Ng A K, Weeks J C, Mauch P M, Kuntz K M
Joint Center for Radiation Therapy and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
J Clin Oncol. 1999 Jan;17(1):241-52. doi: 10.1200/JCO.1999.17.1.241.
To perform a decision analysis that compared the life expectancy and quality-adjusted life expectancy of early-stage, favorable-prognosis Hodgkin's disease (HD) managed with and without staging laparotomy, incorporating data on treatment outcomes of HD in the modern era.
We constructed a decision-analytic model to compare laparotomy versus no laparotomy staging for a hypothetical cohort of 25-year-old patients with clinical stages I and II, favorable-prognosis HD. Markov models were used to simulate the lifetime clinical course of patients, whose prognosis depended on the true pathologic stage and initial treatment. The baseline probability estimates used in the model were derived from results of published studies. Quality-of-life adjustments for procedures and treatments, as well as the various long-term health states, were incorporated.
The life expectancy was 36.67 years for the laparotomy strategy and 35.92 years for no laparotomy, yielding a net expected benefit of 0.75 years for laparotomy staging. The corresponding quality-adjusted life expectancies for the two strategies were 35.97 and 35.38 quality-adjusted life years (QALYs), respectively, resulting in a net expected benefit of laparotomy staging of 0.59 QALYs. Sensitivity analysis showed that the decision of laparotomy versus no laparotomy was most heavily influenced by the quality-of-life weight assigned to the postlaparotomy state.
Our model predicted that on average, for a 25-year-old patient, proceeding with staging laparotomy resulted in a gain in life expectancy of 9 months, or 7 quality-adjusted months. These results suggest that a role remains for surgical staging in the management of early-stage HD.
进行一项决策分析，比较采用和不采用分期剖腹术治疗的早期、预后良好的霍奇金淋巴瘤（HD）患者的预期寿命和质量调整预期寿命，并纳入现代HD治疗结果的数据。
我们构建了一个决策分析模型，以比较剖腹术分期与非剖腹术分期对一组假设的25岁临床I期和II期、预后良好的HD患者的影响。采用马尔可夫模型模拟患者的终生临床病程，其预后取决于真正的病理分期和初始治疗。模型中使用的基线概率估计值来自已发表研究的结果。纳入了手术和治疗以及各种长期健康状态的生活质量调整。
剖腹术策略的预期寿命为36.67年，非剖腹术为35.92年，剖腹术分期的净预期益处为0.75年。两种策略相应的质量调整预期寿命分别为35.97和35.38质量调整生命年（QALY），剖腹术分期的净预期益处为0.59 QALY。敏感性分析表明，剖腹术与非剖腹术的决策受剖腹术后状态生活质量权重的影响最大。
我们的模型预测，平均而言，对于一名25岁的患者，进行分期剖腹术可使预期寿命增加9个月，或质量调整增加7个月。这些结果表明，手术分期在早期HD的治疗中仍有作用。
