Botsis Taxiarchis, Anagnostou Valsamo K, Hartvigsen Gunnar, Hripcsak George, Weng Chunhua
Department of Biomedical Informatics, Columbia University, New York, NY, USA.
Appl Clin Inform. 2010;1(1):38-49. doi: 10.4338/ACI-2009-12-RA-0026.
Current staging systems are not accurate for classifying pancreatic endocrine tumors (PETs) by risk. Here, we developed a prognostic model for PETs and compared it to the WHO classification system. METHODS: We identified 98 patients diagnosed with PET at NewYork-Presbyterian Hospital/Columbia University Medical Center (1999 to 2009). Tumor and clinical characteristics were retrieved and associations with survival were assessed by univariate Cox analysis. A multivariable model was constructed and a risk score was calculated; the prognostic strength of our model was assessed with the concordance index. RESULTS: Our cohort had median age of 60 years and consisted of 61.2% women; median follow-up time was 10.4 months (range: 0.1-99.6) with a 5-year survival of 61.5%. The majority of PETs were non-functional and no difference was observed between functional and non-functional tumors with respect to WHO stage, age, pathologic characteristics or survival. Distant metastases, aspartate aminotransferase-AST and surgical resection (HR=3.39, 95% CI: 1.38-8.35, p=0.008, HR=3.73, 95% CI: 1.20-11.57, p=0.023 and HR=0.20, 95% CI: 0.08-0.51, p<0.001 respectively) were the strongest predictors in the univariate analysis. Age, perineural and/or lymphovascular invasion, distant metastases and AST were the independent prognostic factors in the final multivariable model; a risk score was calculated and classified patients into low (n=40), intermediate (n=48) and high risk (n=10) groups. The concordance index of our model was 0.93 compared to 0.72 for the WHO system. CONCLUSION: Our prognostic model was highly accurate in stratifying patients by risk; novel approaches as such could thus be incorporated into clinical decisions.
当前的分期系统在根据风险对胰腺内分泌肿瘤（PETs）进行分类方面并不准确。在此，我们开发了一种PETs的预后模型，并将其与世界卫生组织（WHO）分类系统进行比较。方法：我们确定了98例在纽约长老会医院/哥伦比亚大学医学中心被诊断为PET的患者（1999年至2009年）。收集肿瘤和临床特征，并通过单变量Cox分析评估与生存的相关性。构建多变量模型并计算风险评分；使用一致性指数评估我们模型的预后强度。结果：我们的队列中位年龄为60岁，女性占61.2%；中位随访时间为10.4个月（范围：0.1 - 99.6），5年生存率为61.5%。大多数PETs无功能，在WHO分期、年龄、病理特征或生存方面，功能性和无功能性肿瘤之间未观察到差异。远处转移、天冬氨酸转氨酶（AST）和手术切除（HR = 3.39，95% CI：1.38 - 8.35，p = 0.008；HR = 3.73，95% CI：1.20 - 11.57，p = 0.023；HR = 0.20，95% CI：0.08 - 0.51，p < 0.001）分别是单变量分析中最强的预测因素。年龄、神经周和/或淋巴管侵犯、远处转移和AST是最终多变量模型中的独立预后因素；计算风险评分并将患者分为低风险（n = 40）、中风险（n = 48）和高风险（n = 10）组。我们模型的一致性指数为0.93，而WHO系统为0.72。结论：我们的预后模型在按风险对患者进行分层方面高度准确；这样的新方法因此可以纳入临床决策。
