Adherence to pelvic lymph node dissection recommendations according to the National Comprehensive Cancer Network pelvic lymph node dissection guideline and the D'Amico lymph node invasion risk stratification

Purpose

To assess adherence rates to pelvic lymph node dissection (PLND) according to National Comprehensive Cancer Network (NCCN) PLND guideline (2% or higher risk) and D’Amico lymph node invasion (LNI) risk stratification (intermediate/high risk) in contemporary North American patients with prostate cancer treated with radical prostatectomy (RP).

Validation of a Nomogram to Predict the Presence of Sentinel Lymph Node Metastases in Melanoma

Background  Lymph node involvement is a very important prognostic factor for cutaneous melanoma. In this paper we try to validate a nomogram that was created at the Memorial Sloan–Kettering Cancer Center, New York, to predict the probability of metastases in the sentinel nodes of patients with cutaneous melanoma. Methods  Values of the following variables were collected in 218 patients with cutaneous melanoma and sentinel lymph node: age, thickness, level of Clark, location of the lesion, and ulceration or not, and the nomogram was applied to assess the probability of sentinel node involvement in each patient. The discrimination of the nomogram was assessed by calculating the area under the receiver operating characteristics (ROC) curve, and to assess the accuracy of the nomogram actual probabilities were plotted against the nomogram-calculated predicted probability. Results  The overall predictive accuracy of the nomogram was 0.869 (95% confidence interval 0.813–0.925). Mean predicted probability of sentinel node metastasis was highly correlated to the observed risk (r = 0.953; P < 0.012). Conclusion  The nomogram is a useful diagnostic tool that provides an adequate accurate prediction of the probability of sentinel lymph node metastases in patients with cutaneous melanoma.     

Analysis of Clinical Applicability of the Breast Cancer Nomogram for Positive Sentinel Lymph Node: The Canadian Experience

Background  A Breast Cancer Nomogram (BCN) for predicting nonsentinel lymph node (NSLN) involvement has been developed and prospectively tested in several series. However, its clinical applicability has never been tested among surgeons. Methods  The BCN was applied to 209 SLN-positive patients. Its performance was assessed by the area under the receiver–operating characteristic (ROC) curve. Surgeons in Quebec were surveyed to determine the predicted NSLN positivity below which they would not dissect the axilla. The accuracy of the BCN was determined in this clinically relevant range. Results  The predictive accuracy of the BCN had an area under the ROC curve of 0.687. Almost half of interviewed surgeons treat over 20 breast cancer per year. Fourteen out of 82 surgeons questioned would never leave the patient without a completion axillary dissection after a positive SLN, regardless of the BCN result. Seventy one percent of them would not complete axillary dissection if the prediction of a positive NSLN was ≤10%. Only 37 of the 209 patients were in this 10% or less category, with a mean observed rate of positive NSLN of 13% (95% confidence interval [CI], 2–24%). Conclusion  The global performance of the BCN was fair. A majority of surgeons in Quebec would omit an axillary lymph node dissection (ALND) if the predicted probability of positive NSLN is 10% or less. Although useful, the BCN data should be used with caution at the low end of the scale. Because of some limitations in the performance in this category, other clinical factors and judgment must accompany its use.     

A nomogram to predict radiation pneumonitis, derived from a combined analysis of RTOG 9311 and institutional data

PURPOSE: To test the Washington University (WU) patient dataset, analysis of which suggested that superior-to-inferior tumor position, maximum dose, and D35 (minimum dose to the hottest 35% of the lung volume) were valuable to predict radiation pneumonitis (RP), against the patient database from Radiation Therapy Oncology Group (RTOG) trial 9311. METHODS AND MATERIALS: The entire dataset consisted of 324 patients receiving definitive conformal radiotherapy for non-small-cell lung cancer (WU = 219, RTOG 9311 = 129). Clinical, dosimetric, and tumor location parameters were modeled to predict RP in the individual datasets and in a combined dataset. Association quality with RP was assessed using Spearman's rank correlation (r) for univariate analysis and multivariate analysis; comparison between subgroups was tested using the Wilcoxon rank sum test. RESULTS: The WU model to predict RP performed poorly for the RTOG 9311 data. The most predictive model in the RTOG 9311 dataset was a single-parameter model, D15 (r = 0.28). Combining the datasets, the best derived model was a two-parameter model consisting of mean lung dose and superior-to-inferior gross tumor volume position (r = 0.303). An equation and nomogram to predict the probability of RP was derived using the combined patient population. CONCLUSIONS: Statistical models derived from a large pool of candidate models resulted in well-tuned models for each subset (WU or RTOG 9311), which did not perform well when applied to the other dataset. However, when the data were combined, a model was generated that performed well on each data subset. The final model incorporates two effects: greater risk due to inferior lung irradiation, and greater risk for increasing normal lung mean dose. This formula and nomogram may aid clinicians during radiation treatment planning for lung cancer.     

Adult-type soft tissue sarcomas in paediatric age: a nomogram-based prognostic comparison with adult sarcoma

IntroductionThe study compares the outcome of paediatric patients with adult-type soft tissue sarcomas with that reported for adults, taking into account the effect of established prognostic factors.MethodsThe actual mortality of our series was compared with that predicted by the nomogram developed for adults at the Memorial Sloan Kettering Cancer Center. From a previously-published series of 182 patients <18 years, 112 cases fulfilling the criteria for the nomogram application were selected.ResultsActual 10-year mortality for the series was 29%, compared with a 16% predicted mortality. The effect of individual covariates was qualitatively consistent with that of adults, but the unfavourable prognostic effect of tumour size was stronger in paediatric cases.ConclusionThe variables known to have a prognostic role in adults are relevant also in children. The worse outcome observed in our series might be explained by the stronger adverse effect of tumour size in young patients.     

基于超声内镜下胃小间质瘤特征表现的诊断预测列线图模型建立

目的建立基于超声内镜下特征表现的胃小间质瘤诊断预测列线图模型。方法回顾性收集2015年6月—2021年8月于同济大学附属同济医院消化内科行内镜下切除的长径<2 cm胃黏膜下肿瘤的189例患者临床病理资料。所有病例通过R软件随机函数按2∶1的比例分为建模组(n=126)和验证组(n=63)。在建模组中采用单因素和多因素Logistic回归分析筛选出超声内镜下诊断胃小间质瘤的独立影响因素, 构建列线图模型。在建模组和验证组中绘制受试者工作特征(receiver operator characteristic, ROC)曲线以评价模型的区分度, 采用Hosmer-Lemeshow检验和校准曲线以评价模型的校准度。结果患者年龄>60岁(OR=2.815, 95%CI:1.148～6.900, P=0.024)、病灶位于贲门/胃底(OR=5.210, 95%CI:1.225～22.165, P=0.025)、起源于固有肌层(OR=6.404, 95%CI:2.262～18.135, P<0.001)、呈腔外生长(OR=6.024, 95%CI:1.252～28.971, P=0...     

内镜逆行胰胆管造影术后急性胆管炎的危险因素研究及其列线图的构建

目的探讨内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography, ERCP)后急性胆管炎的危险因素及其列线图的构建。方法回顾性分析2014年1月—2019年12月在兰州大学第一医院因胆总管结石接受ERCP的患者临床资料, 纳入术后发生急性胆管炎的患者95例(胆管炎组), 以1∶3比例通过软件随机抽样选择术后未发生急性胆管炎的患者285例(无胆管炎组)。采用Logistic回归模型分析影响ERCP术后急性胆管炎的独立危险因素, 根据多因素分析结果, 建立预测ERCP术后急性胆管炎发生率的列线图模型。结果单因素比较发现 ERCP术后发生胆管炎患者和未发生胆管炎患者在年龄、合并糖尿病、丙氨酸转氨酶、碱性磷酸酶、葡萄糖、胆囊壁粗糙、胆管直径、胆管下端狭窄、行经内镜胆道内支架放置术比例、行经内镜鼻胆管引流术比例方面差异均有统计学意义(P<0.05)。Logistic多因素回归分析显示, 高龄(OR=1.108, 95%CI:1.079～1.138, P<0.001)、合并糖尿病(OR=4.524, 95%CI:1.299～1...     

基于美国国家癌症研究所监测、流行病学、结果数据库食管癌病人预后影响因素分析

目的剖析影响食管癌病人生存的临床参数,构建列线图以预测食管癌病人的 1年、 3年及 5年生存率。方法利用美国国家癌症研究所监测、流行病学、结果数据库( National Cancer Institute,The Surveillance Epidemiology and End Results program,SEER),共获 2010年 1月至 2015年 12月 8 863例食管癌病人的年龄、病理等临床资料和相关随访数据。按随机数字表法分为验证组( 2 656例)和列线图建模组( 6 207例)(分配比例是 3∶7)。建模组用 Kaplan-Meier进行单因素生存分析,用 log-rank检验法评估生存率的差异;将在单因素分析中差异有统计学意义的变量纳入多因素 Cox比例风险模型,寻找建模组病人预后独立影响因素,将确定因素纳入并构建列线图,预测食管癌病人 1年、 3年及 5年生存率。通过一致性指数( C-index)和校正曲线评估其预测的准确性和判别能力。结果食管癌病人的年龄、性别、种族、组织分级、美国癌症联合协会( AJCC)第 7版 T分期、 N分期、 M分期、手术、化疗均是其预后独立影响因素( P<0.05)将以上因素纳入并构建列线图。 C-index:建模组内部验证为 0.726(95%CI:0.718~0.734),验证组外部验证为 0.723(95%CI:0.71,1~0.735);同时两组的校正曲线一致性良好。结论分析