Are we ready to predict late effects? A systematic review of clinically useful prediction models.
Are we ready to predict late effects? A systematic review of clinically useful prediction models.
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我们准备好预测后期影响了吗？
DOI：
10.1016/j.ejca.2015.02.002
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Vickers,AndrewJ
中科院分区：
文献类型：
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作者：
Salz,Talya;Baxi,ShrujalS;Raghunathan,Nirupa;Onstad,ErinE;Freedman,AndrewN;Moskowitz,ChayaS;Dalton,SusanneOksbjerg;Goodman,KarynA;Johansen,Christoffer;Matasar,MatthewJ;deNullyBrown,Peter;Oeffinger,KevinC;Vickers,AndrewJ
在完成癌症治疗后，幸存者可能会经历晚期效应：治疗的后果，持续或出现后的潜伏期。目的识别和描述所有的模型，预测风险的迟发效应，并可用于临床实践。数据来源我们检索Medline到2014年4月。研究选择研究描述的模型，（1）预测治疗后至少1年出现晚期效应的绝对风险，和（2）可用于临床环境。数据提取三位作者独立提取了与患者特征，晚期效应，在14项研究中，预测了9种晚期效应：前列腺癌后的勃起功能障碍和尿失禁;乳腺癌后的手臂淋巴水肿、心理发病率、心肌病或心力衰竭和心脏事件;头颈癌后吞咽功能障碍;霍奇金淋巴瘤后乳腺癌和儿童癌症后甲状腺癌。其中，四种晚期效应是治疗的持续效应，五种在潜伏期后出现。两项研究得到了外部验证。六项研究旨在为治疗而不是生存护理的决策提供信息。列线图是最常见的临床output.ConclusionDespite生存专家之间的呼吁，风险分层，很少公布的模型是有用的风险分层预防，早期发现或管理的晚期效应。很少有模型解决严重的，可修改的迟发效应，限制了它们的实用性。癌症幸存者将受益于专注于长期，可修改和严重的晚期效应的模型，以告知生存护理的管理。
BackgroundAfter completing treatment for cancer, survivors may experience late effects: consequences of treatment that persist or arise after a latent period.PurposeTo identify and describe all models that predict the risk of late effects and could be used in clinical practice.Data sourcesWe searched Medline through April 2014.Study selectionStudies describing models that (1) predicted the absolute risk of a late effect present at least 1 year post-treatment, and (2) could be used in a clinical setting.Data extractionThree authors independently extracted data pertaining to patient characteristics, late effects, the prediction model and model evaluation.Data synthesisAcross 14 studies identified for review, nine late effects were predicted: erectile dysfunction and urinary incontinence after prostate cancer; arm lymphoedema, psychological morbidity, cardiomyopathy or heart failure and cardiac event after breast cancer; swallowing dysfunction after head and neck cancer; breast cancer after Hodgkin lymphoma and thyroid cancer after childhood cancer. Of these, four late effects are persistent effects of treatment and five appear after a latent period. Two studies were externally validated. Six studies were designed to inform decisions about treatment rather than survivorship care. Nomograms were the most common clinical output.ConclusionDespite the call among survivorship experts for risk stratification, few published models are useful for risk-stratifying prevention, early detection or management of late effects. Few models address serious, modifiable late effects, limiting their utility. Cancer survivors would benefit from models focused on long-term, modifiable and serious late effects to inform the management of survivorship care.