Multimodal Risk-Adapted Treatment in Surgical Patients With Synovial Sarcoma: A Preoperative Nomogram-Guided Adjuvant Treatment Strategy.
Multimodal Risk-Adapted Treatment in Surgical Patients With Synovial Sarcoma: A Preoperative Nomogram-Guided Adjuvant Treatment Strategy.
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DOI：
10.3389/fsurg.2020.579726
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发表时间：
2020
影响因子：
1.8
通讯作者：
Xie X
中科院分区：
文献类型：
--
作者：
Zeng Z;Yao H;Lv D;Jin Q;Bian Y;Zou Y;Tu J;Wang B;Wen L;Xie X
背景资料：滑膜肉瘤的临床表现具有异质性，这使得很难评估个体患者的病情并设计个人治疗方案。我们建立了一个有效的术前列线图来预测肿瘤特异性生存期（CSS），并提出了一个适应风险的滑膜肉瘤手术患者的辅助治疗策略。研究方法：这项回顾性研究纳入了来自监测、流行病学和最终结果（SEER）数据库的患者，这些患者在1996年至2015年期间被诊断为滑膜肉瘤。患者被随机分为训练组和验证组。使用单变量和多变量考克斯风险模型选择预测因子。验证诺模图的区分能力和校准性能。我们进一步根据诺模图评分将患者分为不同的风险组，并比较化疗、放疗和放化疗联合治疗的疗效。结果：共有915例患者入组本研究，其中874例患者因滑膜肉瘤存活或死亡。我们建立了一个诺模图来预测5年CSS的独立因素，包括性别、年龄、分级、肿瘤大小、位置和范围（所有p <0.05）。我们的模型在训练（c-index = 0.78，95%CI 0.75 - 0.81）和验证（c-index = 0.73，95%CI 0.68 - 0.78）中均显示出预测5年CSS的一致良好的判别能力和校准。根据他们的诺模图评分，我们将患者分为5组。与未接受辅助治疗的患者相比，接受辅助治疗的诺模图I患者的5年CSS没有改善（100.0% vs. 100.0%），诺模图II型患者接受放疗或化疗的5年CSS较高（92.9% vs. 72.2%，p = 0.015），诺模图III型患者化疗和放疗联合治疗的5年CSS更高（70.1% vs. 47.2%，p = 0.004），诺模图IV组患者放疗后5年CSS率较高（41.3% vs. 15.6%，p = 0.015），诺模图V组患者辅助治疗后5年CSS率无改善（28.9% vs. 16.9%，p = 0.18）。结论：诺模图对滑膜肉瘤患者5年CSS的预测具有较好的区分能力和校正能力。基于此列线图，我们根据风险水平对滑膜肉瘤患者进行分层，这使我们能够提供一个有用的分组方案，可以为滑膜肉瘤的多模式风险适应性治疗提供信息。
Background: Synovial sarcoma is characterized by heterogeneous clinical manifestations, making it difficult to evaluate individual patients' prognoses and design personal treatment schemes. We established an effective preoperative nomogram to predict cancer-specific survival (CSS) and present a risk-adapted adjuvant treatment strategy in surgical patients with synovial sarcoma. Methods: This retrospective study included patients from the Surveillance, Epidemiology, and End Results (SEER) database who were diagnosed with synovial sarcoma between 1996 and 2015. The patients were randomly divided into training and validation groups. The predictors were selected using univariate and multivariate Cox hazards models. The nomogram performance was verified for its discriminatory ability and calibration. We further stratified the patients into different risk groups according to the nomogram scores and compared the efficacy of chemotherapy, radiotherapy, and combination of radiotherapy and chemotherapy. Results: There were 915 patients enrolled in our study, with 874 patients either alive or dead due to synovial sarcoma. We established a nomogram to predict 5-year CSS based on independent factors, including sex, age, grade, tumor size, location, and extent (all p < 0.05). Our model showed a consistently good discriminatory ability and calibration for predicting 5-year CSS in both the training (c-index = 0.78, 95% CI 0.75–0.81) and validation (c-index = 0.73, 95% CI 0.68–0.78). Based on their nomogram scores, we divided patients into 5 groups. Compared to patients without adjuvant treatment, nomogram I patients with adjuvant treatment had no improvements in 5-year CSS (100.0% vs. 100.0%), nomogram II patients had higher 5-year CSS with radiotherapy or chemotherapy (92.9% vs. 72.2%, p = 0.015), nomogram III patients had higher 5-year CSS with combination of chemotherapy and radiotherapy (70.1% vs. 47.2%, p = 0.004), nomogram IV patients had higher 5-year CSS with radiotherapy (41.3% vs. 15.6%, p = 0.015), and nomogram V patients had no improvements in 5-year CSS rates with adjuvant treatment (28.9% vs. 16.9%, p = 0.18). Conclusion: The nomogram showed a satisfactory discriminatory ability and calibration for predicting 5-year CSS in synovial sarcoma patients. Based on this nomogram, we stratified synovial sarcoma patients according to risk levels, which enabled us to provide a useful grouping scheme that can inform multimodal risk-adapted treatment in synovial sarcoma.
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影响因子：
3.8
作者：
Hsu CY;Liu PH;Ho SY;Hsia CY;Kudaravalli P;Lee YH;Chiou YY;Tsai YJ;Huang YH;Huo TI
通讯作者：
Huo TI
影响因子：
8.4
作者：
Ferrari, Andrea;Chi, Yueh-Yun;Spunt, Sheri L.
通讯作者：
Spunt, Sheri L.
DOI：
10.1016/s1470-2045(14)71116-7
发表时间：
2015-04
期刊：
The Lancet. Oncology
影响因子：
--
作者：
Balachandran VP;Gonen M;Smith JJ;DeMatteo RP
通讯作者：
DeMatteo RP
符合杭州标准的肝细胞癌手术切除与肝移植：术前列线图指导的治疗策略
DOI：
10.1016/s1499-3872(17)60052-3
发表时间：
2017-10-01
影响因子：
3.3
作者：
Li, Yang;Ruan, Dan-Yun;Jiang, Nan
通讯作者：
Jiang, Nan
影响因子：
2.3
作者：
Khan, Munir;Rankin, Kenneth S.;Gerrand, Craig
通讯作者：
Gerrand, Craig