality*; D006305:Health Status Indicators; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013274:Stomach Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis; D055815:Young Adult
keywords: gastric cancer; morbidity; mortality; receiver operating characteristic curve; scoring systems