TY - JOUR
T1 - A prediction model to help with oncologic mediastinal evaluation for radiation
T2 - Homer
AU - Martinez-Zayas, Gabriela
AU - Almeida, Francisco A.
AU - Simoff, Michael J.
AU - Yarmus, Lonny
AU - Molina, Sofia
AU - Young, Benjamin
AU - Feller-Kopman, David
AU - Sagar, Ala Eddin S.
AU - Gildea, Thomas
AU - Debiane, Labib G.
AU - Grosu, Horiana B.
AU - Casal, Roberto F.
AU - Arain, Muhammad H.
AU - Eapen, George A.
AU - Jimenez, Carlos A.
AU - Noor, Laila Z.
AU - Baghaie, Shiva
AU - Song, Juhee
AU - Li, Liang
AU - Ost, David E.
N1 - Publisher Copyright:
Copyright © 2020 by the American Thoracic Society.
PY - 2020/1/15
Y1 - 2020/1/15
N2 - Rationale: When stereotactic ablative radiotherapy is an option for patients with non–small cell lung cancer (NSCLC), distinguishing between N0, N1, and N2 or N3 (N2j3) disease is important. Objectives: To develop a prediction model for estimating the probability of N0, N1, and N2j3 disease. Methods: Consecutive patients with clinical-radiographic stage T1 to T3, N0 to N3, and M0 NSCLC who underwent endobronchial ultrasound–guided staging from a single center were included. Multivariate ordinal logistic regression analysis was used to predict the presence of N0, N1, or N2j3 disease. Temporal validation used consecutive patients from 3 years later at the same center. External validation used three other hospitals. Measurements and Main Results: In the model development cohort (n = 633), younger age, central location, adenocarcinoma, and higher positron emission tomography–computed tomography nodal stage were associated with a higher probability of having advanced nodal disease. Areas under the receiver operating characteristic curve (AUCs) were 0.84 and 0.86 for predicting N1 or higher (vs. N0) disease and N2j3 (vs. N0 or N1) disease, respectively. Model fit was acceptable (Hosmer-Lemeshow, P = 0.960; Brier score, 0.36). In the temporal validation cohort (n = 473), AUCs were 0.86 and 0.88. Model fit was acceptable (Hosmer-Lemeshow, P = 0.172; Brier score, 0.30). In the external validation cohort (n = 722), AUCs were 0.86 and 0.88 but required calibration (Hosmer-Lemeshow, P, 0.001; Brier score, 0.38). Calibration using the general calibration method resulted in acceptable model fit (Hosmer-Lemeshow, P = 0.094; Brier score, 0.34). Conclusions: This prediction model can estimate the probability of N0, N1, and N2j3 disease in patients with NSCLC. The model has the potential to facilitate decision-making in patients with NSCLC when stereotactic ablative radiotherapy is an option.
AB - Rationale: When stereotactic ablative radiotherapy is an option for patients with non–small cell lung cancer (NSCLC), distinguishing between N0, N1, and N2 or N3 (N2j3) disease is important. Objectives: To develop a prediction model for estimating the probability of N0, N1, and N2j3 disease. Methods: Consecutive patients with clinical-radiographic stage T1 to T3, N0 to N3, and M0 NSCLC who underwent endobronchial ultrasound–guided staging from a single center were included. Multivariate ordinal logistic regression analysis was used to predict the presence of N0, N1, or N2j3 disease. Temporal validation used consecutive patients from 3 years later at the same center. External validation used three other hospitals. Measurements and Main Results: In the model development cohort (n = 633), younger age, central location, adenocarcinoma, and higher positron emission tomography–computed tomography nodal stage were associated with a higher probability of having advanced nodal disease. Areas under the receiver operating characteristic curve (AUCs) were 0.84 and 0.86 for predicting N1 or higher (vs. N0) disease and N2j3 (vs. N0 or N1) disease, respectively. Model fit was acceptable (Hosmer-Lemeshow, P = 0.960; Brier score, 0.36). In the temporal validation cohort (n = 473), AUCs were 0.86 and 0.88. Model fit was acceptable (Hosmer-Lemeshow, P = 0.172; Brier score, 0.30). In the external validation cohort (n = 722), AUCs were 0.86 and 0.88 but required calibration (Hosmer-Lemeshow, P, 0.001; Brier score, 0.38). Calibration using the general calibration method resulted in acceptable model fit (Hosmer-Lemeshow, P = 0.094; Brier score, 0.34). Conclusions: This prediction model can estimate the probability of N0, N1, and N2j3 disease in patients with NSCLC. The model has the potential to facilitate decision-making in patients with NSCLC when stereotactic ablative radiotherapy is an option.
KW - Endobronchial ultrasound
KW - Lung cancer
KW - Lung cancer staging
KW - Mediastinal adenopathy
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U2 - 10.1164/rccm.201904-0831OC
DO - 10.1164/rccm.201904-0831OC
M3 - Article
C2 - 31574238
AN - SCOPUS:85077935935
SN - 1073-449X
VL - 201
SP - 212
EP - 223
JO - American journal of respiratory and critical care medicine
JF - American journal of respiratory and critical care medicine
IS - 2
ER -