霍奇金淋巴瘤诊断时预期生存率的估计：一种权衡预后因素的方法以及治疗选择和临床研究的工具。来自国际霍奇金淋巴瘤数据库（IDHD）的报告。

Estimate of expected survival at diagnosis in Hodgkin's disease: a means of weighting prognostic factors and a tool for treatment choice and clinical research. A report from the International Database on Hodgkin's Disease (IDHD).

作者信息

Gobbi P G, Comelli M, Grignani G E, Pieresca C, Bertoloni D, Ascari E

机构信息

Clinica Medica II, Dipartimento di Medicina Interna, IRCCS S. Matteo, Italy.

出版信息

Haematologica. 1994 May-Jun;79(3):241-55.

PMID:7926973

Abstract

PURPOSE

The aim was to identify a mathematical model that, when fitted with the survival time distribution of a Hodgkin's disease population, would provide a reliable estimate of expected survival at diagnosis for any new Hodgkin patient. This model would be based upon a multivariable selection of the best prognostic factors evaluable at diagnosis and its forecast could be of assistance in the choice of treatment.

METHODS

The study sample consisted of the 5,023 patients whose basic clinical information was collected into the IDHD. These were people treated with standard protocols over the last two decades in 18 institutions. Several survival time distributions (exponential, Weibull, Gompertz, log-logistic and log-normal) were investigated to find the one that best fit the data and to relate its parameters to patient prognostic characteristics.

RESULTS

The log-normal model provided the best fit for the data. The most statistically significant prognostic covariates were stage, age, histotype, B symptoms, serum albumin, sex and involved area distribution. Mediastinal, extranodal or bone marrow involvement, erythrocyte sedimentation rate, hemoglobin, serum alkaline phosphatase and lactate dehydrogenase did not add significant information. An equation containing these seven variables was derived to estimate median survival. Five distinct prognostic classes were identified by four cut-off values for this estimate.

CONCLUSIONS

Direct use of estimated median survival or allocating each patient into one of the five prognostic classes allows better tailoring of clinical strategies according to prognostic characteristics, more accurate patient stratification and evaluation of results in clinical trials and metaanalyses. Instructions are given for using this tool for both clinical and investigational purposes.

摘要

目的

本研究旨在确定一种数学模型，该模型在拟合霍奇金病患者群体的生存时间分布后，能够为任何新诊断的霍奇金病患者提供可靠的预期生存估计。此模型将基于对诊断时可评估的最佳预后因素进行多变量选择，其预测结果有助于治疗方案的选择。

方法

研究样本包括5023例患者，其基本临床信息已录入国际霍奇金病数据库（IDHD）。这些患者是过去二十年来在18家机构接受标准方案治疗的人群。研究了几种生存时间分布（指数分布、威布尔分布、冈珀茨分布、对数逻辑斯蒂分布和对数正态分布），以找出最适合数据的分布，并将其参数与患者的预后特征相关联。

结果

对数正态模型最适合该数据。在统计学上最显著的预后协变量为分期、年龄、组织学类型、B症状、血清白蛋白、性别和受累区域分布。纵隔、结外或骨髓受累、红细胞沉降率、血红蛋白、血清碱性磷酸酶和乳酸脱氢酶并未增加显著信息。由此推导出一个包含这七个变量的方程来估计中位生存期。通过该估计值的四个临界值确定了五个不同的预后类别。