Validation of published nomograms and accordingly individualized induction chemotherapy in nasopharyngeal carcinoma
Validation of published nomograms and accordingly individualized induction chemotherapy in nasopharyngeal carcinoma
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鼻咽癌已发表列线图及相应个体化诱导化疗的验证
DOI：
10.1016/j.oraloncology.2017.01.009
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发表时间：
2017-04-01
期刊：
影响因子：
4.8
通讯作者：
Xie, Fang-Yun
中科院分区：
文献类型：
--
作者：
OuYang, Pu-Yun;Zhang, Lu-Ning;Xie, Fang-Yun
目的：本研究旨在验证两个已发表的鼻咽癌诺模图，并据此制定个体化诱导化疗方案。材料与方法：2007年至2011年，共纳入920例鼻咽癌患者。通过Harrell一致性指数（C指数）、曲线下面积（AUC）和校准曲线评估列线图的有效性。结果：与UICC第7版分期系统相比，Tang's nomogram能更好地区分无病生存期（DFS）和总生存期（OS）（C指数0.629对0.569，P = 0.002; AUC 0.635对0.576，P = 0.018），而Yang的列线图在预测OS方面没有优势（C指数0.648与0.606，P = 0.184; AUC 0.643与0.604，P = 0.157）。校准曲线表明预测的DFS或OS概率与观察到的DFS或OS概率之间具有良好的一致性。在未进行危险分层的情况下，IC对DFS（P >= 0.101）或OS（P >= 0.370）无益处。然而，在580名根据唐氏列线图分层的高危患者中，IC将5年DFS从68.8%提高到74.8%（P = 0.072），OS为82.6%至87.9%（P = 0.065），无病生存率和总生存率的改善率提高到9.3%（P = 0.019）和7.3%（P = 0.036）。结论：Tang的列线图有助于III-IVa-B期NPC的分层，IC对高危患者在临床实践中是有益的。(C)2017作者爱思唯尔有限公司出版
Objectives: We have attempted to validate two published nomograms in nasopharyngeal carcinoma (NPC) and individualize induction chemotherapy (IC) accordingly.Materials and methods: From 2007 to 2011, 920 patients were included in the study. The validity of the nomograms was assessed by Harrell's concordance index (C-index), areas under the curve (AUC), and calibration curves. Disease-free survival (DFS) and overall survival (OS) by IC were evaluated in and out of risk stratified patients with and without propensity score matching analysis.Results: Compared with the 7th edition of the Union for International Cancer Control (UICC) staging system, Tang's nomogram better discriminated DFS (C-index 0.629 versus 0.569, P = 0.002; AUC 0.635 versus 0.576, P = 0.018), whereas Yang's nomogram had no advantage in predicting OS (C-index 0.648 versus 0.606, P = 0.184; AUC 0.643 versus 0.604, P = 0.157). Calibration curves indicated good agreement between predicted and observed DFS or OS probability. Without risk stratification, patients achieved no benefit from IC in DFS (P >= 0.101) or OS (P >= 0.370). However, among 580 high-risk patients stratified by Tang's nomogram, IC improved five-year DFS from 68.8 to 74.8% (P = 0.072), and OS from 82.6 to 87.9% (P = 0.065), and the improvement of DFS and OS increased to 9.3% (P = 0.019) and 7.3% (P = 0.036), respectively, in 426 propensity-matched patients.Conclusions: Tang's nomogram helps to stratify stage III-IVa-b NPC, and IC is beneficial to high-risk patients in clinical practice. (C) 2017 The Authors. Published by Elsevier Ltd.