PDF(Pubmed)
Abstract：
Objective: To assess the association between pretreatment thrombocytosis, anemia, and leukocytosis and overall survival (OS) of advanced-stage EOC. Furthermore, to develop nomograms using established prognostic factors and pretreatment hematologic parameters to predict the OS of advanced EOC patients. Methods: Advanced-stage EOC patients treated between January 1996 and January 2010 in eastern Netherlands were included. Survival outcomes were compared between patients with and without pretreatment thrombocytosis (≥450,000 platelets/µL), anemia (hemoglobin level of <7.5 mmol/L), or leukocytosis (≥11.0 × 109 leukocytes/L). Three nomograms (for ≤3-, ≥5-, and ≥10-year OS) were developed. Candidate predictors were fitted into multivariable logistic regression models. Multiple imputation was conducted. Model performance was assessed on calibration, discrimination, and Brier scores. Bootstrap validation was used to correct for model optimism. Results: A total of 773 advanced-stage (i.e., FIGO stages IIB-IV) EOC patients were included. The median [interquartile range, IQR] OS was 2.3 [1.3-4.2] and 3.0 [1.4-7.0] years for patients with and without pretreatment thrombocytosis (p < 0.01). The median OS was not notably different for patients with and without pretreatment leukocytosis (p = 0.58) or patients with and without pretreatment anemia (p = 0.07). The final nomograms comprised established predictors with either pretreatment leukocyte or platelet count. The ≥5- and ≥10-year OS models demonstrated good calibration and adequate discrimination with optimism-corrected c-indices [95%-CI] of 0.76 [0.72-0.80] and 0.78 [0.73-0.83], respectively. The ≤3-year OS model demonstrated suboptimal performance with an optimism-corrected c-index of 0.71 [0.66-0.75]. Conclusions: Pretreatment thrombocytosis is associated with poorer EOC survival. Two well-performing models predictive of ≥5-year and ≥10-year OS in advanced-stage EOC were developed and internally validated.
摘要：
目的：评估治疗前血小板增多症，贫血,以及晚期EOC的白细胞增多和总体生存率（OS）。此外，使用已确定的预后因素和治疗前血液学参数制作列线图，以预测晚期EOC患者的OS。方法：纳入1996年1月至2010年1月在荷兰东部接受治疗的晚期EOC患者。比较有和没有治疗前血小板增多症（≥450,000血小板/微升）的患者的生存结果，贫血（血红蛋白水平<7.5mmol/L），或白细胞增多（≥11.0×109个白细胞/L）。三个列线图(对于≤3-，≥5-,和≥10年OS)。将候选预测因子拟合到多变量逻辑回归模型中。进行了多次填补。在校准时评估模型性能，歧视,和Brier得分.Bootstrap验证用于校正模型乐观。结果：总共773个晚期阶段(即，包括FIGO阶段IIB-IV）EOC患者。中位数[四分位数间距，IQR]OS分别为2.3[1.3-4.2]和3.0[1.4-7.0]年[p<0.01]。有和没有治疗前白细胞增多的患者（p=0.58）或有和没有治疗前贫血的患者（p=0.07）的中位OS没有显着差异。最终的列线图包括具有预处理白细胞或血小板计数的已确定的预测因子。≥5年和≥10年OS模型显示出良好的校准和足够的辨别能力，乐观校正的c指数[95%-CI]为0.76[0.72-0.80]和0.78[0.73-0.83]，分别。≤3年OS模型表现出次优的性能，乐观校正的c指数为0.71[0.66-0.75]。结论：治疗前血小板增多与EOC生存率降低相关。开发并内部验证了两个在高级EOC中预测≥5年和≥10年OS的性能良好的模型。
