Development and validation of a nomogram in survival prediction among advanced breast cancer patients.
Development and validation of a nomogram in survival prediction among advanced breast cancer patients.
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晚期乳腺癌患者生存预测列线图的开发和验证。
DOI：
10.21037/atm-20-3473
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发表时间：
2020-11
影响因子：
--
通讯作者：
Wang Y
中科院分区：
文献类型：
--
作者：
Zhao J;Yang Y;Pang D;Yu Y;Lin X;Chen K;Ye G;Tang J;Hu Q;Chai J;Bi Z;Ding L;Wu W;Zeng Y;Gui X;Liu D;Yao H;Wang Y
晚期乳腺癌（ABC）患者的总生存期（OS）差异很大。尽管分子亚型被认为是OS分化中最重要的因素，但具有相同分子亚型的患者之间的OS仍然存在显著差异，这导致需要更准确的预后预测模型。本研究旨在建立一个基于当前诊断和治疗的预测模型（诺模图）来预测中国新诊断ABC患者的OS。从该机构的数据库中，我们收集了来自中山纪念医院（国立医院）的368名ABC患者的数据作为训练集，以建立具有预后风险因素的诺模图，计算预测的生存概率。使用一致性指数（C指数）、校准图和风险组分层，对来自其他两个机构的278例ABC患者的列线图进行了独立验证。预后诺模图中包括最初的原发性肿瘤分期、分子亚型、无病生存期（DFS）、脑转移的存在以及转移性疾病（局部复发、寡转移性疾病或多转移性疾病）的肿瘤负担。诺模图在训练集和验证集中的C指数分别为0.77和0.71。列线图能够将患者分别分层为不同的风险组（HR 6.81，95% CI：4.69至9.89，P<0.001）。在低风险评分组（风险评分<11）中，化疗和激素治疗的OS无显著差异（HR 0.81，95% CI：0.44 ~ 1.47，P=0.48）。我们已经构建了一个新的预测诺模图，可以指导医生选择个性化的治疗方案。此外，我们的研究是第一个将寡转移性疾病和原发性内分泌/曲妥珠单抗耐药加入预后模型的研究。
The overall survival (OS) among patients with advanced breast cancer (ABC) varies greatly. Although molecular subtype is known as the most important factor in OS differentiation, significant differences in OS among patients with the same molecular subtype still occur, leading to the need for a more accurate prognostic prediction model. This study aimed to develop a prediction model (nomogram) based on current diagnosis and treatment to predict the OS of newly diagnosed ABC patients in China. From the institution’s database, we collected data of 368 ABC patients from Sun Yat-sen Memorial Hospital (national hospital) as a training set to establish a nomogram with prognostic risk factors that calculated the predicted probability of survival. Nomograms were independently validated with 278 patients with ABC from two other institutions using the concordance index (C-index), calibration plots and risk group stratifications. The initial primary tumor stage, molecular subtype, disease-free survival (DFS), presence of brain metastasis, and the tumor burden of metastasis disease (local recurrence, oligo-metastatic disease, or multiple-metastatic disease) were included in the prognostic nomogram. The nomogram had a C-index of 0.77 and 0.71 in the training and the validation sets, respectively. The nomogram was able to stratify patients into different risk groups, respectively (HR 6.81, 95% CI: 4.69 to 9.89, P<0.001). In the lower risk score group (risk score <11), there was no significant difference between the OS with chemotherapy and hormone therapy (HR 0.81, 95% CI: 0.44 to 1.47, P=0.48). We have constructed a novel prediction nomogram that can guide the physicians to select personalized treatment options. Furthermore, our study is the first to add oligo-metastatic disease and primary endocrine/trastuzumab resistance into the prognostic models.
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DOI：
10.1200/jco.2015.61.5831
发表时间：
2015-11-10
期刊：
Journal of clinical oncology : official journal of the American Society of Clinical Oncology
影响因子：
--
作者：
Ellis MJ;Llombart-Cussac A;Feltl D;Dewar JA;Jasiówka M;Hewson N;Rukazenkov Y;Robertson JF
通讯作者：
Robertson JF
影响因子：
3.9
作者：
Llombart-Cussac, Antonio;Pivot, Xavier;Cortes, Javier
通讯作者：
Cortes, Javier
影响因子：
3.8
作者：
Lee, C. K.;Hudson, M.;Simes, R. J.
通讯作者：
Simes, R. J.
影响因子：
45.3
作者：
Subbiah, Ishwaria M.;Lei, Xiudong;Gonzalez-Angulo, Ana M.
通讯作者：
Gonzalez-Angulo, Ana M.
影响因子：
2.2
作者：
Reblin, Maija;Cloyes, Kristin G.;Ellington, Lee
通讯作者：
Ellington, Lee