Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Higashi-Naniwa-Cho 2-17-77, Amagasaki, Hyogo, Japan; Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, Japan.
Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, Japan.
Lung Cancer. 2017 Nov;113:88-92. doi: 10.1016/j.lungcan.2017.09.012. Epub 2017 Sep 22.
There are several prognostic indices (PIs) to predict overall survival (OS) in malignant pleural mesothelioma (MPM) patients. Before using a clinical prediction model in the actual clinical setting, empiric evaluation of its performance based on datasets that were not used to develop the model (i.e., external validation) is essential. The purpose of this study was to conduct an external validation of the PIs for MPM.
A retrospective cohort study was performed on MPM patients treated at 2 tertiary hospitals in Japan between 2007 and 2015. The primary outcome was OS. Harrell's c-index, and was calculated to examine the discrimination of three models. The bootstrapping technique was used to evaluate optimism.
The participants comprised 183 patients who underwent surgical treatment (n=61), chemotherapy (n=101), and best supportive care (BSC, n=21). The median OS rates were 1014days for surgery, 690days for chemotherapy, and 545days for best supportive care (BSC). The respective discriminations (95% confidence interval) of the Eastern Cooperative Oncology Group Performance Status, the European Organisation for Research and Treatment of Cancer index, regimen, PS, histology or stage (rPHS) index, and Tagawa index for the OS of MPM patients were 0.532 (0.444-0.620), 0.560 (0.472-0.648), 0.584 (0.452-0.716), and 0.525 (0.453-0.596) for surgery; 0.632 (0.539-0.724), 0.622 (0.548-0.696), 0.677 (0.587-0.766), and 0.545 (0.436-0.653) for chemotherapy; and 0.504 (0.365-0.644), 0.583 (0.456--0.710), 0.704 (0.508-0.899), and 0.583 (0.436-0.730) for BSC.
Each PI showed poor discrimination for MPM patients who underwent surgical treatment. The rPHS index showed moderate discrimination for patients given chemotherapy and BSC.
有几种预后指数（PI）可用于预测恶性胸膜间皮瘤（MPM）患者的总生存期（OS）。在实际临床环境中使用临床预测模型之前，基于未用于开发模型的数据进行经验评估（即外部验证）至关重要。本研究的目的是对 MPM 的 PI 进行外部验证。
对 2007 年至 2015 年间在日本 2 家三级医院接受治疗的 MPM 患者进行回顾性队列研究。主要结局为 OS。计算 Harrell 的 c 指数，以检验三种模型的区分能力。使用自举技术评估乐观程度。
纳入 183 名接受手术治疗（n=61）、化疗（n=101）和最佳支持治疗（BSC，n=21）的患者。手术组的中位 OS 率为 1014 天，化疗组为 690 天，BSC 组为 545 天。Eastern Cooperative Oncology Group 表现状态、欧洲癌症研究与治疗组织指数、方案、PS、组织学或分期（rPHS）指数和 Tagawa 指数对 MPM 患者 OS 的各自判别（95%置信区间）分别为 0.532（0.444-0.620）、0.560（0.472-0.648）、0.584（0.452-0.716）和 0.525（0.453-0.596）；632（0.539-0.724）、0.622（0.548-0.696）、0.677（0.587-0.766）和 0.545（0.436-0.653）；0.504（0.365-0.644）、0.583（0.456-0.710）、0.704（0.508-0.899）和 0.583（0.436-0.730）。
每个 PI 对接受手术治疗的 MPM 患者的判别能力均较差。rPHS 指数对接受化疗和 BSC 的患者具有中等的判别能力。
