用于在调强放射治疗时代优化美国癌症联合委员会/国际抗癌联盟鼻咽癌第8版分期系统预后预测的预后列线图。
Prognostic nomogram for refining the prognostication of the proposed 8th edition of the AJCC/UICC staging system for nasopharyngeal cancer in the era of intensity-modulated radiotherapy.
作者信息
Pan Jian Ji, Ng Wai Tong, Zong Jing Feng, Lee Sarah W M, Choi Horace C W, Chan Lucy L K, Lin Shao Jun, Guo Qiao Juan, Sze Henry C K, Chen Yun Bin, Xiao You Ping, Kan Wai Kuen, O'Sullivan Brian, Xu Wei, Le Quynh Thu, Glastonbury Christine M, Colevas A Dimitrios, Weber Randal S, Lydiatt William, Shah Jatin P, Lee Anne W M
机构信息
Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Provincial Clinical College of Fujian Medical University, Fujian, China.
Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fujian, China.
出版信息
Cancer. 2016 Nov 15;122(21):3307-3315. doi: 10.1002/cncr.30198. Epub 2016 Jul 19.
BACKGROUND
The objective of this study was to develop a nomogram for refining prognostication for patients with nondisseminated nasopharyngeal cancer (NPC) staged with the proposed 8th edition of the American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) staging system.
METHODS
Consecutive patients who had been investigated with magnetic resonance imaging, staged with the proposed 8th edition of the AJCC/UICC staging system, and irradiated with intensity-modulated radiotherapy from June 2005 to December 2010 were analyzed. A cohort of 1197 patients treated at Fujian Provincial Cancer Hospital was used as the training set, and the results were validated with 412 patients from Pamela Youde Nethersole Eastern Hospital. Cox regression analyses were performed to identify significant prognostic factors for developing a nomogram to predict overall survival (OS). The discriminative ability was assessed with the concordance index (c-index). A recursive partitioning algorithm was applied to the survival scores of the combined set to categorize the patients into 3 risk groups.
RESULTS
A multivariate analysis showed that age, gross primary tumor volume, and lactate dehydrogenase were independent prognostic factors for OS in addition to the stage group. The OS nomogram based on all these factors had a statistically higher bias-corrected c-index than prognostication based on the stage group alone (0.712 vs 0.622, P <.01). These results were consistent for both the training cohort and the validation cohort. Patients with <135 points were categorized as low-risk, patients with 135 to <160 points were categorized as intermediate-risk, and patients with ≥160 points were categorized as high-risk. Their 5-year OS rates were 92%, 84%, and 58%, respectively.
CONCLUSIONS
The proposed nomogram could improve prognostication in comparison with the TNM stage group. This could aid in risk stratification for individual NPC patients. Cancer 2016;122:3307-3315. © 2016 American Cancer Society.
背景
本研究的目的是开发一种列线图，以优化对采用美国癌症联合委员会（AJCC）/国际癌症控制联盟（UICC）第8版分期系统进行分期的非播散性鼻咽癌（NPC）患者的预后预测。
方法
分析2005年6月至2010年12月期间接受磁共振成像检查、采用AJCC/UICC第8版分期系统进行分期并接受调强放疗的连续患者。将福建省肿瘤医院治疗的1197例患者作为训练集，并在东区尤德夫人那打素医院的412例患者中进行验证。进行Cox回归分析以确定用于开发预测总生存期（OS）列线图的显著预后因素。用一致性指数（c指数）评估判别能力。将递归划分算法应用于合并集的生存分数，将患者分为3个风险组。
结果
多因素分析显示，除分期组外，年龄、原发肿瘤大体体积和乳酸脱氢酶是OS的独立预后因素。基于所有这些因素的OS列线图的偏差校正c指数在统计学上高于仅基于分期组的预后预测（0.712对0.622，P<.01）。这些结果在训练队列和验证队列中均一致。得分<135分的患者被归类为低风险，得分135至<160分的患者被归类为中风险，得分≥160分的患者被归类为高风险。他们的5年OS率分别为92%、84%和58%。
结论
与TNM分期组相比，所提出的列线图可改善预后预测。这有助于对个体NPC患者进行风险分层。《癌症》2016年；122:3307 - 3315。©2016美国癌症协会
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