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Ann Thorac Surg:预测手术完全切除的淋巴结阴性的非小细胞肺癌患者的复发仍具难度

2018-07-26 李新宇 MedSci原创

之前的研究表明五分之一的完全切除的早期非小细胞肺癌(NSCLC)患者将在两年内复发。因此对患者进行风险分层有助于辅助治疗和随访的个体化进行。本研究基于五个临床变量(肿瘤大小和分级,脏层胸膜和淋巴管血管的侵犯,以及手术方式为亚肺叶切除)训练了复发预测模型,并在验证集上进行验证。研究人员还在模型中添加几个长期预后不良的分子标记物(如血管内皮生长因子-C、miR-486、miR-30d)后可以提高模型的

背景:
之前的研究表明五分之一的完全切除的早期非小细胞肺癌NSCLC)患者将在两年内复发。因此对患者进行风险分层有助于辅助治疗和随访的个体化进行。本研究基于五个临床变量(肿瘤大小和分级,脏层胸膜和淋巴管血管的侵犯,以及手术方式为亚肺叶切除)训练了复发预测模型,并在验证集上进行验证。研究人员还在模型中添加几个长期预后不良的分子标记物(如血管内皮生长因子-C、miR-486、miR-30d)后可以提高模型的预测效能。

方法:
本研究使用了肺癌生物样本资源网络对完全切除的淋巴结阴性NSCLC患者进行了一项回顾性的队列研究。该试验运用Cox回归来估计两年内复发的风险。研究人员对模型性能的主要衡量标准是校正后的c统计量。

结果:
该研究共纳入了173例患者(肿瘤平均大小3.6 cm; 12%手术方式为亚肺叶切除术; 32%为低分化; 16%有淋巴管血管侵犯; 26%有脏层胸膜浸润),2年复发率为23%(95%置信区间CI:17-31%)。我们使用五种已知的复发风险因素的预测模型仅比随机预测稍好(校正后的c统计量0.54,95%CI:0.51-0.68)。分子标记物的添加并未明显改善模型预测复发的能力(校正后的c-统计量0.55,95%CI:0.52-0.71)。

结论:
临床医生无法使用基于五个众所周知的临床风险因素和几种分子标记物建立的风险预测模型来预测肺癌复发。进一步的研究应考虑新的复发预测因素,以便根据其复发风险对完全切除的早期NSCLC患者进行风险分层

原文出处:

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    2019-06-20 yyj062
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    2018-07-28 sodoo
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