72002
document
Predicting Overall Survival After Stereotactic Ablative Radiation Therapy in Early-Stage Lung Cancer : Development and External Validation of the Amsterdam Prognostic Model . PURPOSE A prognostic model for 5-year overall survival ( OS ) , consisting of recursive partitioning analysis ( RPA ) and a nomogram , was developed for patients with early-stage non-small cell lung cancer ( ES-NSCLC ) treated with stereotactic ablative radiation therapy ( SABR ) . METHODS AND MATERIALS A primary dataset of 703 ES-NSCLC SABR patients was randomly divided into a training ( 67 % ) and an internal validation ( 33 % ) dataset . In the former group , 21 unique parameters consisting of patient , treatment , and tumor factors were entered into an RPA model to predict OS . Univariate and multivariate models were constructed for RPA-selected factors to evaluate their relationship with OS . A nomogram for OS was constructed based on factors significant in multivariate modeling and validated with calibration plots . Both the RPA and the nomogram were externally validated in independent surgical ( n = 193 ) and SABR ( n = 543 ) datasets . RESULTS RPA identified 2 distinct risk classes based on tumor diameter , age , World Health Organization performance status ( PS ) and Charlson comorbidity index . This RPA had moderate discrimination in SABR datasets ( c-index range : 0.52-0.60 ) but was of limited value in the surgical validation cohort . The nomogram predicting OS included smoking history in addition to RPA-identified factors . In contrast to RPA , validation of the nomogram performed well in internal validation ( r ( 2 ) = 0.97 ) and external SABR ( r ( 2 ) = 0.79 ) and surgical cohorts ( r ( 2 ) = 0.91 ) . CONCLUSIONS The Amsterdam prognostic model is the first externally validated prognostication tool for OS in ES-NSCLC treated with SABR available to individualize patient decision making . The nomogram retained strong performance across surgical and SABR external validation datasets . RPA performance was poor in surgical patients , suggesting that 2 different distinct patient populations are being treated with these 2 effective modalities .
72003
Intervention_Pharmacological
Stereotactic Ablative Radiation Therapy
72004
Intervention_Pharmacological
stereotactic ablative radiation therapy ( SABR
72005
Intervention_Pharmacological
SABR
72006
Outcome_Mortality
Overall Survival After Stereotactic Ablative Radiation Therapy
72007
Outcome_Physical
patient , treatment , and tumor factors
72008
Outcome_Physical
RPA identified 2 distinct risk classes based on tumor diameter , age , World Health Organization performance status ( PS ) and Charlson comorbidity index .
72009
Outcome_Physical
RPA performance
72010
Participant_Condition
early-stage non-small cell lung cancer ( ES-NSCLC ) treated with stereotactic ablative radiation therapy ( SABR )
72011
Participant_Sample-size
703
72012
Participant_Condition
ES-NSCLC SABR