目的:确定黑色素瘤生存的预后模型,复发和转移的美国联合委员会在癌症Ⅰ期和Ⅱ期患者术后;并评估模型性能,包括总生存期(OS)预测。
方法:系统回顾和叙事综合。
方法:搜索MEDLINE,Embase,CINAHL,科克伦图书馆,2000年至2021年9月的科学引文索引和灰色文献来源,包括癌症和指南网站。
方法:纳入了关于≥18岁成人I期和II期黑色素瘤风险预测模型的研究。成果包括操作系统,复发,转移和模型性能。未应用语言或发布国家/地区限制。
方法:两对评审员独立筛选研究,提取数据,并使用关键评估和数据提取的关键评估和预测模型研究核对表和预测研究风险评估工具的系统审查偏差风险评估的风险。异质预测因子阻止了统计综合。
结果:从28967条记录中,包括15项报告20个模型的研究;8项(第一阶段),2(第二阶段),7(阶段I-II)和7(阶段未报告),但显然适用于早期阶段。每个模型的临床病理预测因子范围为3-10。最常见的是:溃疡,Breslow厚度/深度,社会人口统计状况和地点。据报道,判别值≥0.7。校准测量显示预测和观察到的速率之间的良好匹配。没有一项研究评估了模型的临床有用性。在八个模型中,偏差的风险很高,九分之一不清楚,三分之一低。七个模型进行了内部和外部交叉验证,6个模型进行了外部验证,8个模型进行了内部验证.
结论:所有模型的预测性能都是有效的,然而,低质量的证据引发了人们对目前手术治疗后的随访建议是否足够的担忧.未来的模型应纳入生物标志物以提高准确性。
■CRD42018086784。
To identify prognostic models for melanoma survival, recurrence and metastasis among American Joint Committee on Cancer stage I and II patients postsurgery; and evaluate model performance, including overall survival (OS) prediction.
Systematic review and narrative synthesis.
Searched MEDLINE, Embase, CINAHL, Cochrane Library, Science Citation Index and grey literature sources including cancer and guideline websites from 2000 to September 2021.
Included studies on risk prediction models for stage I and II melanoma in adults ≥18 years. Outcomes included OS, recurrence, metastases and model performance. No language or country of publication restrictions were applied.
Two pairs of reviewers independently screened studies, extracted data and assessed the risk of bias using the CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies checklist and the Prediction study Risk of Bias Assessment Tool. Heterogeneous predictors prevented statistical synthesis.
From 28 967 records, 15 studies reporting 20 models were included; 8 (stage I), 2 (stage II), 7 (stages I-II) and 7 (stages not reported), but were clearly applicable to early stages. Clinicopathological predictors per model ranged from 3-10. The most common were: ulceration, Breslow thickness/depth, sociodemographic status and site. Where reported, discriminatory values were ≥0.7. Calibration measures showed good matches between predicted and observed rates. None of the studies assessed clinical usefulness of the models. Risk of bias was high in eight models, unclear in nine and low in three. Seven models were internally and externally cross-validated, six models were externally validated and eight models were internally validated.
All models are effective in their predictive performance, however the low quality of the evidence raises concern as to whether current follow-up recommendations following surgical treatment is adequate. Future models should incorporate biomarkers for improved accuracy.
CRD42018086784.