Department of Diagnostic and Interventional Radiology, Johannes Gutenberg-University Medical Center Mainz, Mainz, Germany.
Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.
PLoS One. 2020 Feb 3;15(2):e0228501. doi: 10.1371/journal.pone.0228501. eCollection 2020.
External validation of prognostic risk models is essential before they are implemented in clinical practice. This study evaluated the recently developed MEGNA score for survival prediction after resection of intrahepatic cholangiocarcinoma (ICC), with a focus on the direct comparison of its prognostic value to that of the current International Union Against Cancer (UICC)/American Joint Committee on Cancer (AJCC) Cancer staging system.
Between 1997 and 2018, 417 consecutive patients with ICC were referred to our tertiary care centre and were retrospectively identified out of a dedicated clinical database. Of this group, 203 patients underwent surgical resection and met the inclusion criteria. Multivariate analysis was performed to assess the predictors of the recently proposed MEGNA score regarding overall survival (OS). Concordance indices (C-indices) and integrated Brier scores (IBS) were calculated to assess the ability of both the MEGNA score and the current (8th) edition of the UICC/AJCC Cancer staging system to predict individual patient outcome.
Stratification according to the MEGNA score resulted in a median OS of 34.5 months, 26.1 months, 21.5 months, and 16.6 months for MEGNA scores 0, 1, 2, and ≥3, respectively (log rank p < 0.001). However, of the five factors that contribute to the MEGNA score, age > 60 years was not a predictor for poor OS in our cohort. The C-index for the MEGNA score was 0.58, the IBS was 0.193. The 8th edition of the UICC/AJCC system performed slightly better, with a C-index of 0.61 and an IBS of 0.186.
The ability of the MEGNA score to predict individual patient outcome was only moderate in this external validation. Its prognostic value did not reach that of the more widely known and used UICC/AJCC system. However, neither scoring system performed well enough to support clear-cut clinical decisions.
在将预后风险模型应用于临床实践之前，对其进行外部验证至关重要。本研究评估了最近开发的用于预测肝内胆管癌（ICC）切除术后生存的 MEGNA 评分，重点是直接比较其预后价值与当前国际抗癌联盟（UICC）/美国癌症联合委员会（AJCC）癌症分期系统。
1997 年至 2018 年间，417 例连续 ICC 患者被转诊至我们的三级护理中心，并从专用临床数据库中回顾性确定。在这组患者中，有 203 例患者接受了手术切除并符合纳入标准。进行多变量分析，以评估最近提出的 MEGNA 评分关于总生存率（OS）的预测指标。计算一致性指数（C 指数）和综合 Brier 评分（IBS），以评估 MEGNA 评分和当前（第 8 版）UICC/AJCC 癌症分期系统对个体患者预后的预测能力。
根据 MEGNA 评分分层，MEGNA 评分为 0、1、2 和≥3 的患者的中位 OS 分别为 34.5 个月、26.1 个月、21.5 个月和 16.6 个月（对数秩检验 p<0.001）。然而，在构成 MEGNA 评分的五个因素中，我们队列中年龄>60 岁不是 OS 不良的预测因素。MEGNA 评分的 C 指数为 0.58，IBS 为 0.193。UICC/AJCC 系统第 8 版的表现略好，C 指数为 0.61，IBS 为 0.186。
在这项外部验证中，MEGNA 评分预测个体患者预后的能力仅为中等。其预后价值未达到更为广泛使用的 UICC/AJCC 系统的水平。然而，这两种评分系统都没有好到足以支持明确的临床决策。
