Lora David, Gómez de la Cámara Agustín, Fernández Sara Pedraza, Enríquez de Salamanca Rafael, Gómez José Fermín Pérez Regadera
Clinical Research Unit, Instituto de Investigación Hospital 12 de Octubre, Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Hospital Universitario 12 de Octubre, Madrid, Spain.
Department of Radiation Oncology, Hospital Universitario de Cruces, Barakaldo, Spain.
J Gynecol Oncol. 2017 Sep;28(5):e58. doi: 10.3802/jgo.2017.28.e58. Epub 2017 May 26.
To externally validate the prognostic models for predicting the time-dependent outcome in patients with locally advanced cervical cancer (LACC) who were treated with concurrent chemoradiotherapy in an independent cohort.
A historical cohort of 297 women with LACC who were treated with radical concurrent chemoradiotherapy from 1999 to 2014 at the 12 de Octubre University Hospital (H12O), Madrid, Spain. The external validity of prognostic models was quantified regarding discrimination, calibration, measures of overall performance, and decision curve analyses.
The review identified 8 studies containing 13 prognostic models. Different (International Federation of Gynecology and Obstetrics [FIGO] stages, parametrium involvement, hydronephrosis, location of positive nodes, and race) but related cohorts with validation cohort (5-year overall survival [OS]=70%; 5-year disease-free survival [DFS]=64%; average age of 50; and over 79% squamous cell) were evaluated. The following models exhibited good external validity in terms of discrimination and calibration but limited clinical utility: the OS model at 3 year from Kidd et al.'s study (area under the receiver operating characteristic curve [AUROC]=0.69; threshold of clinical utility [TCU] between 36% and 50%), the models of DFS at 1 year from Kidd et al.'s study (AUROC=0.64; TCU between 24% and 32%) and 2 years from Rose et al.'s study (AUROC=0.70; TCU between 19% and 58%) and the distant recurrence model at 5 years from Kang et al.'s study (AUROC=0.67; TCU between 12% and 36%).
The external validation revealed the statistical and clinical usefulness of 4 prognostic models published in the literature.
在一个独立队列中对外验证用于预测接受同步放化疗的局部晚期宫颈癌（LACC）患者时间依赖性结局的预后模型。
对1999年至2014年在西班牙马德里12月10日大学医院（H12O）接受根治性同步放化疗的297例LACC女性患者进行历史性队列研究。从区分度、校准度、总体性能指标和决策曲线分析方面对预后模型的外部效度进行量化。
该综述纳入了8项研究，包含13种预后模型。评估了与验证队列不同（国际妇产科联盟[FIGO]分期、宫旁组织受累情况、肾盂积水、阳性淋巴结位置和种族）但相关的队列（5年总生存率[OS]=70%；5年无病生存率[DFS]=64%；平均年龄50岁；鳞状细胞癌超过79%）。以下模型在区分度和校准度方面表现出良好的外部效度，但临床实用性有限：Kidd等人研究中的3年总生存模型（受试者操作特征曲线下面积[AUROC]=0.69；临床实用性阈值[TCU]在36%至50%之间）、Kidd等人研究中的1年无病生存模型（AUROC=0.64；TCU在24%至32%之间）、Rose等人研究中的2年无病生存模型（AUROC=0.70；TCU在19%至58%之间）以及Kang等人研究中的5年远处复发模型（AUROC=0.67；TCU在12%至36%之间）。
外部验证揭示了文献中发表的4种预后模型的统计学和临床实用性。
