Population-based validation of the National Cancer Comprehensive Network recommendations for breast cancer staging
Population-based validation of the National Cancer Comprehensive Network recommendations for breast cancer staging
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DOI：
10.1007/s10549-018-4893-9
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发表时间：
2018-11-01
影响因子：
3.8
通讯作者：
Abdel-Rahman, Omar
中科院分区：
文献类型：
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作者：
Abdel-Rahman, Omar
目的：本研究的目的是评估国家综合癌症网络（NCCN）分期建议在乳腺癌肺、骨和肝转移检测方面的表现特点。方法进入监测、流行病学和终点（SEER）数据库（2010-2015），提取乳腺癌患者的Tstage和clinicalN分期、ER状态、Her2状态和转移部位的完整信息。本研究评估的性能特征包括敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）、需要调查的数量（NNI）和准确性。结果共纳入239196例患者。在整个队列中，检测1例肺转移所需的PPV（识别肺转移）为10.6%，NNI为9.4。同样，PPV（骨转移的识别）为18.6%，NNI检测一例骨转移为5.3。此外，PPV（识别肝转移）为7.6%，NNI检测1例肝转移为13.1。当改变基线成像的阈值以包括det2n1患者时，观察到ER+/Her2-患者的敏感性和特异性之间更好的平衡（三个转移部位的敏感性和特异性均为bb0 92%）。另一方面，提出的改变提高了敏感性，但显著降低了Her2+和三阴性亚型的特异性（特异性）
ObjectiveThe aim of the current study is to evaluate the performance characteristics of the National Comprehensive Cancer Network (NCCN) staging recommendations for breast cancer with regard to the detection of lung, bone, and liver metastases.MethodsSurveillance, epidemiology, and end points (SEER) database (2010-2015) was accessed, and patients with breast cancer and complete information about Tstage and clinicalN stage, ER status, Her2 status, and metastatic sites were extracted. Performance characteristics evaluated for the current study included sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), number needed to investigate (NNI), and accuracy.ResultsA total of 239,196 patients were included in the analysis. For the overall cohort, the required PPV (for the recognition of lung metastases) is 10.6% and NNI to detect one case of lung metastasis is 9.4. Likewise, PPV (for the recognition of bone metastases) is 18.6% and NNI to detect one case of bone metastasis is 5.3. Moreover, PPV (for the recognition of liver metastases) is 7.6% and NNI to detect one case of liver metastasis is 13.1. When changing the threshold for baseline imaging to includeT2N1 patients, a better balance between sensitivity and specificity among ER+/Her2- patients (>92% for both sensitivity and specificity for the three metastatic sites) was observed. On the other hand, the proposed change improved sensitivity while it lowers significantly the specificity among Her2+ and triple negative subtypes (specificity