title: Predicting death from surgery for lung cancer: A comparison of two scoring systems in two European countries.
abstract: OBJECTIVE
  Current British guidelines advocate the use of risk prediction scores such as Thoracoscore to estimate mortality prior to radical surgery for non-small cell lung cancer (NSCLC). A recent publication used the National Lung Cancer Audit (NLCA) to produce a score to predict 90 day mortality (NLCA score). The aim of this study is to validate the NLCA score, and compare its performance with Thoracoscore.
  
  
  METHODS
  We performed an internal validation using 2858 surgical patients from NLCA and an external validation using 3191 surgical patients from the Danish Lung Cancer Registry (DLCR). We calculated the proportion that died within 90 days of surgery. The discriminatory power of both scores was assessed by a receiver operating characteristic (ROC) and an area under the curve (AUC) calculation.
  
  
  RESULTS
  Ninety day mortality was 5% in both groups. AUC values for internal and external validation of NLCA score and validation of Thoracoscore were 0.68 (95% CI 0.63-0.72), 0.60 (95% CI 0.56-0.65) and 0.60 (95% CI 0.54-0.66) respectively. Post-hoc analysis was performed using NLCA records on 15554 surgical patients to derive summary tables for 30 and 90 day mortality, stratified by procedure type, age and performance status.
  
  
  CONCLUSIONS
  Neither score performs well enough to be advocated for individual risk stratification prior to lung cancer surgery. It may be that additional physiological parameters are required; however this is a further project. In the interim we propose the use of our summary tables that provide the real-life range of mortality for lobectomy and pneumonectomy.
authors.affiliation: Division of Public Health and Epidemiology, Clinical Sciences Building, Nottingham City Campus, Hucknall Road, Nottingham NG5 1PB, United Kingdom. Electronic address: emma.odowd@nottingham.ac.uk.
authors.forename: Emma L
authors.initials: EL
authors.lastname: O'Dowd
authors.affiliation: Division of Cancer Epidemiology and Population Health, King's College London, 3rd Floor, Bermondsey Wing, Guy's Hospital, London, United Kingdom.
authors.forename: Margreet
authors.initials: M
authors.lastname: Lüchtenborg
authors.affiliation: Department of Respiratory Medicine, David Evans Building, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, United Kingdom.
authors.forename: David R
authors.initials: DR
authors.lastname: Baldwin
authors.affiliation: Division of Public Health and Epidemiology, Clinical Sciences Building, Nottingham City Campus, Hucknall Road, Nottingham NG5 1PB, United Kingdom.
authors.forename: Tricia M
authors.initials: TM
authors.lastname: McKeever
authors.affiliation: Division of Public Health and Epidemiology, Clinical Sciences Building, Nottingham City Campus, Hucknall Road, Nottingham NG5 1PB, United Kingdom.
authors.forename: Helen A
authors.initials: HA
authors.lastname: Powell
authors.affiliation: Division of Cancer Epidemiology and Population Health, King's College London, 3rd Floor, Bermondsey Wing, Guy's Hospital, London, United Kingdom.
authors.forename: Henrik
authors.initials: H
authors.lastname: Møller
authors.affiliation: Department of Thoracic Surgery, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark.
authors.forename: Erik
authors.initials: E
authors.lastname: Jakobsen
authors.affiliation: Division of Public Health and Epidemiology, Clinical Sciences Building, Nottingham City Campus, Hucknall Road, Nottingham NG5 1PB, United Kingdom.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Hubbard
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis* / Q000401:mortality* / Q000601:surgery; D015897:Comorbidity; D016208:Databases, Factual; D003718:Denmark / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000401:mortality* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy; D011379:Prognosis; D012372:ROC Curve; D012042:Registries; D015203:Reproducibility of Results; D012129:Respiratory Function Tests
keywords: Lung cancer; Mortality; Thoracic surgery; Validation study