模型化 AUC（AFP-hCG）的预测价值，这是一个描述血清肿瘤标志物在非精原细胞瘤生殖细胞肿瘤患者中下降的动态动力学参数。

Predictive value of modeled AUC(AFP-hCG), a dynamic kinetic parameter characterizing serum tumor marker decline in patients with nonseminomatous germ cell tumor.

机构信息

Université de Lyon, Lyon, France.

出版信息

Urology. 2010 Aug;76(2):423-9.e2. doi: 10.1016/j.urology.2010.02.049. Epub 2010 May 15.

DOI:10.1016/j.urology.2010.02.049

PMID:20472276

Abstract

OBJECTIVE

The early decline profile of alpha-fetoprotein (AFP) and human chorionic gonadotropin (hCG) in patients with nonseminomatous germ cell tumors (NSGCT) treated with chemotherapy may be related to the risk of relapse. We assessed the predictive values of areas under the curve of hCG (AUC(hCG)) and AFP (AUC(AFP)) of modeled concentration-time equations on progression-free survival (PFS).

METHODS

Single-center retrospective analysis of hCG and AFP time-points from 65 patients with IGCCCG intermediate-poor risk NSGCT treated with 4 cycles of bleomycin-etoposide-cisplatin (BEP). To determine AUC(hCG) and AUC(AFP) for D0-D42, AUCs for D0-D7 were calculated using the trapezoid rule and AUCs for D7-D42 were calculated using the mathematic integrals of equations modeled with NONMEM. Combining AUC(AFP) and AUC(hCG) enabled us to define 2 predictive groups: namely, patients with favorable and unfavorable AUC(AFP-hCG). Survival analyses and ROC curves assessed the predictive values of AUC(AFP-hCG) groups regarding progression-free survival (PFS) and compared them with those of half-life (HL) and time-to-normalization (TTN).

RESULTS

Mono-exponential models best fit the patterns of marker decreases. Patients with a favorable AUC(AFP-hCG) had a significantly better PFS (100% vs 71.5%, P = .014). ROC curves confirmed the encouraging predictive accuracy of AUC(AFP-hCG) against HL or TTN regarding progression risk (ROC AUCs = 79.6 vs 71.9 and 70.2 respectively). Because of the large number of patients with missing data, multivariate analysis could not be performed.

CONCLUSION

AUC(AFP-hCG) is a dynamic parameter characterizing tumor marker decline in patients with NSGCT during BEP treatment. Its value as a promising predictive factor should be validated.

摘要

目的

化疗治疗非精原细胞瘤生殖细胞肿瘤（NSGCT）患者的甲胎蛋白（AFP）和人绒毛膜促性腺激素（hCG）早期下降情况可能与复发风险相关。我们评估了 hCG（AUC(hCG)) 和 AFP（AUC(AFP)) 的浓度-时间曲线下面积（AUC）模型对无进展生存期（PFS）的预测价值。

方法

对 65 例接受 4 周期博来霉素-依托泊苷-顺铂（BEP）治疗的 IGCCCG 中危-差风险 NSGCT 患者的 hCG 和 AFP 时间点进行单中心回顾性分析。为了确定 D0-D42 的 AUC(hCG) 和 AUC(AFP)，D0-D7 的 AUC 使用梯形法则计算，D7-D42 的 AUC 使用 NONMEM 模型方程的数学积分计算。结合 AUC(AFP) 和 AUC(hCG)，我们可以定义 2 个预测组：即，AUC(AFP-hCG）有利和不利的患者。生存分析和 ROC 曲线评估了 AUC(AFP-hCG)组对无进展生存期（PFS）的预测价值，并将其与半衰期（HL）和恢复正常时间（TTN）进行了比较。

结果

单指数模型最适合标志物下降的模式。AUC(AFP-hCG）有利的患者 PFS 显著更好（100%比 71.5%，P=0.014）。ROC 曲线证实 AUC(AFP-hCG）对 HL 或 TTN 对进展风险的预测准确性令人鼓舞（ROC AUC 分别为 79.6、71.9 和 70.2）。由于大量患者数据缺失，无法进行多变量分析。