Walz Jochen, Gallina Andrea, Perrotte Paul, Jeldres Claudio, Trinh Quoc-Dien, Hutterer Georg C, Traumann Miriam, Ramirez Alvaro, Shariat Shahrokh F, McCormack Michael, Perreault Jean-Paul, Bénard Francois, Valiquette Luc, Saad Fred, Karakiewicz Pierre I
Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, Quebec, Canada.
BJU Int. 2007 Dec;100(6):1254-8. doi: 10.1111/j.1464-410X.2007.07130.x.
To test the accuracy of predicting life-expectancy (LE) among 19 raters, as the accurate prediction of LE in candidates for definitive therapy for localized prostate cancer is crucial, and little is known of the ability of clinicians to predict LE.
We randomly selected the case-vignettes of 50 patients treated with either radical prostatectomy (RP, 25) or external beam radiotherapy (EBRT, 25) for prostate cancer, and who either survived for > 10 years or died earlier with no evidence of disease relapse. The median age at treatment was 67 years and the median Charlson Comorbidity Index (CCI) was 2. The raters consisted of urology staff (six), urology residents (10) and medical students (three). The case-vignettes included patient age, comorbidities and CCI score, and raters were asked to predict the survival at 10 years (yes vs no), assuming no disease relapse.
Of the 50 cases, 20 (40%) did not survive for > 10 years; clinicians estimated a mean (range) of 23 (10-35) deaths before 10 years. The mean (95% confidence interval) overall predictive accuracy (0.5 = chance, 1.0 = perfect prediction) of LE predictions was 0.68 (0.64-0.71). Individual accuracy ranged from 0.52 (staff) to 0.78 (staff). There were no important differences among the rater groups (residents 0.69 vs staff 0.67 vs medical students 0.67).
Clinicians are relatively poor at predicting LE; tools to predict LE might be able to improve clinicians' performance in this important part of decision-making about prostate cancer treatment. It remains to be determined whether this limitation exclusively applies to prostate cancer or also to other malignancies.
测试19名评估者预测预期寿命（LE）的准确性，因为准确预测局限性前列腺癌确定性治疗候选者的预期寿命至关重要，而临床医生预测预期寿命的能力鲜为人知。
我们随机选取了50例接受前列腺癌根治术（RP，25例）或外照射放疗（EBRT，25例）治疗的患者的病例 vignettes，这些患者要么存活超过10年，要么早期死亡且无疾病复发证据。治疗时的中位年龄为67岁，中位查尔森合并症指数（CCI）为2。评估者包括泌尿外科工作人员（6名）、泌尿外科住院医师（10名）和医学生（3名）。病例 vignettes 包括患者年龄、合并症和CCI评分，要求评估者在假设无疾病复发的情况下预测10年生存率（是与否）。
在50例病例中，20例（40%）未存活超过10年；临床医生估计10年前平均（范围）有23例（10 - 35例）死亡。LE预测的总体预测准确性（0.5 = 随机概率，1.0 = 完美预测）的平均值（95%置信区间）为0.68（0.64 - 0.71）。个体准确性范围从0.52（工作人员）到0.78（工作人员）。评估者组之间无重要差异（住院医师0.69 vs 工作人员0.67 vs 医学生0.67）。
临床医生在预测LE方面相对较差；预测LE的工具可能能够改善临床医生在前列腺癌治疗这一重要决策环节中的表现。这种局限性是否仅适用于前列腺癌还是也适用于其他恶性肿瘤仍有待确定。
