Division of Biostatistics, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Neuro Oncol. 2010 Feb;12(2):164-72. doi: 10.1093/neuonc/nop019. Epub 2009 Dec 21.
The purpose of this study is to determine prognostic factors in patients with high-grade recurrent glioma for 3 outcome variables (overall survival, progression-free survival [PFS], and PFS rate 6 months after study registration [PFS6]). Data from 15 North Central Cancer Treatment Group (NCCTG) trials (n = 469, 1980-2004) and 12 North American Brain Tumor Consortium (NABTC) trials (n = 596, 1998-2002) were included. Eighteen prognostic variables were considered including type of treatment center (community/academic) and initial low-grade histology (yes/no). Recursive partitioning analysis (RPA), Cox proportional hazards, and logistic regression models with bootstrap resampling were used to identify prognostic variables. Longer survival was associated with last known grade (Grade) of III, younger age, ECOG performance score (PS) of 0, shorter time from initial diagnosis (DxTime), and no baseline steroid use. Factors associated with longer PFS were Grade III and shorter DxTime. For patients without temozolomide as part of the treatment regimen, the only factor associated with better PFS6 was Grade III, although DxTime was important in RPA and PS was important in logistic regression. Grade was the most important prognostic factor for all three endpoints regardless of the statistical method used. Other important variables for one or more endpoints included age, PS, and DxTime. Neither type of treatment center nor initial low-grade histology was identified as a major predictor for any endpoint.
本研究旨在确定高级别复发性神经胶质瘤患者的预后因素，针对 3 个结局变量（总生存、无进展生存[PFS]和研究登记后 6 个月的 PFS[PFS6]）。共纳入了来自 15 项美国北部癌症治疗协作组（NCCTG）试验（n = 469，1980-2004 年）和 12 项北美脑肿瘤协作组（NABTC）试验（n = 596，1998-2002 年）的数据。共考虑了 18 个预后因素，包括治疗中心类型（社区/学术）和初始低级别组织学（是/否）。采用递归分区分析（RPA）、Cox 比例风险和逻辑回归模型进行了预后因素分析，模型中采用了自举重采样。最后已知的分级（Grade）、年龄较小、ECOG 表现评分（PS）为 0、初始诊断到疾病进展时间（DxTime）较短和基线无类固醇使用与更长的生存时间相关。与更长的 PFS 相关的因素是 Grade III 和较短的 DxTime。对于未将替莫唑胺作为治疗方案一部分的患者，唯一与更好的 PFS6 相关的因素是 Grade III，尽管 DxTime 在 RPA 中很重要，PS 在逻辑回归中很重要。无论使用何种统计方法，分级都是所有三个结局的最重要预后因素。对于一个或多个结局重要的其他变量包括年龄、PS 和 DxTime。治疗中心类型或初始低级别组织学都未被确定为任何结局的主要预测因素。
