An individualized conditional survival calculator for patients with rectal cancer.
An individualized conditional survival calculator for patients with rectal cancer.
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DOI：
10.1097/dcr.0b013e31827bd287
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发表时间：
2013-05
影响因子：
3.9
通讯作者：
Chang GJ
中科院分区：
文献类型：
--
作者：
Bowles TL;Hu CY;You NY;Skibber JM;Rodriguez-Bigas MA;Chang GJ
有条件的生存估计说明了自确诊以来的存活时间，为长期癌症幸存者提供预后信息。对于直肠癌，分期相关的治疗(例如新辅助放射治疗)会影响病理分期，从而影响分期相关的生存估计。目的：评估直肠癌患者的条件生存期，并开发一种用于个体化患者咨询的交互式计算器。直肠腺癌患者是根据监测流行病学和最终结果登记(1988-2002，N=22,610)确定的。COX回归模型用于确定调整后的生存估计值(1-10年)，并用于计算5年调整后的条件生存率。未放疗、术前放疗、术后放疗和IV期患者分别建立模型。协变量包括年龄、性别、种族、肿瘤分级和手术类型。开发了一种基于互联网的条件生存计算器。放疗占42.6%(术前14.1%，术后28.4%)。除了I期外，所有阶段的5年条件生存率都有显著改善，因为最初诊断时的生存概率很高。晚期患者的条件生存改善最大，5年绝对值增加33%(IIIC期)和54%(IV期)。其他与条件生存相关的因素包括放疗和手术顺序、年龄、种族和肿瘤分级。基于互联网的条件生存计算器可以在www.mdanderson.org/rectalculator上访问。使用的数据来源不包括化疗、新辅助治疗后分期的变化或患者合并疾病的信息。直肠癌患者的条件生存估计在5年内有所改善，在晚期患者中改善最大。条件生存计算器是一种个性化的决策支持工具，它通知必须做出与治疗无关的生活决定的患者及其临床医生计划随访和监测。
Conditional survival estimates account for time survived since diagnosis to provide prognostic information for long-term cancer survivors. For rectal cancer, stage-related treatment (e.g. neoadjuvant radiotherapy) affects pathologic stage and therefore stage-associated survival estimates. To estimate conditional survival for rectal cancer patients and to develop an interactive calculator to use for individualized patient counseling. Patients with rectal adenocarcinoma were identified using the Surveillance Epidemiology and End Results registry (1988-2002, N=22,610). Cox regression models were developed to determine adjusted survival estimates (years 1-10) and used to calculate 5-year adjusted conditional survival. Models were built separately for no radiotherapy, preoperative radiotherapy, postoperative radiotherapy and stage IV patients. Covariates included age, gender, race, tumor grade, and type of surgery. An internet-based conditional survival calculator was developed. Radiotherapy was given to 42.6% of patients (14.1% pre-operative, 28.4% post-operative). Significant improvements in 5-year conditional survival were observed for all stages, except stage I due to initial high survival probability at diagnosis. Patients with advanced stage had the greatest improvements in conditional survival, with 5-year absolute increases of 33% (stage IIIC) and 54% (IV). Other factors associated with conditional survival included sequence of radiotherapy and surgery, age, race, and tumor grade. The internet-based conditional survival calculator can be accessed at www.mdanderson.org/rectalcalculator. Data source used does not include information on chemotherapy treatment, change in staging after neoadjuvant treatment, or patient comorbidities. Conditional survival estimates improve over 5 years in rectal cancer patients, with the greatest improvements observed among advanced stage patients. The conditional survival calculator is an individualized decision support tool that informs patients, who must make non-treatment-related life decisions, and their clinicians planning follow-up and surveillance.