A new prognostic and predictive tool for shared decision making in stage III colon cancer
A new prognostic and predictive tool for shared decision making in stage III colon cancer
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DOI：
10.1016/j.ejca.2020.07.031
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发表时间：
2020-10-01
影响因子：
8.4
通讯作者：
Bruzzi, Paolo
中科院分区：
文献类型：
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作者：
Sobrero, Alberto F.;Puccini, Alberto;Bruzzi, Paolo
背景：根据T-N分期，III期结肠癌患者的生存率差异很大。估计每个T-N亚组中的每个治疗选择的益处可以提供更准确的信息，帮助医生和患者在复杂的辅助therapy.Methods共享决策过程：12,834例III期结肠癌患者参加IDEA试验的结果数据作为我们的数据库。根据T-N分类，将患者分为16个子阶段。我们创建了一个元回归模型来预测每个T-N子阶段内的预期5年DFS。然后，我们评估了每一个治疗方案的疗效，在每个子阶段，向后工作减法，使用相关试验出版物中报告的HR的平均值作为一个转换factor.Results：在5年DFS率之间观察到的亚组，从89%（T1 N1 a）到31%（T4 N2 b）在总人口的巨大差异。在这种情况下，各治疗选择对结局的贡献在各亚阶段之间差异很大。根据我们的模型，T1 N1 a癌症患者仅接受手术的5年DFS预计为79.6%。单独使用辅助氟嘧啶导致DFS绝对增加5.6%;奥沙利铂治疗3个月和6个月分别额外增加2.3%和0.8%。T4 N2 b癌患者单纯手术的5年无病生存率为13.9%，采用上述辅助治疗方案的5年无病生存率分别增加11.2%、6.4%、2.5%。由此产生的叠加条形图为患者和医生提供了每种治疗方案的预计相对收益，并可能大大有助于共同决策过程，尽管由于估计值的显著差异，在使用该模型时必须谨慎。(C)2020爱思唯尔有限公司保留所有权利。
Background: Survival of patients with stage III colon cancer varies widely according to T-N sub-stages. Estimating the benefit of each therapeutic option in each T-N subgroup may provide more accurate information helping doctors and patients in the complex shared decision-making process surrounding adjuvant therapy.Methods: The outcomes data of 12,834 patients with stage III colon cancer enrolled in the IDEA trial served as our database. Patients were categorised in 16 sub-stages, based on T-N categories. We created a meta-regression model to predict the expected 5-year DFS within each T-N sub-stage. We then evaluated the efficacy of each therapeutic option in every substage, working backward by subtraction, using an average of the HRs reported in pertinent trial publications as a conversion factor.Results: Large differences in 5-year DFS rate were observed among the subgroups, ranging from 89% (T1N1a) to 31% (T4N2b) in the overall population. The contribution to the outcome of each therapeutic option in this setting varied widely across sub-stages. According to our model, patients with T1N1a cancers have a projected 5-year DFS of 79.6% with surgery alone. Adjuvant fluoropyrimidine alone results in 5.6% absolute DFS gain; an additional 2.3% and 0.8% gain is seen with oxaliplatin for 3 and 6 months, respectively. Patients with T4N2b cancers show a 13.9% 5-year DFS with surgery alone, and an 11.2%, 6.4%, 2.5% increase with the aforementioned adjuvant options, respectively.Conclusion: The resulting overlay bar graph gives patients and doctors the projected relative benefit of each treatment option and may substantially help the shared decision-making process, although caution must be exercised in using this model due to the significant variance of the estimates. (C) 2020 Elsevier Ltd. All rights reserved.