Tanadini-Lang S, Rieber J, Filippi A R, Fode M M, Streblow J, Adebahr S, Andratschke N, Blanck O, Boda-Heggemann J, Duma M, Eble M J, Ernst I, Flentje M, Gerum S, Hass P, Henkenberens C, Hildebrandt G, Imhoff D, Kahl H, Klass N D, Krempien R, Lohaus F, Petersen C, Schrade E, Wendt T G, Wittig A, Høyer M, Ricardi U, Sterzing F, Guckenberger M
Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland.
Department of Radiation Oncology, University Hospital Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Germany.
Radiother Oncol. 2017 May;123(2):182-188. doi: 10.1016/j.radonc.2017.01.003. Epub 2017 Feb 4.
Radical local treatment of pulmonary metastases is practiced with increasing frequency due to acknowledgment and better understanding of oligo-metastatic disease. This study aimed to develop a nomogram predicting overall survival (OS) after stereotactic body radiotherapy (SBRT) for pulmonary metastases.
A multi-institutional database of 670 patients treated with SBRT for pulmonary metastases was used as training cohort. Cox regression analysis with bidirectional variable elimination was performed to identify factors to be included into the nomogram model to predict 2-year OS. The calibration rate of the nomogram was assessed by plotting the actual Kaplan-Meier 2-year OS against the nomogram predicted survival. The nomogram was externally validated using two separate monocentric databases of 145 and 92 patients treated with SBRT for pulmonary metastases.
The median follow up of the trainings cohort was 14.3months, the 2-year and 5-year OS was 52.6% and 23.7%, respectively. Karnofsky performance index, type of the primary tumor, control of the primary tumor, maximum diameter of the largest treated metastasis and number of metastases (1 versus >1) were significant prognostic factors in the Cox model (all p<0.05). The calculated concordance-index for the nomogram was 0.73 (concordance indexes of all prognostic factors between 0.54 and 0.6). Based on the nomogram the training cohort was divided into 4 groups and 2-year OS ranged between 24.2% and 76.1% (predicted OS between 30.2% and 78.4%). The nomogram discriminated between risk groups in the two validation cohorts (concordance index 0.68 and 0.67).
A nomogram for prediction of OS after SBRT for pulmonary metastases was generated and externally validated. This tool might be helpful for interdisciplinary discussion and evaluation of local and systemic treatment options in the oligo-metastatic setting.
A nomogram for prediction of overall survival after stereotactic body radiotherapy (SBRT) for pulmonary metastases was developed and externally validated. This tool might be helpful for interdisciplinary discussion and evaluation of local and systemic treatment options in the oligo-metastatic setting.
由于对寡转移疾病的认识和更好理解，肺部转移瘤的根治性局部治疗应用得越来越频繁。本研究旨在开发一种列线图，用于预测立体定向体部放疗（SBRT）治疗肺部转移瘤后的总生存期（OS）。
一个包含670例接受SBRT治疗肺部转移瘤患者的多机构数据库被用作训练队列。采用双向变量消除的Cox回归分析来确定纳入列线图模型以预测2年总生存期的因素。通过绘制实际的Kaplan-Meier 2年总生存期与列线图预测生存期来评估列线图的校准率。该列线图使用两个分别包含145例和92例接受SBRT治疗肺部转移瘤患者的单中心数据库进行外部验证。
训练队列的中位随访时间为14.3个月，2年和5年总生存期分别为52.6%和23.7%。卡诺夫斯基功能状态评分、原发肿瘤类型、原发肿瘤控制情况、最大治疗转移瘤的最大直径以及转移瘤数量（1个与>1个）是Cox模型中的显著预后因素（所有p<0.05）。列线图计算出的一致性指数为0.73（所有预后因素的一致性指数在0.54至0.6之间）。根据列线图，训练队列被分为4组，2年总生存期在24.2%至76.1%之间（预测总生存期在30.2%至78.4%之间）。列线图在两个验证队列中区分了风险组（一致性指数分别为0.68和0.67）。
生成了一种用于预测SBRT治疗肺部转移瘤后总生存期的列线图并进行了外部验证。该工具可能有助于在寡转移情况下进行跨学科讨论以及评估局部和全身治疗方案。
开发并外部验证了一种用于预测立体定向体部放疗（SBRT）治疗肺部转移瘤后总生存期的列线图。该工具可能有助于在寡转移情况下进行跨学科讨论以及评估局部和全身治疗方案。
