Predicting postrecurrence survival among completely resected nonsmall-cell lung cancer patients
Predicting postrecurrence survival among completely resected nonsmall-cell lung cancer patients
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DOI：
10.1016/j.athoracsur.2005.09.020
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发表时间：
2006-03-01
影响因子：
4.6
通讯作者：
Yang, P
中科院分区：
文献类型：
--
作者：
Williams, BA;Sugimura, H;Yang, P
背景。非小细胞肺癌（NSCLC）完全切除后复发后的生存一直被认为是一个多因素过程，取决于人口统计学、临床、生物学和治疗特点。本研究旨在量化这些特征对复发后生存的预后影响。我们研究了390名接受了完全切除并随后复发的非小细胞肺癌患者。通过Cox比例风险模型评估初始和复发疾病特征与复发后生存率之间的关系。多变量Cox模型确定了与复发后生存最密切相关的因素。基于该模型的简单算法有助于估计复发后死亡率的风险，并通过风险评分点进行量化。与复发后生存最密切相关的因素是复发时的表现状态（3,4,4.2分；2,2.8分；和1,1.5分），复发时的症状（3.6分），肝脏复发（2.3分），初始肺癌IIB期或更严重（1.8分）和多次复发（1.0分）。基于这些因素，将患者分层为低危（总分4.0分以下）、中低危（总分4.1 - 6.1分）、中高危（总分6.1 - 8.0分）和高危（总分8.0分以上），12个月生存率分别为75%、51%、25%和9%。两组患者术后生存率差异有统计学意义（p < 0.01）。所提出的预测工具为临床医生提供了一个快速评估复发后死亡风险的简洁工具。组成该仪器的特征可以很容易地确定和测量，使其具有潜在的临床价值。
Background. Survival after recurrence subsequent to complete resection of nonsmall-cell lung cancer (NSCLC) has been considered a multifactorial process dependent on demographic, clinical, biological, and treatment characteristics. This study sought to quantify the prognostic effects of these characteristics on postrecurrence survival.Methods. Three hundred ninety NSCLC patients who underwent complete resection and subsequently had recurrent cancer were studied. The associations between characteristics of both the initial and recurrent disease with postrecurrence survival were evaluated by Cox proportional hazards models. A multivariable Cox model determined those factors most strongly associated with postrecurrence survival. A simple algorithm based on this model facilitates estimating risk of postrecurrence mortality, as quantified by risk score points.Results. The factors most strongly associated with postrecurrence survival were performance status at recurrence (3 or 4, 4.2 points; 2, 2.8 points; and 1, 1.5 points), symptoms at recurrence (3.6 points), liver recurrence (2.3 points), initial lung cancer stage IIB or worse (1.8 points), and multiple recurrences (1.0 points). Based on these factors, patients were stratified as low risk (4.0 or fewer total points), moderate-low risk (4.1 to 6.1 points), moderate-high risk (6.1 to 8.0 points), and high risk (more than 8.0 points), with 12-month survival of 75%, 51%, 25%, and 9%, respectively. Postrecurrence survival was significantly different across groups (p < 0.01).Conclusions. The proposed prediction instrument offers clinicians a succinct tool for rapidly evaluating mortality risk after recurrence. The characteristics comprising this instrument can be easily ascertained and measured, making it of potential clinical value.