Development and Validation of Web-Based Nomograms to Precisely Predict Conditional Risk of Site-Specific Recurrence for Patients With Completely Resected Non-small Cell Lung Cancer A Multiinstitutional Study
Development and Validation of Web-Based Nomograms to Precisely Predict Conditional Risk of Site-Specific Recurrence for Patients With Completely Resected Non-small Cell Lung Cancer A Multiinstitutional Study
复制标题
开发和验证基于网络的列线图以精确预测完全切除的非小细胞肺癌患者特定部位复发的条件风险一项多机构研究
DOI：
10.1016/j.chest.2018.04.040
复制
发表时间：
2018-09-01
期刊：
影响因子：
9.6
通讯作者：
Chen, Haiquan
中科院分区：
文献类型：
--
作者：
Zhang, Yang;Zheng, Difan;Chen, Haiquan
背景：目前对于完全切除的非小细胞肺癌（NSCLC）患者的最佳术后随访策略尚未达成共识。我们的目的是开发基于网络的列线图，以精确预测 NSCLC 患者的特定部位术后复发，并指导个体监测策略，包括何时随访和进行哪些诊断测试。 方法：我们调查了 2,017 名在复旦大学上海肿瘤中心接受完整手术切除的 NSCLC（鳞状细胞癌和非鳞状浸润性腺癌）患者的复发模式（开发队列），并开发了基于网络的临床病理学预测模型基于 Cox 回归的特定部位复发的条件风险。分析中使用的变量包括性别、年龄、吸烟史、肿瘤大小、肿瘤组织学、淋巴血管侵犯、内脏胸膜侵犯和病理TNM分期。采用上海胸科医院 3,308 例 NSCLC 患者的单独队列进行外部验证。 结果：在所建立的列线图预测总体复发、胸部复发、腹部复发、颈部复发、脑部复发和骨复发的开发队列和外部验证队列中，Harrell 等人的 C 统计量分别为 0.743 和 0.748、0.728 和 0.703、0.760 和分别为 0.749、0.779 和 0.757、0.787 和 0.784、以及 0.777 和 0.739。校准图显示列线图预测的 3 年无复发生存率与实际 3 年无复发生存率之间的最佳一致性。结论：这些用户友好的列线图可以根据临床病理特征精确预测完全切除的 NSCLC 患者的特定部位复发。他们可以帮助医生制定个体术后随访计划。
BACKGROUND: There is currently no consensus regarding the optimal postoperative follow-up strategy for patients with completely resected non-small cell lung cancer (NSCLC). We aimed to develop web-based nomograms to precisely predict site-specific postoperative recurrence in patients with NSCLC and to guide individual surveillance strategies including when to follow up and what diagnostic tests to perform.METHODS: We investigated the pattern of recurrence in a series of 2,017 patients with NSCLC (squamous cell carcinoma and nonlepidic invasive adenocarcinoma) who underwent complete surgical resection at Fudan University Shanghai Cancer Center (development cohort), and developed web-based clinicopathologic prediction models for conditional risk of sitespecific recurrence based on Cox regression. The variables used in the analysis included sex, age, smoking history, tumor size, tumor histology, lymphovascular invasion, visceral pleural invasion, and pathologic TNM stage. A separate cohort of 3,308 patients with NSCLC from Shanghai Chest Hospital was used for external validation.RESULTS: In the development cohort and the external validation cohort for the established nomograms to predict overall recurrence, thorax recurrence, abdomen recurrence, neck recurrence, brain recurrence, and bone recurrence, the C-statistics of Harrell et al were 0.743 and 0.748, 0.728 and 0.703, 0.760 and 0.749, 0.779 and 0.757, 0.787 and 0.784, and 0.777 and 0.739, respectively. The calibration plots showed optimal agreement between nomogrampredicted 3-year recurrence-free survival and actual 3-year recurrence-free survival.CONCLUSIONS: These user-friendly nomograms can precisely predict site-specific recurrence in patients with completely resected NSCLC, based on clinicopathologic features. They may help physicians to make individual postoperative follow-up plans.