Assessment of Risk Prediction Model for 90-Day Mortality After Esophagectomy for Cancer

Investigators sought to develop and validate a risk prediction model for death within 90 days after esophagectomy for cancer, utilizing the IESG database

The International Esodata Study Group (IESG) risk prediction model allowed stratification of an individual’s risk for death within 90 days following esophagectomy for cancer, according to study results published in JAMA Surgery. These findings suggest that this model can aid in the decision-making process when esophageal cancer surgery is being considered and in providing informed consent.

A number of risk prediction models for mortality after esophagectomy have been developed. However, most models were not designed to predict death within 90 days. In addition, clinical application of these preexisting models remains limited due to low performance, poor discrimination, absence of certain pivotal variables, and lack of proper validation studies.

In this diagnostic/prognostic study, investigators sought to develop and validate a risk prediction model for death within 90 days after esophagectomy for cancer, utilizing the IESG database. This database is the largest existing prospective, multicenter collection of data reporting on standardized postoperative outcomes. Between January 1, 2015, and December 31, 2019, the researchers performed a retrospective analysis of patients from 39 institutions in 19 countries.

Patients with esophageal cancer (N=8403) were randomly assigned to development (n=4172) and validation (n=4231) cohorts. Based on logistic regression β coefficients, a scoring system that predicted death within 90 days was conducted. The final prognostic score was determined and patients were categorized according to the integer of their final score into homogenous risk groups that predicted death within 90 days. Between cohorts, calibration and discriminations tests were evaluated. The primary outcome of the study was all-cause postoperative 90-day mortality.

The mean age of the study participants was approximately 63.6 (SD, 9.0) years and the majority were men (79.0%). The researchers found that 164 patients (2.0%) died within 30 days and 353 patients (4.2%) died within 90 days.

The multiple logistic regression model revealed that 10 weighted point variables factored into the prognostic score: age, sex, body mass index, performance status, myocardial infarction, connective tissue disease, peripheral vascular disease, liver disease, neoadjuvant treatment, and hospital volume.

The prognostic scores were categorized into 5 different risk groups: very low risk (score >1; 90-day mortality, 1.8%), low risk (score 0; 90-day mortality, 3.0%), medium risk (score –1 to –2; 90-day mortality, 5.8%), high risk (score −3 to −4; 90-day mortality, 8.9%), and very high risk (score < −5; 90-day mortality, 18.2%).

According to investigators, the discrimination (area under the receiver operating characteristic curve) was 0.68 (95% CI, 0.64-0.72) in the development cohort and 0.64 (95% CI, 0.60-0.69) in the validation cohort.

This study is not without limitations. The results were confined to the strict framework of the Esodata. Therefore, researchers could not conduct in-depth analysis.    

“On the basis of a prospectively collected, large, contemporary data set and on preoperative variables combining clinical, demographic, and hospital volume data, the proposed IESG risk prediction model allows for stratification of individual patient risk of death within 90 days after esophagectomy for cancer,” the study authors wrote.

Disclosure: Some study authors declared affiliations with the industry. Please see the original reference for a full list of authors’ disclosures.

Disclosure: This research was supported by the Marseille Research Thoracic Oncology Foundation. Please see the original reference for a full list of disclosures.


D’Journo XB, Boulate D, Fourdrain A, et al. Risk prediction model of 90-day mortality after esophagectomy for cancer. JAMA Surg. Published online June 23, 2021. doi:10.1001/jamasurg.2021.2376