Background: Worst-case, typical, and best-case scenarios for survival, based on simple multiples of an individual's expected survival time (EST), estimated by their oncologist, are a useful way of formulating and explaining prognosis. We aimed to determine the accuracy and prognostic significance of oncologists' estimates of EST, and the accuracy of the resulting scenarios for survival time, in advanced gastric cancer.
Materials and methods: Sixty-six oncologists estimated the EST at baseline for each of the 152 participants they enrolled in the INTEGRATE trial. We hypothesized that oncologists' estimates of EST would be unbiased (∼50% would be longer or shorter than the observed survival time [OST]); imprecise (<33% within 0.67-1.33 times the OST); independently predictive of overall survival (OS); and accurate at deriving scenarios for survival time with approximately 10% of patients dying within a quarter of their EST (worst-case scenario), 50% living within half to double their EST (typical scenario), and 10% living three or more times their EST (best-case scenario).
Results: Oncologists' estimates of EST were unbiased (45% were shorter than the OST, 55% were longer); imprecise (29% were within 0.67-1.33 times observed); moderately discriminative (Harrell's C-statistic 0.62, p = .001); and an independently significant predictor of OS (hazard ratio, 0.89; 95% confidence interval, 0.83-0.95; p = .001) in a Cox model including performance status, number of metastatic sites, neutrophil-to-lymphocyte ratio ≥3, treatment group, age, and health-related quality of life (EORTC-QLQC30 physical function score). Scenarios for survival time derived from oncologists' estimates were remarkably accurate: 9% of patients died within a quarter of their EST, 57% lived within half to double their EST, and 12% lived three times their EST or longer.
Conclusion: Oncologists' estimates of EST were unbiased, imprecise, moderately discriminative, and independently significant predictors of OS. Simple multiples of the EST accurately estimated worst-case, typical, and best-case scenarios for survival time in advanced gastric cancer.
Implications for practice: Results of this study demonstrate that oncologists' estimates of expected survival time for their patients with advanced gastric cancer were unbiased, imprecise, moderately discriminative, and independently significant predictors of overall survival. Simple multiples of the expected survival time accurately estimated worst-case, typical, and best-case scenarios for survival time in advanced gastric cancer.
摘要
背景。肿瘤学家根据个人预期生存时间 (EST) 的简单倍数估计的最坏生存情况设想、一般生存情况设想和最佳生存情况设想是制定和解释预后的有效方法。我们的目的在于确定肿瘤学家估计的晚期胃癌EST的准确性和预后意义，以及由此产生的生存时间设想的准确性。
材料和方法。六十六位肿瘤学家估计了 152 名参与 INTEGRATE 试验的参与者中每位参与者的基线EST。我们假设肿瘤学家估计的EST是中肯的 [~50% 患者的预期生存时间将比观察生存时间 (OST)长或短]；不精确(<33%在OST的 0.67–1.33 倍之间)；可独立预测总生存期 (OS)；并且准确得出生存时间的设想，其中，约 10% 的患者在其EST的四分之一内死亡(最坏情况设想)，50% 患者的生存时间在EST的一半至两倍之间(一般情况设想)，10% 患者的生存时间为EST的三倍或以上(最佳情况设想)。
结果。肿瘤学家估计的EST是中肯的(45% 的患者比OST短，55% 的患者比OST长)；不精确(29%在OST的 0.67–1.33 倍之间)；比较具有判别性(Harrell 的 C 统计量为 0.62，p = 0.001)；并且是 Cox 模型中OS的独立重要的预测因子(风险比， 0.89；95% 置信区间，0.83–0.95；p = 0.001)，包括体能状况、转移灶数量、中性粒细胞与淋巴细胞比率 ≥3、治疗小组、年龄和健康相关的生活质量(EORTC‐QLQC30 身体机能评分)。根据肿瘤学家的估计得出的生存时间设想非常准确:9% 的患者在EST的四分之一内死亡，57% 患者的生存时间在EST的一半至两倍之间，12% 患者的生存时间为EST的三倍或以上。
结论。肿瘤学家估计的ESY是中肯的、不精确、比较具有判别性，并且是OS独立重要的预测因子。简单的EST倍数准确估计了晚期胃癌生存时间的最坏情况、一般情况和最佳情况设想。
实践意义:本研究的结果表明，肿瘤学家估计的晚期胃癌患者的预期生存时间是中肯的、不精确、比较具有判别性，并且是总生存期独立重要的预测因子。简单的预期生存时间倍数准确估计了晚期胃癌生存时间的最坏情况、一般情况和最佳情况设想。
Keywords: Estimating survival times; Prognosis in gastric cancer.
© AlphaMed Press 2019.