A Novel Clinical Prediction Model for Prognosis in Malignant Pleural Mesothelioma Using Decision Tree Analysis
A Novel Clinical Prediction Model for Prognosis in Malignant Pleural Mesothelioma Using Decision Tree Analysis
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DOI：
10.1016/j.jtho.2015.12.108
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发表时间：
2016-04-01
影响因子：
20.4
通讯作者：
Nowak, Anna K.
中科院分区：
文献类型：
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作者：
Brims, Fraser J. H.;Meniawy, Tarek M.;Nowak, Anna K.
简介：恶性胸膜间皮瘤（MPM）是一种罕见的癌症，具有异质性预后。预后模型在临床上并未广泛应用。分类和回归树 (CART) 分析检查多个变量与给定结果的相互作用。方法：2005 年至 2014 年间，所有经病理证实的 MPM 病例均记录了常规可用的组织学、临床和实验室特征。使用 29 个变量进行分类和回归树分析，并以 18 个月生存率作为因变量。根据生存和临床特征细化风险组。然后该模型在外部国际队列中进行了测试。结果：派生队列中总共纳入了 482 例病例；中位生存期为 12.6 个月，中位年龄为 69 岁。该模型定义了四个具有明显生存差异的风险组 (p < 0.0001)。最强的预测变量是体重减轻。 18 个月时生存率最高的组（存活率 86.7%，中位生存期 34.0 个月，称为风险组 1）没有体重减轻，血红蛋白水平大于 153 g/L，血清白蛋白水平大于 43 g/L。存活率最差的组（存活率为 0%，中位存活期 7.5 个月，称为 4d 风险组）体重减轻，表现评分为 0 或 1，并具有肉瘤样组织学特征。该模型的 C 统计量为 0.761，敏感性为 94.5%。对 174 个外部病例的验证证实了该模型能够以公平的性能区分替代数据集中的风险组（C 统计量 0.68）。 结论：我们开发并验证了一个简单的、临床相关的模型，可以使用未选择的 MPM 患者群体诊断时的常规可用变量，可靠地区分高死亡风险和低死亡风险的患者。 (C) 2016 年国际肺癌研究协会。由爱思唯尔公司出版。保留所有权利。
Introduction: Malignant pleural mesothelioma (MPM) is a rare cancer with a heterogeneous prognosis. Prognostic models are not widely utilized clinically. Classification and regression tree (CART) analysis examines the interaction of multiple variables with a given outcome.Methods: Between 2005 and 2014, all cases with pathologically confirmed MPM had routinely available histological, clinical, and laboratory characteristics recorded. Classification and regression tree analysis was performed using 29 variables with 18-month survival as the dependent variable. Risk groups were refined according to survival and clinical characteristics. The model was then tested on an external international cohort.Results: A total of 482 cases were included in the derivation cohort; the median survival was 12.6 months, and the median age was 69 years. The model defined four risk groups with clear survival differences (p < 0.0001). The strongest predictive variable was the presence of weight loss. The group with the best survival at 18 months (86.7% alive, median survival 34.0 months, termed risk group 1) had no weight loss, a hemoglobin level greater than 153 g/L, and a serum albumin level greater than 43 g/L. The group with the worst survival (0% alive, median survival 7.5 months, termed risk group 4d) had weight loss, a performance score of 0 or 1, and sarcomatoid histological characteristics. The C-statistic for the model was 0.761, and the sensitivity was 94.5%. Validation on 174 external cases confirmed the model's ability to discriminate between risk groups in an alternative data set with fair performance (C-statistic 0.68).Conclusions: We have developed and validated a simple, clinically relevant model to reliably discriminate patients at high and lower risk of death using routinely available variables from the time of diagnosis in unselected populations of patients with MPM. (C) 2016 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.