Predicting serious complications in patients with cancer and pulmonary embolism using decision tree modelling: the EPIPHANY Index.
Predicting serious complications in patients with cancer and pulmonary embolism using decision tree modelling: the EPIPHANY Index.
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DOI：
10.1038/bjc.2017.48
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发表时间：
2017-04-11
影响因子：
8.8
通讯作者：
Vicente V
中科院分区：
文献类型：
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作者：
Carmona-Bayonas A;Jiménez-Fonseca P;Font C;Fenoy F;Otero R;Beato C;Plasencia JM;Biosca M;Sánchez M;Benegas M;Calvo-Temprano D;Varona D;Faez L;de la Haba I;Antonio M;Madridano O;Solis MP;Ramchandani A;Castañón E;Marchena PJ;Martín M;Ayala de la Peña F;Vicente V
我们的目标是开发一种预后分层工具，使患有癌症和肺栓塞（PE）的患者，无论是偶然的还是症状性的，能够在15天内根据严重并发症的风险进行分类。样本包括来自国家癌症患者肺血栓栓塞登记的病例（来自14个西班牙中心的1075例患者）。53.5%的病例是偶然诊断。穷尽CHAID分析采用10倍交叉验证来预测PE诊断后严重并发症的发展。约208例患者（19.3%，95%可信区间（CI）， 17.1-21.8%）在PE诊断后出现严重并发症。15天死亡率为10.1% （95% CI, 8.4-12.1%）。决策树检测到六个解释性协变量：hestia样临床决策规则（存在任何风险标准与无风险标准），东部合作组绩效量表（ECOG-PS; <2 vs大于或小于2），O2饱和度（<90 vs大于或小于90%），pe特异性症状的存在，肿瘤反应（进展，未知或未评估），以及原发性肿瘤切除。创建了三个风险等级（低、中、高风险）。15天内严重并发症发生率组间差异有统计学意义：1.6、9.4、30.6% P<0.0001。低、中、高风险患者的15天死亡率也逐渐上升：0.3、6.1和17.1% P<0.0001。交叉验证的风险估计为0.191 （s.e.=0.012）。受试者工作特征曲线下的乐观校正面积为0.779 （95% CI, 0.717-0.840）。我们已经开发并内部验证了一个预后指数，用于预测可能影响癌症和PE患者决策的严重并发症。
Our objective was to develop a prognostic stratification tool that enables patients with cancer and pulmonary embolism (PE), whether incidental or symptomatic, to be classified according to the risk of serious complications within 15 days. The sample comprised cases from a national registry of pulmonary thromboembolism in patients with cancer (1075 patients from 14 Spanish centres). Diagnosis was incidental in 53.5% of the events in this registry. The Exhaustive CHAID analysis was applied with 10-fold cross-validation to predict development of serious complications following PE diagnosis. About 208 patients (19.3%, 95% confidence interval (CI), 17.1–21.8%) developed a serious complication after PE diagnosis. The 15-day mortality rate was 10.1%, (95% CI, 8.4–12.1%). The decision tree detected six explanatory covariates: Hestia-like clinical decision rule (any risk criterion present vs none), Eastern Cooperative Group performance scale (ECOG-PS; <2 vs ⩾2), O2 saturation (<90 vs ⩾90%), presence of PE-specific symptoms, tumour response (progression, unknown, or not evaluated vs others), and primary tumour resection. Three risk classes were created (low, intermediate, and high risk). The risk of serious complications within 15 days increases according to the group: 1.6, 9.4, 30.6% P<0.0001. Fifteen-day mortality rates also rise progressively in low-, intermediate-, and high-risk patients: 0.3, 6.1, and 17.1% P<0.0001. The cross-validated risk estimate is 0.191 (s.e.=0.012). The optimism-corrected area under the receiver operating characteristic curve is 0.779 (95% CI, 0.717–0.840). We have developed and internally validated a prognostic index to predict serious complications with the potential to impact decision-making in patients with cancer and PE.