Development and Validation of Nomograms Predictive of Overall and Progression-Free Survival in Patients With Oropharyngeal Cancer
Development and Validation of Nomograms Predictive of Overall and Progression-Free Survival in Patients With Oropharyngeal Cancer
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DOI：
10.1200/jco.2016.72.0748
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发表时间：
2017-12-20
影响因子：
45.3
通讯作者：
Gillison, Maura L.
中科院分区：
文献类型：
--
作者：
Fakhry, Carole;Zhang, Qiang;Gillison, Maura L.
口咽鳞状细胞癌（OPSCC）的治疗正朝着基于风险的治疗强度调整方向发展，这需要患者特异性的总生存期（OS）和无进展生存期（PFS）的估计。我们使用了493例已知p16肿瘤状态的OPSCC患者的衍生队列，（人乳头瘤病毒的替代物）和吸烟史（包-年），随机分配到使用铂基放化疗的临床试验（NRG肿瘤放射治疗肿瘤组[RTOG] 0129和0522）。列线图由考克斯模型创建，并通过使用自助法和交叉验证进行内部验证。模型的区别是衡量校准图和一致性指数。在随机分配到第三个试验NRG Oncology RTOG 9003的153例OPSCC患者队列中，对诺模图进行外部验证。结果两个模型均包括年龄、Zubrod体能状态、包-年、教育、p16状态、T和N分期，OS模型还包括贫血和年龄3包-年的相互作用。PFS模型还包括婚姻状况、体重减轻和p16 3 Zubrod相互作用。预测与观察到的2年和5年结果相关性良好。OS和PFS的未校正一致性指数分别为0.76（95% CI，0.72 - 0.80）和0.70（95% CI，0.66 - 0.74），偏倚校正指数相似。在验证集中，OS和PFS模型得到了很好的校准，OS和PFS在诺模图评分的三分位数之间存在显著差异（对数秩P = .003; < .001）。(c)2017年美国临床肿瘤学会
PurposeTreatment of oropharyngeal squamous cell carcinoma (OPSCC) is evolving toward risk-based modification of therapeutic intensity, which requires patient-specific estimates of overall survival (OS) and progression-free survival (PFS).MethodsTo develop and validate nomograms for OS and PFS, we used a derivation cohort of 493 patients with OPSCC with known p16 tumor status (surrogate of human papillomavirus) and cigarette smoking history (pack-years) randomly assigned to clinical trials using platinum-based chemoradiotherapy (NRG Oncology Radiation Therapy Oncology Group [RTOG] 0129 and 0522). Nomograms were created from Cox models and internally validated by use of bootstrap and cross-validation. Model discrimination was measured by calibration plots and the concordance index. Nomograms were externally validated in a cohort of 153 patients with OPSCC randomly assigned to a third trial, NRG Oncology RTOG 9003.ResultsBoth models included age, Zubrod performance status, pack-years, education, p16 status, and T and N stage; the OS model also included anemia and age 3 pack-years interaction; and the PFS model also included marital status, weight loss, and p16 3 Zubrod interaction. Predictions correlated well with observed 2-year and 5-year outcomes. The uncorrected concordance index was 0.76 (95% CI, 0.72 to 0.80) for OS and 0.70 (95% CI, 0.66 to 0.74) for PFS, and bias-corrected indices were similar. In the validation set, OS and PFS models were well calibrated, and OS and PFS were significantly different across tertiles of nomogram scores (log-rank P = .003; < .001).ConclusionThe validated nomograms provided useful prediction of OS and PFS for patients with OPSCC treated with primary radiation-based therapy. (c) 2017 by American Society of Clinical Oncology