Alberto Carmona-Bayonas and Francisco Ayala de la Peña, Hospital Universitario Morales Meseguer; Jerónimo Martínez, Hospital Universitario Virgen de la Arrixaca, Murcia; Paula Jiménez-Fonseca, Hospital Universitario Central de Asturias, Oviedo; Juan Virizuela Echaburu, Hospital Universitario Virgen Macarena; Carmen Beato, Hospital Nisa Aljarafe, Seville; Maite Antonio, Institut Català d'Oncologia Duran i Reynals; Carme Font, Hospital Universitario Clínic; Mercè Biosca, Hospital Universitario Vall d'Hebron; María Ángeles Arcusa Lanza, Consorci Sanitari de Terrassa, Barcelona; Avinash Ramchandani, Hospital Universitario de Las Palmas, Las Palmas; Jorge Hernando Cubero, Hospital Universitario Miguel Servet, Zaragoza; Javier Espinosa, Hospital General Universitario de Ciudad Real, Ciudad Real; Eva Martínez de Castro, Hospital Universitario Marqués de Valdecilla, Santander; Ismael Ghanem, Hospital Universitario La Paz; Rebeca Mondéjar, Hospital Virgen de la Luz de Cuenca; Aránzazu Manzano, Hospital Universitario Clínico San Carlos, Madrid; Ana Blasco, Hospital General Universitario de Valencia, Valencia; Yaiza Bonilla, Hospital de Santa Lucía, Cartagena; Isabel Aragón Manrique, Hospital Juan Ramón Jiménez, Huelva; Elena Sevillano, Hospital Universitario Son Espases, Palma de Mallorca; Eduardo Castañón, Clínica Universitaria Navarra, Navarre; Mercé Cardona, Hospital de Tortosa Verge de la Cinta, Tarragona; Elena Gallardo Martín, Complejo Universitario de Pontevedra, Pontevedra; Quionia Pérez Armillas, Hospital Universitario de Valladolid, Valladolid; Fernando Sánchez Lasheras, University of Oviedo, Gijón, Spain; and Marcelo Garrido, Universidad Católica Pontificia de Chile, Santiago de Chile, Chile.
J Clin Oncol. 2015 Feb 10;33(5):465-71. doi: 10.1200/JCO.2014.57.2347. Epub 2015 Jan 5.
To validate a prognostic score predicting major complications in patients with solid tumors and seemingly stable episodes of febrile neutropenia (FN). The definition of clinical stability implies the absence of organ dysfunction, abnormalities in vital signs, and major infections.
We developed the Clinical Index of Stable Febrile Neutropenia (CISNE), with six explanatory variables associated with serious complications: Eastern Cooperative Oncology Group performance status ≥ 2 (2 points), chronic obstructive pulmonary disease (1 point), chronic cardiovascular disease (1 point), mucositis of grade ≥ 2 (National Cancer Institute Common Toxicity Criteria; 1 point), monocytes < 200 per μL (1 point), and stress-induced hyperglycemia (2 points). We integrated these factors into a score ranging from 0 to 8, which classifies patients into three prognostic classes: low (0 points), intermediate (1 to 2 points), and high risk (≥ 3 points). We present a multicenter validation of CISNE.
We prospectively recruited 1,133 patients with seemingly stable FN from 25 hospitals. Complication rates in the training and validation subsets, respectively, were 1.1% and 1.1% in low-, 6.1% and 6.2% in intermediate-, and 32.5% and 36% in high-risk patients; mortality rates within each class were 0% in low-, 1.6% and 0% in intermediate-, and 4.3% and 3.1% in high-risk patients. Areas under the receiver operating characteristic curves in the validation subset were 0.652 (95% CI, 0.598 to 0.703) for Talcott, 0.721 (95% CI, 0.669 to 0.768) for Multinational Association for Supportive Care in Cancer (MASCC), and 0.868 (95% CI, 0.827 to 0.903) for CISNE (P = .002 for comparison between CISNE and MASCC).
CISNE is a valid model for accurately classifying patients with cancer with seemingly stable FN episodes.
验证一种预测实体瘤患者伴有看似稳定发热性中性粒细胞减少症（FN）的主要并发症的预后评分。临床稳定性的定义意味着不存在器官功能障碍、生命体征异常和重大感染。
我们开发了临床稳定发热性中性粒细胞减少症指数（CISNE），其中包含六个与严重并发症相关的解释变量：东部合作肿瘤组表现状态≥2（2 分）、慢性阻塞性肺疾病（1 分）、慢性心血管疾病（1 分）、黏膜炎≥2 级（国家癌症研究所常见毒性标准；1 分）、单核细胞<200/μL（1 分）和应激性高血糖（2 分）。我们将这些因素整合到一个 0 到 8 分的评分中，将患者分为三个预后类别：低危（0 分）、中危（1 到 2 分）和高危（≥3 分）。我们介绍了 CISNE 的多中心验证。
我们前瞻性地从 25 家医院招募了 1133 名看似稳定 FN 的患者。在训练和验证亚组中，分别为低危患者的并发症发生率为 1.1%和 1.1%，中危患者为 6.1%和 6.2%，高危患者为 32.5%和 36%；每个类别的死亡率分别为低危患者为 0%，中危患者为 1.6%和 0%，高危患者为 4.3%和 3.1%。验证亚组中 Talcott 的接受者操作特征曲线下面积为 0.652（95%CI，0.598 至 0.703），Multinational Association for Supportive Care in Cancer（MASCC）为 0.721（95%CI，0.669 至 0.768），CISNE 为 0.868（95%CI，0.827 至 0.903）（CISNE 与 MASCC 之间的比较 P=0.002）。
CISNE 是一种准确分类癌症伴看似稳定 FN 发作患者的有效模型。
