Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan.
Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan.
Cancer. 2018 Feb 15;124(4):706-716. doi: 10.1002/cncr.31087. Epub 2017 Nov 7.
Accurate prognostication is essential to the optimal management of laryngeal cancer. Predictive models have been developed to calculate the risk of oncologic outcomes, but extensive external validation of accuracy and reliability is necessary before implementing them into clinical practice.
Four published prognostic calculators that predict 5-year overall survival for patients with laryngeal cancer were evaluated using patient information from a prospective epidemiology study cohort (n = 246; median follow-up, 60 months) with previously untreated, stage I through IVb laryngeal squamous cell carcinoma.
Different calculators yielded substantially different predictions for individual patients. The observed 5-year overall survival was significantly higher than the averaged predicted 5-year overall survival of the 4 calculators (71.9%; 95% confidence interval [CI], 65%-78%] vs 47.7%). Statistical analyses demonstrated the calculators' limited capacity to discriminate outcomes for risk-stratified patients. The area under the receiver operating characteristic curve ranged from 0.68 to 0.72. C-index values were similar for each of the 4 models (range, 0.66-0.68). There was a lower than expected hazard of death for patients who received induction (bioselective) chemotherapy (hazard ratio, 0.46; 95% CI, 0.24-0.88; P = .024) or primary surgical intervention (hazard ratio, 0.43; 95 % CI, 0.21-0.90; P = .024) compared with those who received concurrent chemoradiation.
Suboptimal reliability and accuracy limit the integration of existing individualized prediction tools into routine clinical decision making. The calculators predicted significantly worse than observed survival among patients who received induction chemotherapy and primary surgery, suggesting a need for updated consideration of modern treatment modalities. Further development of individualized prognostic calculators may improve risk prediction, treatment planning, and counseling for patients with laryngeal cancer. Cancer 2018;124:706-16. © 2017 American Cancer Society.
准确的预后对于喉癌的最佳治疗至关重要。已经开发出预测模型来计算肿瘤学结果的风险，但在将其纳入临床实践之前，需要进行广泛的外部准确性和可靠性验证。
使用一项前瞻性流行病学研究队列的患者信息（n=246；中位随访时间为 60 个月）评估了 4 种已发表的预测 5 年总生存率的预后计算器，这些患者患有未经治疗的 I 期至 IVb 期喉鳞状细胞癌。
不同的计算器为个别患者提供了截然不同的预测。观察到的 5 年总生存率明显高于 4 个计算器平均预测的 5 年总生存率（71.9%；95%置信区间[CI]，65%-78%）（71.9%；95%置信区间[CI]，65%-78%）。统计分析表明，这些计算器在区分风险分层患者的结果方面能力有限。接收者操作特征曲线下面积范围为 0.68 至 0.72。4 个模型的 C 指数值相似（范围为 0.66-0.68）。接受诱导（生物选择）化疗（风险比，0.46；95%CI，0.24-0.88；P=0.024）或原发性手术干预（风险比，0.43；95%CI，0.21-0.90；P=0.024）的患者的死亡风险低于接受同期放化疗的患者。
可靠性和准确性不理想限制了将现有个体化预测工具纳入常规临床决策。在接受诱导化疗和原发手术的患者中，这些计算器预测的生存率明显低于观察到的生存率，这表明需要重新考虑现代治疗方式。个体化预后计算器的进一步开发可能会改善喉癌患者的风险预测、治疗计划和咨询。癌症 2018；124:706-16。©2017 美国癌症协会。
