Department of Oncology, Johns Hopkins University, Baltimore, MD, USA.
Semin Oncol. 2010 Feb;37(1):39-46. doi: 10.1053/j.seminoncol.2009.12.005.
Two Web-based prognostic calculators (Adjuvant! and Numeracy) are widely used to individualize decisions regarding adjuvant therapy among patients with resected stage II and III colon cancer. However, these tools have not been directly compared. Hypothetical scenarios were formulated for the Numeracy calculator based on all potential combinations of age, lymph nodes status, tumor stage, and grade of tumor. These were then applied to three postsurgical therapy choices: observation, 5-fluorouracil (5-FU), or FOLFOX (5-FU, leucovorin, and oxaliplatin chemotherapy) to obtain the predicted 5-year disease-free survival (DFS) and overall survival (OS). Wilcoxon signed rank tests were used to compare the numerical predictions between the Adjuvant! and Numeracy calculators for each combination. A total of 192 hypothetical patient scenarios were obtained. For these patients, DFS and OS predictions from Adjuvant! were statistically significantly different than Numeracy (P <.05), except for four of 144 categories. While the estimated benefit in DFS and OS for 5-FU compared to surgery obtained from Adjuvant! and Numeracy were similar, the benefit in DFS and OS for FOLFOX over 5-FU, obtained from the Adjuvant! tool was slightly lower than that estimated from Numeracy. Among patients with resected stage II and III colon cancer, the DFS and OS estimates obtained from Numeracy and Adjuvant!, regarding the benefit of 5-FU over surgery, are similar, but the benefits of FOLFOX over 5-FU differ. Validation studies are needed to clarify the discrepancy and to assess the accuracy of these tools for predicting actual patient outcomes.
两种基于网络的预后计算器（Adjuvant! 和 Numeracy）广泛用于针对 II 期和 III 期结肠癌患者的辅助治疗决策进行个体化。然而，这些工具尚未进行直接比较。根据年龄、淋巴结状态、肿瘤分期和肿瘤分级的所有潜在组合，为 Numeracy 计算器制定了假设情况。然后，将这些情况应用于三种术后治疗选择：观察、5-氟尿嘧啶（5-FU）或 FOLFOX（5-FU、亚叶酸和奥沙利铂化疗），以获得预测的 5 年无病生存率（DFS）和总生存率（OS）。Wilcoxon 符号秩检验用于比较每个组合中 Adjuvant! 和 Numeracy 计算器的数值预测。共获得 192 个假设患者情况。对于这些患者，Adjuvant! 的 DFS 和 OS 预测与 Numeracy 有统计学显著差异（P <.05），除了 144 个类别中的 4 个。虽然 Adjuvant! 和 Numeracy 获得的 5-FU 与手术相比的 DFS 和 OS 估计获益相似，但 Adjuvant! 工具获得的 FOLFOX 与 5-FU 相比的 DFS 和 OS 获益略低于 Numeracy 估计的获益。在接受 II 期和 III 期结肠癌切除的患者中，Numeracy 和 Adjuvant! 获得的关于 5-FU 优于手术的 DFS 和 OS 估计值相似，但 FOLFOX 优于 5-FU 的获益不同。需要验证研究来阐明差异，并评估这些工具预测实际患者结局的准确性。
