Developing a clinical and PET/CT volumetric prognostic index for risk assessment and management of NSCLC patients after initial therapy.
Developing a clinical and PET/CT volumetric prognostic index for risk assessment and management of NSCLC patients after initial therapy.
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DOI：
10.31083/j.fbl2701016
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发表时间：
2022-01
期刊：
影响因子：
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通讯作者：
Liu Liu-Liu;Jingmian Zhang;M. Ferguson;D. Appelbaum;James X Zhang;Y. Pu
中科院分区：
文献类型：
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作者：
Liu Liu-Liu;Jingmian Zhang;M. Ferguson;D. Appelbaum;James X Zhang;Y. Pu
背景目前，临床实践中，在NSCLC患者的预后评估中，在TNM分期后依次使用单个临床预后变量和风险分层，这对于估计多个个体变量对患者结局的集体影响是无效的。在这里，我们开发了一种临床和PET/CT体积预后（CPVP）指数，该指数整合了多个临床变量和基线FDG-PET代谢肿瘤体积的预后能力，可在确定性治疗后立即使用。患者和方法这项回顾性队列研究纳入了2004年至2017年诊断的998例NSCLC患者，随机分配到两个队列，使用考克斯回归模型对CPVP指数进行建模，检查总生存期（OS）并进行后续验证。结果模型队列产生的CPVP指数包括治疗前变量（全身代谢肿瘤体积[MTVVP]、临床TNM分期、肿瘤组织学、体力状态、年龄、种族、性别、吸烟史）和治疗类型。还生成了不含MTVT的临床变量（CV）指数和不含临床变量的PET/CT体积预后（PVP）指数进行比较。在验证队列中，单变量考克斯模型显示该指数与总生存期显著相关（OS;风险比[HR] 3.14; 95%置信区间[95%CI] = 2.71至3.65，p < 0.001）。多因素考克斯回归分析显示该指数与OS显著相关（HR = 3.13，95%CI = 2.66 ~ 3.67，p < 0.001）。该指数显示出比其任何独立变量更大的预后能力（C-统计量= 0.72），包括临床TNM分期（C-统计量范围从0.50至0.69，所有p < 0.003）、CV指数（C-统计量= 0.68，p < 0.001）和PVP指数（C-统计量= 0.70，p = 0.006）。结论：CPVP指数对NSCLC患者具有中等强的预后能力，比其个体预后变量和其他指数更具预后意义。该指标可用于NSCLC患者初治后的定量预后评估，为NSCLC患者的个体化治疗和监测提供参考。
BACKGROUND Currently, individual clinical prognostic variables are used sequentially with risk-stratification after TNM staging in clinical practice for the prognostic assessment of patients with NSCLC, which is not effective for estimating the collective impact of multiple individual variables on patient outcomes. Here, we developed a clinical and PET/CT volumetric prognostic (CPVP) index that integrates the prognostic power of multiple clinical variables and metabolic tumor volume from baseline FDG-PET, for use immediately after definitive therapy. PATIENTS AND METHODS This retrospective cohort study included 998 NSCLC patients diagnosed between 2004 and 2017, randomly assigned to two cohorts for modeling the CPVP index using Cox regression models examining overall survival (OS) and subsequent validation. RESULTS The CPVP index generated from the model cohort included pretreatment variables (whole-body metabolic tumor volume [MTVwb], clinical TNM stage, tumor histology, performance status, age, race, gender, smoking history) and treatment type. A clinical variable (CV) index without MTVwb and PET/CT volumetric prognostic (PVP) index without clinical variables were also generated for comparison. In the validation cohort, univariate Cox modeling showed a significant association of the index with overall survival (OS; Hazard Ratio [HR] 3.14; 95% confidence interval [95% CI] = 2.71 to 3.65, p < 0.001). Multivariate Cox regression analysis demonstrated a significant association of the index with OS (HR = 3.13, 95% CI = 2.66 to 3.67, p < 0.001). The index showed greater prognostic power (C-statistic = 0.72) than any of its independent variables including clinical TNM stage (C-statistic ranged from 0.50 to 0.69, all p < 0.003), CV index (C-statistic = 0.68, p < 0.001) and PVP index (C-statistic = 0.70, p = 0.006). CONCLUSIONS The CPVP index for NSCLC patients has moderately strong prognostic power and is more prognostic than its individual prognostic variables and other indices. It provides a practical tool for quantitative prognostic assessment after initial treatment and therefore may be helpful for the development of individualized treatment and monitoring strategy for NSCLC patients.