Department of Radiation Oncology, Good Samaritan Hospital Medical Center, West Islip, NY, USA.
New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, USA.
Cancer Res Treat. 2018 Oct;50(4):1433-1443. doi: 10.4143/crt.2017.223. Epub 2018 Jan 24.
We previously developed a model to more accurately predict life expectancy for stage IV cancer patients referred to radiation oncology. The goals of this study are to validate this model and to compare competing published models.
From May 2012 to March 2015, 280 consecutive patientswith stage IV cancerwere prospectively evaluated by a single radiation oncologist. Patients were separated into training, validation and combined sets. TheNEAT model evaluated number of active tumors ("N"), Eastern Cooperative Oncology Group performance status ("E"), albumin ("A") and primary tumor site ("T"). The Odette Cancer Center model validated performance status, bone only metastases and primary tumor site. The Harvard TEACHH model investigated primary tumor type, performance status, age, prior chemotherapy courses, liver metastases, and hospitalization within 3 months. Cox multivariable analyses and logisticalregressionwere utilized to compare model performance.
Number of active tumors, performance status, albumin, primary tumor site, prior hospitalizationwithin the last 3 months, and liver metastases predicted overall survival on uinvariate and multivariable analysis (p < 0.05 for all). The NEAT model separated patients into four prognostic groups with median survivals of 24.9, 14.8, 4.0, and 1.2 months, respectively (p < 0.001). The NEAT model had a C-index of 0.76 with a Nagelkerke's R2 of 0.54 suggesting good discrimination, calibration and total performance compared to competing prognostic models.
The NEAT model warrants further investigation as a clinically useful approach to predict survival in patients with stage IV cancer.
我们之前开发了一种模型，以便更准确地预测转至放射肿瘤科的 IV 期癌症患者的预期寿命。本研究的目的是验证该模型并比较竞争发表的模型。
从 2012 年 5 月至 2015 年 3 月，280 例连续的 IV 期癌症患者由一位放射肿瘤学家进行前瞻性评估。患者分为训练、验证和综合组。NEAT 模型评估了活跃肿瘤的数量（“N”）、东部合作肿瘤学组表现状态（“E”）、白蛋白（“A”）和原发肿瘤部位（“T”）。奥代特癌症中心模型验证了表现状态、仅骨转移和原发肿瘤部位。哈佛 TEACHH 模型研究了原发肿瘤类型、表现状态、年龄、先前化疗疗程、肝转移和 3 个月内住院情况。Cox 多变量分析和逻辑回归用于比较模型性能。
活跃肿瘤数量、表现状态、白蛋白、原发肿瘤部位、最近 3 个月内的住院治疗和肝转移在单变量和多变量分析中均预测了总生存（p<0.05）。NEAT 模型将患者分为四个预后组，中位生存期分别为 24.9、14.8、4.0 和 1.2 个月（p<0.001）。NEAT 模型的 C 指数为 0.76，Nagelkerke 的 R2 为 0.54，表明与竞争预后模型相比，其具有良好的区分度、校准度和总体性能。
NEAT 模型值得进一步研究，作为一种预测 IV 期癌症患者生存的临床有用方法。
