Comorbidity predicts poor prognosis in nasopharyngeal carcinoma: Development and validation of a predictive score model
Comorbidity predicts poor prognosis in nasopharyngeal carcinoma: Development and validation of a predictive score model
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合并症预测鼻咽癌的不良预后：预测评分模型的开发和验证。
DOI：
10.1016/j.radonc.2014.12.002
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发表时间：
2015-02-01
影响因子：
5.7
通讯作者：
Ma, Jun
中科院分区：
文献类型：
--
作者：
Guo, Rui;Chen, Xiao-Zhong;Ma, Jun
背景与目的：鼻咽癌（NPC）合并症对预后的影响尚不清楚。材料和方法：采用成人共病评估-27 （ACE-27）系统，评估共病的预后价值，并利用受试者工作曲线下面积分析，在训练集（n = 658）、内部验证集（n = 658）和独立集（n = 652）中建立、验证和确认预测评分模型。结果：1968例患者中40.4%存在合并症（轻度，30.1%；中度，9.1%；重度，1.2%）。与ACE-27评分为1的训练组总生存期（OS）和无病生存期（DFS）较短（P < 0.001）相比，其他组的结果相似（P < 0.05）。在多因素分析中，ACE-27评分是OS和DFS的重要独立预后因素。包括ACE-27在内的联合风险评分模型在内部验证集（0.70 vs. 0.66, P = 0.02）、独立集（0.73 vs. 0.67, P = 0.002）和所有患者（0.71 vs. 0.67, P < 0.001）中均优于TNM分期。结论：合并症显著影响预后，尤其是II期和III期，应纳入鼻咽癌TNM分期体系。评估合并症可以改善预后预测，并有助于定制个体化治疗。2014爱思唯尔爱尔兰有限公司版权所有。
Background and purpose: The impact of comorbidity on prognosis in nasopharyngeal carcinoma (NPC) is poorly characterized.Material and methods: Using the Adult Comorbidity Evaluation-27 (ACE-27) system, we assessed the prognostic value of comorbidity and developed, validated and confirmed a predictive score model in a training set (n = 658), internal validation set (n = 658) and independent set (n = 652) using area under the receiver operating curve analysis.Results: Comorbidity was present in 40.4% of 1968 patients (mild, 30.1%; moderate, 9.1%; severe, 1.2%). Compared to an ACE-27 score 1 in the training set had shorter overall survival (OS) and disease-free survival (DFS) (both P < 0.001), similar results were obtained in the other sets (P < 0.05). In multivariate analysis, ACE-27 score was a significant independent prognostic factor for OS and DFS. The combined risk score model including ACE-27 had superior prognostic value to TNM stage alone in the internal validation set (0.70 vs. 0.66; P = 0.02), independent set (0.73 vs. 0.67; P = 0.002) and all patients (0.71 vs. 0.67; P < 0.001).Conclusions: Comorbidity significantly affects prognosis, especially in stages II and III, and should be incorporated into the TNM staging system for NPC. Assessment of comorbidity may improve outcome prediction and help tailor individualized treatment. (C) 2014 Elsevier Ireland Ltd. All rights reserved.