title: The PER (Preoperative Esophagectomy Risk) Score: A Simple Risk Score to Predict Short-Term and Long-Term Outcome in Patients with Surgically Treated Esophageal Cancer.
abstract: Esophageal resection in patients with esophageal cancer (EC) is still associated with high mortality and morbidity rates. We aimed to develop a simple preoperative risk score for the prediction of short-term and long-term outcomes for patients with EC treated by esophageal resection. In total, 498 patients suffering from esophageal carcinoma, who underwent esophageal resection, were included in this retrospective cohort study. Three preoperative esophagectomy risk (PER) groups were defined based on preoperative functional evaluation of different organ systems by validated tools (revised cardiac risk index, model for end-stage liver disease score, and pulmonary function test). Clinicopathological parameters, morbidity, and mortality as well as disease-free survival (DFS) and overall survival (OS) were correlated to the PER score. The PER score significantly predicted the short-term outcome of patients with EC who underwent esophageal resection. PER 2 and PER 3 patients had at least double the risk of morbidity and mortality compared to PER 1 patients. Furthermore, a higher PER score was associated with shorter DFS (P < 0.001) and OS (P < 0.001). The PER score was identified as an independent predictor of tumor recurrence (hazard ratio [HR] 2.1; P < 0.001) and OS (HR 2.2; P < 0.001). The PER score allows preoperative objective allocation of patients with EC into different risk categories for morbidity, mortality, and long-term outcomes. Thus, multicenter studies are needed for independent validation of the PER score.
authors.affiliation: From the Departments of General, Visceral and Thoracic Surgery (MR, JM, FGU, MN, TG, MB, JRI, YKV) and Department of Intensive Care (SK), University Medical Centre Hamburg-Eppendorf, University of Hamburg, Hamburg; and Departments of General, Visceral and Thoracic Surgery (UW), University Hospital Schleswig-Holstein, Campus Lübeck, University of Lübeck, Lübeck, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Reeh
authors.forename: Johannes
authors.initials: J
authors.lastname: Metze
authors.forename: Faik G
authors.initials: FG
authors.lastname: Uzunoglu
authors.forename: Michael
authors.initials: M
authors.lastname: Nentwich
authors.forename: Tarik
authors.initials: T
authors.lastname: Ghadban
authors.forename: Ullrich
authors.initials: U
authors.lastname: Wellner
authors.forename: Maximilian
authors.initials: M
authors.lastname: Bockhorn
authors.forename: Stefan
authors.initials: S
authors.lastname: Kluge
authors.forename: Jakob R
authors.initials: JR
authors.lastname: Izbicki
authors.forename: Yogesh K
authors.initials: YK
authors.lastname: Vashist
mesh_terms: D000367:Age Factors; D000368:Aged; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000401:mortality*; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D016019:Survival Analysis