Birim Ozcan, Kappetein A Pieter, Waleboer Marco, Puvimanasinghe John P A, Eijkemans Marinus J C, Steyerberg Ewout W, Versteegh Michel I M, Bogers Ad J J C
Department of Cardio-Thoracic Surgery, Erasmus MC, Rotterdam, The Netherlands.
J Thorac Cardiovasc Surg. 2006 Sep;132(3):491-8. doi: 10.1016/j.jtcvs.2006.04.010.
At present, there is no prognostic model that is specific for prediction of survival after non-small cell lung cancer surgery. We aimed to develop a prognostic model that can be used to estimate the postoperative survival of individual patients.
A total of 766 patients underwent resection for primary non-small cell lung cancer. Comorbid conditions were scaled according to the Charlson comorbidity index (CCI). Cox proportional hazard analyses were used to determine risk factors for survival. A prognostic model for survival with a preoperative and postoperative mode was established. Performance of the prognostic model, the CCI, and pathologic tumor stage were quantified by a concordance statistic to indicate discriminative ability.
The factors associated with an impaired survival were male sex, age, chronic obstructive pulmonary disease, congestive heart failure, any prior tumor, moderate-to-severe renal disease (preoperative and postoperative mode), clinical tumor stage (preoperative mode), type of resection, and pathologic tumor stage (postoperative mode). The discriminative performance was poor for the CCI (c = 0.55), better for pathologic tumor stage (c = 0.60) and for the preoperative mode (c = 0.61), and best for the postoperative mode (c = 0.65). The discriminative performance of the postoperative mode was better than the discriminative performance of the CCI (P < .0001), the preoperative mode (P < .0002), and pathologic tumor stage (P < .0001). The discriminative performance of the preoperative mode was better than the discriminative performance of the CCI (P < .0001) and similar (P = .90) to a model that only included pathologic tumor stage.
The prognostic model, particularly the postoperative mode, successfully estimates long-term survival of individual patients and could help clinicians in clinical decision-making and treatment tailoring.
目前，尚无专门用于预测非小细胞肺癌手术后生存情况的预后模型。我们旨在开发一种可用于估计个体患者术后生存情况的预后模型。
共有766例患者接受了原发性非小细胞肺癌切除术。根据Charlson合并症指数（CCI）对合并症进行评分。采用Cox比例风险分析来确定生存的危险因素。建立了术前和术后模式的生存预后模型。通过一致性统计量对预后模型、CCI和病理肿瘤分期的性能进行量化，以表明其判别能力。
与生存受损相关的因素包括男性、年龄、慢性阻塞性肺疾病、充血性心力衰竭、任何既往肿瘤、中重度肾病（术前和术后模式）、临床肿瘤分期（术前模式）、切除类型和病理肿瘤分期（术后模式）。CCI的判别性能较差（c = 0.55），病理肿瘤分期（c = 0.60）和术前模式（c = 0.61）较好，术后模式最佳（c = 0.65）。术后模式的判别性能优于CCI（P <.0001）、术前模式（P <.0002）和病理肿瘤分期（P <.0001）。术前模式的判别性能优于CCI（P <.0001），且与仅包括病理肿瘤分期的模型相似（P =.90）。
该预后模型，尤其是术后模式，成功地估计了个体患者的长期生存情况，并有助于临床医生进行临床决策和制定个体化治疗方案。
