Papamichael Demetris, Renfro Lindsay A, Matthaiou Christiana, Yothers Greg, Saltz Leonard, Guthrie Katherine A, Van Cutsem Eric, Schmoll Hans-Joachim, Labianca Roberto, André Thierry, O'Connell Michael, Alberts Steven R, Haller Daniel G, Kountourakis Panteleimon, Sargent Daniel J
B.O. Cyprus Oncology Centre, Nicosia, Cyprus.
Mayo Clinic, Rochester, MN, United States.
J Geriatr Oncol. 2016 Nov;7(6):422-429. doi: 10.1016/j.jgo.2016.07.002. Epub 2016 Jul 25.
Adjuvant! Online is a tool used for clinical decision making in patients with early stage colon cancer. As details of the tool's construction are not published, the ability of Adjuvant! Online to accurately predict outcomes for older patients (age 70+) with node positive colon cancer receiving adjuvant chemotherapy is unclear.
Individual data from older patients with stage III colon cancer who enrolled into multiple trials within the ACCENT database were entered into the Adjuvant! Online program to obtain predicted probabilities of 5-year overall survival (OS) and recurrence-free survival (RFS). Median predictions were compared with known rates. As co-morbidities were not known for ACCENT patients, but required for calculator entry, patients were assumed to have either "minor" or "average for age" co-morbidities.
2967 older patients from 10 randomized studies were included. When "minor" co-morbidities were assumed, the median predicted 5-year OS rate of 64% nearly matched the actual rate of 65%; when "average for age" co-morbidities were assumed, the median prediction dropped to 58%, outside the CI for the actual rate. On the other hand, assuming "minor" co-morbidities gave a median 5-year RFS prediction of 62%, outside the 95% CI for the actual rate of 58%, while assuming "average for age" co-morbidities yielded a better median prediction of 57%.
Adjuvant! Online is reasonably accurate overall for predicting outcomes in older trial patients with stage III colon cancer, though accuracy may differ between 5-year RFS and 5-year OS predictions when a fixed degree of co-morbidities is assumed.
辅助化疗在线工具（Adjuvant! Online）是用于早期结肠癌患者临床决策的工具。由于该工具的构建细节未公布，辅助化疗在线工具能否准确预测接受辅助化疗的老年（70岁及以上）结肠癌患者的预后尚不清楚。
将ACCENT数据库中多项试验纳入的老年III期结肠癌患者的个体数据输入辅助化疗在线程序，以获得5年总生存率（OS）和无复发生存率（RFS）的预测概率。将预测中位数与已知率进行比较。由于ACCENT患者的合并症情况未知，但计算器输入需要，因此假设患者合并症为“轻度”或“年龄平均水平”。
纳入了来自10项随机研究的2967例老年患者。假设合并症为“轻度”时，预测的5年OS率中位数为64%，与实际率65%几乎匹配；假设合并症为“年龄平均水平”时，预测中位数降至58%，超出实际率的置信区间。另一方面，假设合并症为“轻度”时，5年RFS预测中位数为62%，超出实际率58%的95%置信区间，而假设合并症为“年龄平均水平”时，中位数预测更好，为57%。
辅助化疗在线工具总体上能合理准确地预测老年III期结肠癌试验患者的预后，不过在假设固定合并症程度时，5年RFS和5年OS预测的准确性可能有所不同。
