Development of a Prognostic Model to Identify the Suitable Definitive Radiation Therapy Candidates in de Novo Metastatic Nasopharyngeal Carcinoma: A Real-World Study.
Development of a Prognostic Model to Identify the Suitable Definitive Radiation Therapy Candidates in de Novo Metastatic Nasopharyngeal Carcinoma: A Real-World Study.
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开发一个预后模型来确定新发转移性鼻咽癌合适的最终放射治疗候选者：一项真实世界研究。
DOI：
10.1016/j.ijrobp.2020.08.045
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发表时间：
2021-01-01
影响因子：
7
通讯作者：
Xiang, Yan-Qun
中科院分区：
文献类型：
--
作者：
Li, Wang-Zhong;Lv, Shu-Hui;Liu, Guo-Ying;Liang, Hu;Guo, Xiang;Lv, Xing;Liu, Kui-Yuan;Qiang, Meng-Yun;Chen, Xi;Gu, Sophie Z.;Xie, Chang-Qing;Xia, Wei-Xiong;Xiang, Yan-Qun
我们的目的是建立一个准确的预后模型，以确定确定性放射治疗（DRT）除了姑息化疗（PCT）的原发转移性鼻咽癌（mNPC）患者的合适的候选人。纳入了接受一线PCT（伴或不伴DRT）的原发mNPC患者。使用治疗权重调整的生存分析的逆概率估计单独接受PCT与PCT + DRT的患者的总生存期。我们开发并验证了一个预测模型，以预测新发mNPC的生存和分层风险。应用基于模型的树方法，使用从预后模型获得的预后评分估计分层治疗效应，并确定合适的DRT候选药物。优势分析用于确定接受DRT的每个预测因子的相对重要性。共入组460例患者; 244例接受PCT + DRT，216例仅接受PCT。6个月条件标志、治疗权重调整的逆概率考克斯回归分析显示，PCT加DRT与显著的生存获益相关（风险比：0.516; 95%置信区间，0.403-0.660; P < .001）。建立了一个基于5个独立预后因素的预后模型，包括血清乳酸脱氢酶、转移部位数量、肝转移的存在、治疗后EB病毒DNA水平和转移对化疗的反应，并随后进行了验证。从预后模型中获得的预后评分用于风险分层和疗效估计。使用所提出的模型确定的高风险患者不会从额外的DRT中获益，而低风险患者则会获得显著的生存获益。社会经济因素，包括保险状况和受教育程度，在接受DRT中起重要作用。PCT后额外的DRT与原发mNPC患者的总生存期增加相关，特别是新开发的预后模型确定的低风险患者。
We aimed to develop an accurate prognostic model to identify suitable candidates for definitive radiation therapy (DRT) in addition to palliative chemotherapy (PCT) among patients with de novo metastatic nasopharyngeal carcinoma (mNPC). Patients with de novo mNPC who received first-line PCT with or without DRT were included. Overall survival for patients who received PCT alone versus PCT plus DRT was estimated using inverse probability of treatment weighting–adjusted survival analyses. We developed and validated a prognostic model to predict survival and stratify risks in de novo mNPC. A model-based trees approach was applied to estimate stratified treatment effects using prognostic scores obtained from the prognostic model and to identify suitable DRT candidates. Dominance analysis was used to determine the relative importance of each predictor of receiving DRT. A total of 460 patients were enrolled; 244 received PCT plus DRT and 216 received PCT alone. The 6-month conditional landmark, inverse probability of treatment weighting–adjusted Cox regression analysis showed that PCT plus DRT was associated with a significant survival benefit (hazard ratio: 0.516; 95% confidence interval, 0.403–0.660; P < .001). A prognostic model based on 5 independent prognostic factors, including serum lactate dehydrogenase, number of metastatic sites, presence of liver metastasis, posttreatment Epstein–Barr virus DNA level, and response of metastases to chemotherapy was developed and subsequently validated. Prognostic scores obtained from the prognostic model were used for risk stratification and efficacy estimation. High-risk patients identified using the proposed model would not benefit from additional DRT, whereas low-risk patients experienced significant survival benefits. Socioeconomic factors, including insurance status and education level, played an important role in receipt of DRT. Additional DRT after PCT was associated with increased overall survival in patients with de novo mNPC, especially low-risk patients identified with a newly developed prognostic model.
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影响因子：
8.4
作者：
Eisenhauer, E. A.;Therasse, P.;Verweij, J.
通讯作者：
Verweij, J.
DOI：
10.1002/hed.21890
发表时间：
2012-08-01
影响因子：
2.9
作者：
Hsu, Cheng-Lung;Chang, Kai-Ping;Wang, Hung-Ming
通讯作者：
Wang, Hung-Ming
影响因子：
45.3
作者：
Fandi, A;Bachouchi, M;Cvitkovic, E
通讯作者：
Cvitkovic, E
鼻咽癌中 microRNA 特征的预后价值：microRNA 表达分析
影响因子：
51.1
作者：
Liu, Na;Chen, Nian-Yong;Ma, Jun
通讯作者：
Ma, Jun
影响因子：
6.2
作者：
An, Xin;Wang, Feng-Hua;Li, Yu-Hong
通讯作者：
Li, Yu-Hong