Just how accurate are the major risk stratification systems for early-stage endometrial cancer?
Just how accurate are the major risk stratification systems for early-stage endometrial cancer?
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DOI：
10.1038/bjc.2015.35
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发表时间：
2015-03-03
影响因子：
8.8
通讯作者：
Ballester, M.
中科院分区：
文献类型：
--
作者：
Bendifallah, S.;Canlorbe, G.;Collinet, P.;Arsene, E.;Huguet, F.;Coutant, C.;Hudry, D.;Graesslin, O.;Raimond, E.;Touboul, C.;Darai, E.;Ballester, M.
比较五种主要危险分层系统（RSS）对早期子宫内膜癌（EC）复发和淋巴结转移风险分类的准确性。从2001年1月至2012年12月的前瞻性多中心数据库中提取了553例早期EC患者的数据。在PubMed文献检索中确定了以下RSS，包括子宫内膜癌术后放疗（PORTEC-1）、妇科肿瘤组（GOG）-99、主动脉旁淋巴结切除术的生存效应（SEPAL）、ESMO和ESMO改良分类。根据无复发生存率（RFS）和淋巴结转移情况，评价每个RSS的准确性。总体而言，ESMO改良RSS对RFS和淋巴结转移的区分度最高，一致性指数（C指数）分别为0.73（95% CI，0.70-0.76），曲线下面积（AUC）分别为0.80（0.78-0.72）。其他RSS执行如下：PORTEC 1、GOG-99、SEPAL、ESMO分类给出的C指数为0.68（0.66-0.70）、0.65（0.63-0.67）、0.66 RFS的AUC分别为0.69（0.66-0.72）、0.69（0.67-0.71）、0.68（0.66- 0.70）、0.70（0.68- 0.72），淋巴结转移的AUC分别为0.69（0.66 - 0.72）、0.69（0.67-0.71）、0.68（0.66-0.70）、0.70（0.68-0.72）。五个主要的RSS中没有一个在对早期EC患者的复发或淋巴结转移风险进行分层时显示出高准确性，尽管ESMO修改的分类对这两个参数的区分能力最高。因此，有必要使用其他工具（如生物标志物）重新审视现有RSS，以更好地对这些患者的风险进行分层。
To compare the accuracy of five major risk stratification systems (RSS) in classifying the risk of recurrence and nodal metastases in early-stage endometrial cancer (EC). Data of 553 patients with early-stage EC were abstracted from a prospective multicentre database between January 2001 and December 2012. The following RSS were identified in a PubMed literature search and included the Post Operative Radiation Therapy in Endometrial Carcinoma (PORTEC-1), the Gynecologic Oncology Group (GOG)-99, the Survival effect of para-aortic lymphadenectomy (SEPAL), the ESMO and the ESMO-modified classifications. The accuracy of each RSS was evaluated in terms of recurrence-free survival (RFS) and nodal metastases according to discrimination. Overall, the ESMO -modified RSS provided the highest discrimination for both RFS and for nodal metastases with a concordance index (C-index) of 0.73 (95% CI, 0.70–0.76) and an area under the curve (AUC) of 0.80 (0.78–0.72), respectively. The other RSS performed as follows: the PORTEC1, GOG-99, SEPAL, ESMO classifications gave a C-index of 0.68 (0.66–0.70), 0.65 (0.63–0.67), 0.66 (0.63–0.69), 0.71 (0.68–0.74), respectively, for RFS and an AUC of 0.69 (0.66–0.72), 0.69 (0.67–0.71), 0.68 (0.66–0.70), 0.70 (0.68–0.72), respectively, for node metastases. None of the five major RSS showed high accuracy in stratifying the risk of recurrence or nodal metastases in patients with early-stage EC, although the ESMO-modified classification emerged as having the highest power of discrimination for both parameters. Therefore, there is a need to revisit existing RSS using additional tools such as biological markers to better stratify risk for these patients.
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影响因子：
19.7
作者：
LUSTED, LB
通讯作者：
LUSTED, LB
影响因子：
51.1
作者：
Ballester, Marcos;Dubernard, Gil;Darai, Emile
通讯作者：
Darai, Emile
影响因子：
10.3
作者：
Panici, Pierluigi Benedetti;Basile, Stefano;Mangioni, Costantino
通讯作者：
Mangioni, Costantino
影响因子：
4.7
作者：
Nugent, E. K.;Bishop, E. A.;McMeekin, D. S.
通讯作者：
McMeekin, D. S.
影响因子：
168.9
作者：
Blake, P.;Swart, Ann Marie;Orton, J.;Kitchener, H.;Whelan, T.;Lukka, H.;Eisenhauer, E.;Bacon, M.;Tu, D.;Parmar, M. K. B.;Amos, C.;Murray, C.;Qian, W.
通讯作者：
Qian, W.