Systems Biology and Personalised Medicine Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.
Department of Medical Biology, The University of Melbourne, Parkville, VIC, Australia.
Int J Cancer. 2019 Jul 1;145(1):132-142. doi: 10.1002/ijc.32100. Epub 2019 Jan 20.
Adjuvant! Online Inc (A!O), the Memorial Sloan Kettering Cancer Center (MSKCC), MD Anderson (MDA) and Mayo Clinic (MC) provide calculators to predict survival probabilities for patients with resected early-stage colon cancer, trained on data from United States (US) patient cohorts or patients enrolled in international clinical trials. Limited data exist on the transferability of calculators across healthcare systems. Calculator transferability to Australian community practice was evaluated for 1,401 stage II/III patients. Calibration and discrimination were assessed for overall (OS), cancer-specific (CSS) or recurrence-free survival (RFS). The US patient cohort-based calculators, A!O, MSKCC and MDA, significantly overestimated risks of recurrence and death in Australian patients, with 5-year OS, CSS and RFS prediction differences of -6.5% to -9.9%, -9.1% to -14.4% and - 3.8% to -6.8%, respectively (p < 0.001). Significant heterogeneity in calibration was observed for subgroups by tumor stage and treatment, age, gender, tumor location, ECOG and ASA score. Calibration appeared acceptable for the clinical trial patient-based MC calculator, but restricted tool applicability (stage III patients, ≥12 examined lymph nodes, receiving adjuvant treatment) limited the sample size. Compared to AJCC 7th edition tumor staging, calculators showed improved discrimination for OS, but no improvement for CSS and RFS. In conclusion, deficiencies in calibration limited transferability of US patient cohort-based survival calculators for early-stage colon cancer to the setting of Australian community practice. Our results demonstrate the utility for multi-feature survival calculators to improve OS predictions but highlight the importance for performance assessment of tools prior to implementation in an external health care setting.
辅助在线公司（A!O）、纪念斯隆-凯特琳癌症中心（MSKCC）、MD 安德森癌症中心（MDA）和梅奥诊所（MC）提供了用于预测接受早期结肠癌切除术患者的生存概率的计算器，这些计算器是基于美国（US）患者队列或参与国际临床试验的患者的数据进行训练的。关于计算器在医疗保健系统之间的可转移性，相关数据有限。对 1401 例 II/III 期患者进行了计算器在澳大利亚社区实践中的可转移性评估。评估了整体（OS）、癌症特异性（CSS）或无复发生存（RFS）的校准和区分度。基于美国患者队列的 A!O、MSKCC 和 MDA 计算器显著高估了澳大利亚患者的复发和死亡风险，5 年 OS、CSS 和 RFS 预测差异分别为-6.5%至-9.9%、-9.1%至-14.4%和-3.8%至-6.8%（p < 0.001）。在肿瘤分期和治疗、年龄、性别、肿瘤位置、ECOG 和 ASA 评分等亚组中观察到校准存在显著异质性。基于临床试验患者的 MC 计算器的校准似乎是可以接受的，但工具适用性受限（III 期患者、≥12 个检查的淋巴结、接受辅助治疗）限制了样本量。与 AJCC 第 7 版肿瘤分期相比，计算器在 OS 方面提高了区分度，但在 CSS 和 RFS 方面没有提高。总之，校准方面的缺陷限制了基于美国患者队列的早期结肠癌生存计算器在澳大利亚社区实践中的可转移性。我们的结果表明，多特征生存计算器可用于提高 OS 预测，但突出了在将工具应用于外部医疗保健环境之前对工具进行性能评估的重要性。
