A Continuous Correlation Between Residual Tumor Volume and Survival Recommends Maximal Safe Resection in Glioblastoma Patients: A Nomogram for Clinical Decision Making and Reference for Non-Randomized Trials.
A Continuous Correlation Between Residual Tumor Volume and Survival Recommends Maximal Safe Resection in Glioblastoma Patients: A Nomogram for Clinical Decision Making and Reference for Non-Randomized Trials.
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DOI：
10.3389/fonc.2021.748691
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发表时间：
2021
影响因子：
4.7
通讯作者：
Tatagiba MS
中科院分区：
文献类型：
--
作者：
Skardelly M;Kaltenstadler M;Behling F;Mäurer I;Schittenhelm J;Bender B;Paulsen F;Hedderich J;Renovanz M;Gempt J;Barz M;Meyer B;Tabatabai G;Tatagiba MS
切除范围或残余肿瘤体积对胶质母细胞瘤患者总生存率的确切作用仍存在争议。我们的目的是创建一个统计模型，显示切除范围/残留肿瘤体积与总生存率之间的关联，并提供列线图来评估个体患者的生存获益，并作为非随机研究的参考。在这项回顾性多中心队列研究中，我们在胶质母细胞瘤患者中使用了非参数 Cox 回归和参数对数逻辑加速失效时间模型。针对 303 名患者（训练集），我们开发了一个模型来评估切除范围/残余肿瘤体积对总生存期的影响，并创建了一个评分来估计个体总生存期。该模型的稳定性通过 20 倍交叉验证和由 253 名患者组成的外部队列（验证集）的预测准确性进行了验证。我们发现切除范围或残留肿瘤体积与总生存率之间存在连续关系。我们最终的加速失败时间模型（伪 R2 = 0.423；C 指数 = 0.749）包括残余肿瘤体积、年龄、O6-甲基鸟嘌呤-DNA-甲基转移酶甲基化、治疗方式、可切除性和心室壁浸润作为总体生存的独立预测因子。基于这些因素，我们开发了一个用于评估个体患者生存的列线图，其显示中位绝对预测误差为 2.78（平均值：1.83）个月，与最有希望的已建立模型相比提高了约 40%。残余肿瘤体积和总生存率之间的连续关系支持最大安全切除的概念。由于绝对预测误差较低并且考虑了协变量的不均匀分布，该模型适用于临床决策并有助于评估非随机研究的结果。
The exact role of the extent of resection or residual tumor volume on overall survival in glioblastoma patients is still controversial. Our aim was to create a statistical model showing the association between resection extent/residual tumor volume and overall survival and to provide a nomogram that can assess the survival benefit of individual patients and serve as a reference for non-randomized studies. In this retrospective multicenter cohort study, we used the non-parametric Cox regression and the parametric log-logistic accelerated failure time model in patients with glioblastoma. On 303 patients (training set), we developed a model to evaluate the effect of the extent of resection/residual tumor volume on overall survival and created a score to estimate individual overall survival. The stability of the model was validated by 20-fold cross-validation and predictive accuracy by an external cohort of 253 patients (validation set). We found a continuous relationship between extent of resection or residual tumor volume and overall survival. Our final accelerated failure time model (pseudo R2 = 0.423; C-index = 0.749) included residual tumor volume, age, O6-methylguanine-DNA-methyltransferase methylation, therapy modality, resectability, and ventricular wall infiltration as independent predictors of overall survival. Based on these factors, we developed a nomogram for assessing the survival of individual patients that showed a median absolute predictive error of 2.78 (mean: 1.83) months, an improvement of about 40% compared with the most promising established models. A continuous relationship between residual tumor volume and overall survival supports the concept of maximum safe resection. Due to the low absolute predictive error and the consideration of uneven distributions of covariates, this model is suitable for clinical decision making and helps to evaluate the results of non-randomized studies.
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影响因子：
158.5
作者：
Stupp, R;Mason, WP;Ryan, G
通讯作者：
Ryan, G
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作者：
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影响因子：
158.5
作者：
Hegi, ME;Diserens, A;Stupp, R
通讯作者：
Stupp, R