Dinglin Xiao-Xiao, Ma Shu-Xiang, Wang Fang, Li De-Lan, Liang Jian-Zhong, Chen Xin-Ru, Liu Qing, Zeng Yin-Duo, Chen Li-Kun
Department of Medical Oncology, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
Department of Molecular Diagnostics, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
Clin Lung Cancer. 2017 May;18(3):e179-e186. doi: 10.1016/j.cllc.2016.12.016. Epub 2017 Jan 13.
The current published prognosis models for brain metastases (BMs) from cancer have not addressed the issue of either newly diagnosed non-small-cell lung cancer (NSCLC) with BMs or the lung cancer genotype. We sought to build an adjusted prognosis analysis (APA) model, a new prognosis model specifically for NSCLC patients with BMs at the initial diagnosis using adjusted prognosis analysis (APA).
The model was derived using data from 1158 consecutive patients, with 837 in the derivation cohort and 321 in the validation cohort. The patients had initially received a diagnosis of BMs from NSCLC at Sun Yat-Sen University Cancer Center from 1994 to 2015. The prognostic factors analyzed included patient characteristics, disease characteristics, and treatments. The APA model was built according to the numerical score derived from the hazard ratio of each independent prognostic variable. The predictive accuracy of the APA model was determined using a concordance index and was compared with current prognosis models. The results were validated using bootstrap resampling and a validation cohort.
We established 2 prognostic models (APA 1 and 2) for the whole group of patients and for those with known epidermal growth factor receptor (EGFR) genotype, respectively. Six factors were independently associated with survival time: Karnofsky performance status, age, smoking history (replaced by EGFR mutation in APA 2), local treatment of intracranial metastases, EGFR-tyrosine kinase inhibitor treatment, and chemotherapy. Patients in the derivation cohort were stratified into low- (score, 0-2), moderate- (score, 3-5), and high-risk (score 6-7) groups according to the median survival time (16.6, 10.3, and 5.2 months, respectively; P < .001). The results were further confirmed in the validation cohort.
Compared with recursive partition analysis and graded prognostic assessment, APA seems to be more suitable for initially diagnosed NSCLC with BMs.
目前已发表的癌症脑转移（BMs）预后模型未涉及初诊非小细胞肺癌（NSCLC）伴BMs或肺癌基因型问题。我们试图构建一种调整后的预后分析（APA）模型，这是一种专门针对初诊时伴有BMs的NSCLC患者，采用调整后的预后分析（APA）构建的新预后模型。
该模型使用了1158例连续患者的数据推导得出，其中837例在推导队列，321例在验证队列。这些患者于1994年至2015年在中山大学肿瘤防治中心初诊为NSCLC伴BMs。分析的预后因素包括患者特征、疾病特征和治疗情况。APA模型根据每个独立预后变量的风险比得出的数值评分构建。使用一致性指数确定APA模型的预测准确性，并与当前预后模型进行比较。结果通过自助重采样和验证队列进行验证。
我们分别为全体患者以及已知表皮生长因子受体（EGFR）基因型的患者建立了2个预后模型（APA 1和APA 2）。六个因素与生存时间独立相关：卡氏功能状态、年龄、吸烟史（在APA 2中被EGFR突变取代）、颅内转移灶的局部治疗、EGFR酪氨酸激酶抑制剂治疗以及化疗。根据中位生存时间（分别为16.6、10.3和5.2个月；P <.001），推导队列中的患者被分为低风险（评分0 - 2）、中风险（评分3 - 5）和高风险（评分6 - 7）组。验证队列进一步证实了结果。
与递归划分分析和分级预后评估相比，APA似乎更适用于初诊的NSCLC伴BMs。
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