Rehabilitation Services, St. Jude Children's Research Hospital, Memphis, Tennessee; School of Communication Sciences and Disorders, University of Memphis, Memphis, Tennessee.
Pediatr Blood Cancer. 2014 Apr;61(4):601-5. doi: 10.1002/pbc.24830. Epub 2013 Nov 1.
Reporting ototoxicity is frequently complicated by use of various ototoxicity criteria. The International Society of Pediatric Oncology (SIOP) ototoxicity grading scale was recently proposed for standardized use in reporting hearing loss outcomes across institutions. The aim of this study was to evaluate the concordance between the Chang and SIOP ototoxicity grading scales. Differences between the two scales were identified and the implications these differences may have in the clinical setting were discussed.
Audiological evaluations were reviewed for 379 patients with newly diagnosed medulloblastoma (ages 3-21 years). Each patient was enrolled on one of two St. Jude clinical protocols that included craniospinal radiation therapy and four courses of 75 mg/m(2) cisplatin chemotherapy. The latest audiogram conducted 5.5-24.5 months post-protocol treatment initiation was graded using the Chang and SIOP ototoxicity criteria. Clinically significant hearing loss was defined as Chang grade ≥2a and SIOP ≥2. Hearing loss was considered serious (requiring a hearing aid) at the level of Chang grade ≥2b and SIOP ≥3.
A strong concordance was observed between the Chang and SIOP ototoxicity scales (Stuart's tau-c statistic = 0.89, 95% CI: 0.86, 0.91). Among those patients diagnosed with serious hearing loss, the two scales were in good agreement. However, the scales deviated from one another in classifying patients with less serious or no hearing loss.
Although discrepancies between the Chang and SIOP ototoxicity scales exist primarily for patients with no or minimal hearing loss, the scales share a strong concordance overall.
报道耳毒性通常因使用各种耳毒性标准而变得复杂。最近，国际小儿肿瘤学会（SIOP）提出了耳毒性分级标准，以便在各机构报告听力损失结果时进行标准化使用。本研究旨在评估 Chang 和 SIOP 耳毒性分级标准之间的一致性。确定了这两种标准之间的差异，并讨论了这些差异在临床环境中可能产生的影响。
对 379 例新诊断为髓母细胞瘤（年龄 3-21 岁）的患者进行了听力评估回顾。每位患者均参加了两项圣裘德临床方案之一，其中包括全脑脊髓放疗和四疗程 75mg/m2顺铂化疗。在方案治疗开始后 5.5-24.5 个月进行最新听力图检查，根据 Chang 和 SIOP 耳毒性标准进行分级。Chang 分级≥2a 和 SIOP≥2 定义为临床显著听力损失。Chang 分级≥2b 和 SIOP≥3 定义为严重听力损失（需要助听器）。
Chang 和 SIOP 耳毒性分级标准之间存在很强的一致性（Stuart's tau-c 统计量=0.89，95%CI：0.86，0.91）。在诊断为严重听力损失的患者中，两种标准具有良好的一致性。然而，在分类无或轻度听力损失的患者时，两种标准存在差异。
尽管 Chang 和 SIOP 耳毒性分级标准之间存在差异，主要是对于无或轻度听力损失的患者，但总体上两种标准具有很强的一致性。
