Modeling treatment outcomes for patients with advanced ovarian cancer: Projected benefits of a test to optimize treatment selection.
Modeling treatment outcomes for patients with advanced ovarian cancer: Projected benefits of a test to optimize treatment selection.
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DOI：
10.1016/j.ygyno.2018.02.007
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发表时间：
2018-05
影响因子：
4.7
通讯作者：
Davis T. Weaver;Tiana J. Raphel;A. Melamed;J. Rauh-Hain;J. Schorge;Amy B. Knudsen;P. Pandharipande
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文献类型：
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作者：
Davis T. Weaver;Tiana J. Raphel;A. Melamed;J. Rauh-Hain;J. Schorge;Amy B. Knudsen;P. Pandharipande
目的对于晚期上皮性卵巢癌(EOC)患者，诊断试验的重点在于能够区分两种治疗方案中的哪一种--初级细胞减少性手术(PCS)或新辅助化疗后间歇性细胞减少性手术(NACT+ICS)--优化患者水平的预后。我们的目标是预测通过这样的测试可以达到的潜在预期寿命(LE)的增加。方法我们开发了一个微观模拟模型来预测IIIC期EOC患者的LE。我们进行了比较：根据当前的临床实践，将患者分流到PCS和NACT+ICS；以及根据假设性测试的结果对患者进行分流的“测试”策略。从LE的角度来看，我们确定了测试策略优于护理标准策略的测试性能特征。结果即使有一个完美的测试，LE收益也是适度的(LE与标准护理策略相比，LE=67.6个月对66.4个月；LE收益=111.2个月)。为了超过护理标准，测试必须有很高的概率正确地识别PCS的“可切除”患者(即那些有可能完全或最佳细胞减少的患者)；这一测试属性比正确分诊不能切除的患者以适应+ICS更重要。结果对基础疾病可在PCS切除的患者的比例敏感。结论旨在对晚期EOC患者进行分类的诊断性测试对LE可能只有轻微的影响。
ObjectiveFor patients with advanced stage epithelial ovarian cancer (EOC), substantial emphasis has been placed on diagnostic tests that can discern which of two treatment options – primary cytoreductive surgery (PCS) or neoadjuvant chemotherapy followed by interval cytoreductive surgery (NACT + ICS) – optimizes patient-level outcomes. Our goal was to project potential life expectancy (LE) gains that could be achieved by use of such a test.MethodsWe developed a microsimulation model to project LE for patients with stage IIIC EOC. We compared: a “standard-of-care” strategy, in which patients were triaged to PCS vs. NACT + ICS based on current clinical practice; and a “test” strategy, in which patients were triaged based on results of a hypothetical test. We identified those test performance characteristics for which the test strategy outperformed the standard-of-care strategy, from a LE standpoint. Effects of parameter uncertainty were evaluated in sensitivity analysis.ResultsEven with a perfect test, the LE gain was modest (LE with test vs. standard-of-care strategy = 67.6 vs. 66.4 months; LE gain = 1.2 months). In order to outperform the standard-of-care, the test had to have a high probability of correctly identifying “resectable” patients at PCS (i.e. those for whom complete or optimal cytoreduction would be possible); this test property was more important than correct triage of unresectable patients to NACT + ICS. Results were sensitive to the proportion of patients whose underlying disease was resectable at PCS.ConclusionDiagnostic tests that are designed to triage patients with advanced stage EOC will likely have only a modest effect on LE.