Said Sherin Abdo, IntHout Joanna, den Ouden Judith E, Walraven Janneke E W, van der Aa Maaike A, de Hullu Joanne A, van Altena Anne M
Department of Obstetrics and Gynecology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands.
Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), 3512 CV Utrecht, The Netherlands.
J Clin Med. 2024 May 9;13(10):2789. doi: 10.3390/jcm13102789.
To assess the association between pretreatment thrombocytosis, anemia, and leukocytosis and overall survival (OS) of advanced-stage EOC. Furthermore, to develop nomograms using established prognostic factors and pretreatment hematologic parameters to predict the OS of advanced EOC patients. : Advanced-stage EOC patients treated between January 1996 and January 2010 in eastern Netherlands were included. Survival outcomes were compared between patients with and without pretreatment thrombocytosis (≥450,000 platelets/µL), anemia (hemoglobin level of <7.5 mmol/L), or leukocytosis (≥11.0 × 10 leukocytes/L). Three nomograms (for ≤3-, ≥5-, and ≥10-year OS) were developed. Candidate predictors were fitted into multivariable logistic regression models. Multiple imputation was conducted. Model performance was assessed on calibration, discrimination, and Brier scores. Bootstrap validation was used to correct for model optimism. : A total of 773 advanced-stage (i.e., FIGO stages IIB-IV) EOC patients were included. The median [interquartile range, IQR] OS was 2.3 [1.3-4.2] and 3.0 [1.4-7.0] years for patients with and without pretreatment thrombocytosis ( < 0.01). The median OS was not notably different for patients with and without pretreatment leukocytosis ( = 0.58) or patients with and without pretreatment anemia ( = 0.07). The final nomograms comprised established predictors with either pretreatment leukocyte or platelet count. The ≥5- and ≥10-year OS models demonstrated good calibration and adequate discrimination with optimism-corrected -indices [95%-CI] of 0.76 [0.72-0.80] and 0.78 [0.73-0.83], respectively. The ≤3-year OS model demonstrated suboptimal performance with an optimism-corrected c-index of 0.71 [0.66-0.75]. : Pretreatment thrombocytosis is associated with poorer EOC survival. Two well-performing models predictive of ≥5-year and ≥10-year OS in advanced-stage EOC were developed and internally validated.
评估晚期上皮性卵巢癌(EOC)治疗前血小板增多、贫血和白细胞增多与总生存期(OS)之间的关联。此外,利用既定的预后因素和治疗前血液学参数制定列线图,以预测晚期EOC患者的OS。纳入1996年1月至2010年1月在荷兰东部接受治疗的晚期EOC患者。比较有和没有治疗前血小板增多(≥450,000个血小板/微升)、贫血(血红蛋白水平<7.5毫摩尔/升)或白细胞增多(≥11.0×10⁹白细胞/升)的患者的生存结局。制定了三个列线图(用于≤3年、≥5年和≥10年OS)。将候选预测因素纳入多变量逻辑回归模型。进行多次插补。根据校准、区分度和Brier评分评估模型性能。使用自助法验证来校正模型的乐观性。共纳入773例晚期(即国际妇产科联盟(FIGO)分期IIB-IV期)EOC患者。有和没有治疗前血小板增多的患者的中位[四分位间距,IQR]OS分别为2.3[1.3 - 4.2]年和3.0[1.4 - 7.0]年(P<0.01)。有和没有治疗前白细胞增多的患者(P = 0.58)或有和没有治疗前贫血的患者(P = 0.07)的中位OS无显著差异。最终的列线图包括既定的预测因素以及治疗前白细胞或血小板计数。≥5年和≥10年OS模型显示出良好的校准和充分的区分度,校正乐观性后的C指数[95%置信区间]分别为0.76[0.72 - 0.80]和0.78[0.73 - 0.83]。≤3年OS模型表现欠佳,校正乐观性后的C指数为0.71[0.66 - 0.75]。治疗前血小板增多与EOC较差的生存相关。开发并内部验证了两个预测晚期EOC患者≥5年和≥10年OS的性能良好的模型。
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