Department of radiation oncology, University Medical Centre Utrecht, HP Q00.118, Postbus 85500, 3508 GA, Utrecht, The Netherlands,
Strahlenther Onkol. 2013 Dec;189(12):1009-14. doi: 10.1007/s00066-013-0467-2. Epub 2013 Nov 8.
The aim of our study was to assess the prognostic value of tumor volume compared to and in addition to T-stage on local control (LC), disease-free survival (DFS), and overall survival (OS) in glottic and supraglottic laryngeal carcinoma patients.
In 150 patients, we determined tumor volume on diagnostic CT scans. We applied crude and multivariable Cox regression analysis to relate volume (continuous), T-stage and the combination to 5-year DFS, OS, and LC. Before, we examined the linearity assumption of the association between volume and outcome with restricted cubic spline functions. Prognostic performance of the models was examined by determination of the model's discrimination. Discriminative ability was determined with the C statistic referring to the ability to discriminate between patients who do and do not develop an event during follow-up.
A strong association between tumor volume and DFS and OS was found. The restricted cubic spline plot did not indicate a non-linear relationship between tumor volume and DFS and local control. Tumor volume demonstrated a better discriminative ability to predict DFS and OS compared to T-stage (0.68 and 0.57 vs. 0.59 and 0.54, respectively). For local control, T-stage showed a higher discriminative ability than tumor volume (0.63 vs. 0.61). The combined model increased discriminative power (0.69).
Volume seems to be more important than T-stage in prediction of DFS or OS in laryngeal squamous cell carcinoma patients. Perhaps prediction of DFS, OS, and LC could be improved by including tumor volume into the staging process.
我们研究的目的是评估肿瘤体积相对于 T 分期以及在声门和喉上部鳞状细胞癌患者的局部控制（LC）、无病生存（DFS）和总生存（OS）中的预后价值。
在 150 例患者中，我们在诊断 CT 扫描上确定肿瘤体积。我们应用粗和多变量 Cox 回归分析将体积（连续）、T 分期和组合与 5 年 DFS、OS 和 LC 相关联。在这之前，我们用限制立方样条函数来检验体积与结局之间关联的线性假设。通过确定模型对随访中是否发生事件的区分能力来检验模型的预测性能。区分能力通过 C 统计量来确定，该统计量表示区分患者是否发生事件的能力。
肿瘤体积与 DFS 和 OS 之间存在很强的相关性。限制立方样条图未表明肿瘤体积与 DFS 和局部控制之间存在非线性关系。与 T 分期相比，肿瘤体积在预测 DFS 和 OS 方面表现出更好的区分能力（0.68 和 0.57 与 0.59 和 0.54 相比）。对于局部控制，T 分期的区分能力高于肿瘤体积（0.63 与 0.61 相比）。联合模型提高了区分能力（0.69）。
在预测喉鳞状细胞癌患者的 DFS 或 OS 方面，体积似乎比 T 分期更重要。或许通过将肿瘤体积纳入分期过程可以提高 DFS、OS 和 LC 的预测能力。
