Validity of prognostic models: when is a model clinically useful?
Validity of prognostic models: when is a model clinically useful?
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DOI：
10.1053/suro.2002.32521
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发表时间：
2002-05-01
期刊：
影响因子：
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通讯作者：
Habbema, J Dik F
中科院分区：
文献类型：
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作者：
Vergouwe, Yvonne;Steyerberg, Ewout W;Habbema, J Dik F
预后模型结合了患者的特征来预测医疗结果。不幸的是，这样的模型在其他患者身上的表现并不总是像那些从其数据中得出模型的患者一样好。因此，预后模型的有效性需要在新患者中进行评估。预测的概率可以用该模型计算，并与实际观察的结果进行比较。我们可以区分有效性的几个方面：(1)预测概率和观察概率之间的一致性(校准)，(2)模型区分不同结果的受试者的能力(辨别)，以及(3)模型改善决策过程的能力(临床实用性)。我们讨论了这些方面，并通过使用睾丸癌和前列腺癌的模型显示了一些措施。我们得出的结论是，良好的校准和区分能力不足以使模型在临床上有用。如果一个预测模型能够为临床决策提供有用的补充信息，那么该模型的应用是合理的。
Prognostic models combine patient characteristics to predict medical outcomes. Unfortunately, such models do not always perform as well for other patients as those from whose data the models were derived. Therefore, validity of prognostic models needs to be assessed in new patients. Predicted probabilities can be calculated with the model and compared with the actually observed outcomes. We may distinguish several aspects of validity: (1) agreement between predicted probabilities and observed probabilities (calibration), (2) ability of the model to distinguish subjects with different outcomes (discrimination), and (3) ability of the model to improve the decision-making process (clinical usefulness). We discuss those aspects and show some measures by using models for testicular and prostate cancer. We conclude that good calibration and discriminative ability are not sufficient for a model to be clinically useful. Application of a prognostic model is sensible, if the model is able to provide useful additional information for clinical decision making.