Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50 Yonsei-ro, 03722, Seoul, Korea (Republic of).
Department of Radiation Oncology, Cancer Research Institute, Institute of Radiation Medicine, Seoul National University College of Medicine, 101 Daehak-ro, 03080, Seoul, Korea (Republic of).
Strahlenther Onkol. 2020 Jan;196(1):58-69. doi: 10.1007/s00066-019-01512-y. Epub 2019 Sep 5.
To optimize and validate a current (NRG [a newly constituted National Clinical Trials Network group through National Surgical Adjuvant Breast and Bowel Project [NSABP], the Radiation Therapy Oncology Group [RTOG] and the Gynecologic Oncology Group (GOG)]) nomogram for glioblastoma patients as part of continuous validation.
We identified patients newly diagnosed with glioblastoma who were treated with temozolomide-based chemoradiotherapy between 2006 and 2016 at three large-volume hospitals. The extent of resection was determined via postoperative MRI. The discrimination and calibration abilities of the prediction algorithm were assessed; if additional factors were identified as independent prognostic factors, updated models were developed using the data from two hospitals and were externally validated using the third hospital. Models were internally validated using cross-validation and bootstrapping.
A total of 837 patients met the eligibility criteria. The median overall survival (OS) was 20.0 (95% CI 18.5-21.5) months. The original nomogram was able to estimate the 6‑, 12-, and 24-month OS probabilities, but it slightly underestimated the OS values. In multivariable Cox regression analysis, MRI-defined total resection had a greater impact on OS than that shown by the original nomogram, and two additional factors-IDH1 mutation and tumor contacting subventricular zone-were newly identified as independent prognostic values. An updated nomogram incorporating these new variables outperformed the original nomogram (C-index at 6, 12, 24, and 36 months: 0.728, 0.688, 0.688, and 0.685, respectively) and was well calibrated. External validation using an independent cohort showed C‑indices of 0.787, 0.751, 0.719, and 0.702 at 6, 12, 24, and 36 months, respectively, and was well calibrated.
An updated and validated nomogram incorporating the contemporary parameters can estimate individual survival outcomes in patients with glioblastoma with better accuracy.
优化和验证当前（NRG[通过美国国家外科辅助乳腺和肠道项目（NSABP）、放射治疗肿瘤学组（RTOG）和妇科肿瘤学组（GOG）新成立的国家临床研究网络小组]）胶质母细胞瘤患者的列线图，作为持续验证的一部分。
我们在三家大医院中，鉴定了在 2006 年至 2016 年间接受替莫唑胺为基础的放化疗治疗的新诊断为胶质母细胞瘤的患者。通过术后 MRI 确定切除范围。评估预测算法的区分和校准能力；如果发现其他因素为独立的预后因素，则使用来自两家医院的数据开发更新的模型，并使用第三家医院进行外部验证。使用交叉验证和自举法对模型进行内部验证。
共有 837 名患者符合入选标准。中位总生存期（OS）为 20.0（95%CI 18.5-21.5）个月。原始列线图能够估计 6、12 和 24 个月的 OS 概率，但 OS 值略有低估。在多变量 Cox 回归分析中，MRI 定义的完全切除对 OS 的影响大于原始列线图，并且 IDH1 突变和肿瘤接触侧脑室下区这两个新变量被确定为独立的预后因素。纳入这些新变量的更新列线图表现优于原始列线图（6、12、24 和 36 个月的 C 指数分别为 0.728、0.688、0.688 和 0.685），且校准良好。使用独立队列进行外部验证的结果显示，6、12、24 和 36 个月的 C 指数分别为 0.787、0.751、0.719 和 0.702，且校准良好。
纳入当代参数的更新和验证列线图可以更准确地估计胶质母细胞瘤患者的个体生存结局。
