A nomogram to predict survival time in women starting first-line chemotherapy for advanced breast cancer
A nomogram to predict survival time in women starting first-line chemotherapy for advanced breast cancer
复制标题
DOI：
10.1007/s10549-011-1471-9
复制
发表时间：
2011-09-01
影响因子：
3.8
通讯作者：
Simes, R. J.
中科院分区：
文献类型：
--
作者：
Lee, C. K.;Hudson, M.;Simes, R. J.
对晚期乳腺癌开始一线化疗的女性具有不同的基线特征和生存时间。我们试图利用现有的临床和实验室数据来开发和验证一个实用的预后诺模图来预测总存活率(OS)。该预后模型是在两个一线化疗试验(ANZ8101和ANZ8614)的训练队列(n=693)中建立的，并在另外两个试验(ANZ0001和ANZ9311)中得到验证，分别有324名和233名患者。根据治疗前的人口学特征和疾病特征构建了比例风险模型。患者被分为预后良好(评分88)、中等(88-157)和预后较差(157)组。根据训练队列中确定的预测因子，从所有四个试验的组合数据集构建了一个诺模图(n=1250)。诺模图预测OS的一致性指数为0.65(95%CI，0.62~0.67)。图中的因素包括年龄、运动状态、雌激素受体状态、受累器官数量(肺、肝和脑)、血红蛋白浓度、中性粒细胞计数和血清碱性磷酸酶。预后好、中、差的中位生存期分别为15.4个月(95%CI，12.7~19.1)、10.2个月(95%CI，9.0~11.6)和6.1个月(95%CI，4.4~6.7)。在为每个验证队列重新校准新的基线生存函数后，实际和模型预测的18个月存活概率吻合得很好。一张结合了七个现成基线特征的诺模图使晚期乳腺癌患者分成三组，生存时间有显著差异。在未来的随机试验中，这个诺模图可能对个体化治疗和患者分层有用。
Women starting first-line chemotherapy for advanced breast cancer have differing baseline characteristics and survival times. We sought to develop and validate a pragmatic prognostic nomogram to predict overall survival (OS) by using available clinical and laboratory data. The prognostic model was developed in a training cohort (n = 693) from two first-line chemotherapy trials (ANZ8101 and ANZ8614) and validated in two other trials (ANZ0001 and ANZ9311) with 324 and 233 patients, respectively. The proportional-hazards model was constructed from pretreatment demographic and disease characteristics. Patients were classified into good (score < 88), medium (88-157), and poor (> 157) prognostic groups. A nomogram was constructed (n = 1250) from the combined datasets of all four trials, based on the predictors identified in the training cohort. The nomogram predicted OS with a concordance index of 0.65 (95%CI, 0.62-0.67). Factors in the nomogram were age, performance status, estrogen receptor status, number of involved organs (lung, liver and brain), hemoglobin concentration, neutrophil count, and serum alkaline phosphatase. The median survival for good, medium, and poor prognosis was 15.4 months (95%CI, 12.7-19.1), 10.2 months (95%CI, 9.0-11.6), and 6.1 months (95%CI, 4.4-6.7), respectively. The actual and model-predicted probabilities of 18-month survival agreed well, after recalibration for the new baseline survival functions for each validation cohort. A nomogram combining seven readily available baseline characteristics enabled stratification of advanced breast cancer patients into three groups with significantly different survival times. This nomogram could be useful for individualising treatment and for stratifying patients in future randomized trials.