External validation and comparison with other models of the International Metastatic Renal-Cell Carcinoma Database Consortium prognostic model: a population-based study.
External validation and comparison with other models of the International Metastatic Renal-Cell Carcinoma Database Consortium prognostic model: a population-based study.
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DOI：
10.1016/s1470-2045(12)70559-4
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发表时间：
2013-02
期刊：
影响因子：
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通讯作者：
Choueiri TK
中科院分区：
文献类型：
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作者：
Heng DY;Xie W;Regan MM;Harshman LC;Bjarnason GA;Vaishampayan UN;Mackenzie M;Wood L;Donskov F;Tan MH;Rha SY;Agarwal N;Kollmannsberger C;Rini BI;Choueiri TK
国际转移性肾细胞癌数据库联盟模型为转移性肾细胞癌患者提供预后信息。我们在外部人群中测试了该模型的准确性，并将其与其他预后模型进行了比较。我们纳入了转移性肾细胞癌患者，这些患者在13个国际癌症中心接受了一线vegf靶向治疗，并在联盟数据库中注册，但没有参与联盟数据库模型的初始开发。主要终点是总生存期。我们将数据库联盟模型与克利夫兰诊所基金会（CCF）模型、国际肾癌工作组（IKCWG）模型、法国模型和纪念斯隆-凯特琳癌症中心（MSKCC）模型通过一致性指数和其他模型拟合措施进行比较。总体而言，1028例患者纳入本研究，其中849例具有完整的数据来评估Database Consortium模型。中位总生存期为18.8个月（95%为17.6 - 21.4）。预先定义的Database Consortium危险因素（贫血、血小板增加、嗜中性粒细胞、高钙血症、Karnofsky性能状态<80%、从诊断到治疗<1年）是外部验证集中总生存率差的独立预测因素（风险比范围为1.27 ~ 2.08，一致性指数为0.71,95% CI为0.68 ~ 0.73）。将患者分为三种危险类别，有利危险组（无危险因素，157例）的中位总生存期为43.2个月（95% CI 34.1 ~ 50.1），中等危险组（1 ~ 2个危险因素，440例）的中位总生存期为22.5个月（18.7 ~ 25.1），差危险组（3个及以上危险因素，252例，p< 0.0001；一致性指数为0.664,95% CI 0.639 ~ 0.689）的中位总生存期为7.8个月（6.5 ~ 9.7）。672例患者有完整的数据来测试所有五种模型。CCF模型的一致性指数为0.662 (95% CI为0.636 ~ 0.687)，French模型为0.664 (0.614 ~ 0.665)，IKCWG模型为0.668 (0.645 ~ 0.692)，MSKCC模型为0.657（0.632 ~ 0.682）。与其他模型相比，数据库联盟模型中报告的2年死亡人数与预测的2年死亡人数最相似。数据库联盟模型现在得到了外部验证，可以应用于临床试验中根据风险对患者进行分层，并就预后向患者提供咨询。
The International Metastatic Renal-Cell Carcinoma Database Consortium model offers prognostic information for patients with metastatic renal-cell carcinoma. We tested the accuracy of the model in an external population and compared it with other prognostic models. We included patients with metastatic renal-cell carcinoma who were treated with first-line VEGF-targeted treatment at 13 international cancer centres and who were registered in the Consortium’s database but had not contributed to the initial development of the Consortium Database model. The primary endpoint was overall survival. We compared the Database Consortium model with the Cleveland Clinic Foundation (CCF) model, the International Kidney Cancer Working Group (IKCWG) model, the French model, and the Memorial Sloan-Kettering Cancer Center (MSKCC) model by concordance indices and other measures of model fit. Overall, 1028 patients were included in this study, of whom 849 had complete data to assess the Database Consortium model. Median overall survival was 18·8 months (95% 17·6–21·4). The predefined Database Consortium risk factors (anaemia, thrombocytosis, neutrophilia, hypercalcaemia, Karnofsky performance status <80%, and <1 year from diagnosis to treatment) were independent predictors of poor overall survival in the external validation set (hazard ratios ranged between 1·27 and 2·08, concordance index 0·71, 95% CI 0·68–0·73). When patients were segregated into three risk categories, median overall survival was 43·2 months (95% CI 31·4–50·1) in the favourable risk group (no risk factors; 157 patients), 22·5 months (18·7–25·1) in the intermediate risk group (one to two risk factors; 440 patients), and 7·8 months (6·5–9·7) in the poor risk group (three or more risk factors; 252 patients; p<0·0001; concordance index 0·664, 95% CI 0·639–0·689). 672 patients had complete data to test all five models. The concordance index of the CCF model was 0·662 (95% CI 0·636–0·687), of the French model 0·640 (0·614–0·665), of the IKCWG model 0·668 (0·645–0·692), and of the MSKCC model 0·657 (0·632–0·682). The reported versus predicted number of deaths at 2 years was most similar in the Database Consortium model compared with the other models. The Database Consortium model is now externally validated and can be applied to stratify patients by risk in clinical trials and to counsel patients about prognosis.