TY - JOUR
T1 - NTCP model for postoperative complications and one-year mortality after trimodality treatment in oesophageal cancer
AU - Thomas, Melissa
AU - Defraene, Gilles
AU - Lambrecht, Maarten
AU - Deng, Wei
AU - Moons, Johnny
AU - Nafteux, Philippe
AU - Lin, Steven H.
AU - Haustermans, Karin
N1 - Funding Information:
Melissa Thomas and Gilles Defraene were supported by Kom op tegen Kanker (Stand up to Cancer), the Flemish cancer society . Karin Haustermans is a senior clinical investigator at the Research Foundation Flanders (FWO).
Funding Information:
Melissa Thomas and Gilles Defraene were supported by Kom op tegen Kanker (Stand up to Cancer), the Flemish cancer society. Karin Haustermans is a senior clinical investigator at the Research Foundation Flanders (FWO).
Publisher Copyright:
© 2019 Elsevier B.V.
PY - 2019/12
Y1 - 2019/12
N2 - Purpose/Objectives: To develop normal tissue complication probability (NTCP) models for postoperative pulmonary and cardiac complications and one-year mortality after preoperative chemoradiotherapy and surgery in oesophageal cancer patients. Methods: 691 patients from two institutions (2002–2017) were included; 134 treated with protons. Multivariable logistic regression analyses on 601 patients studied the predictive value of clinical/treatment-related (gender, age, body mass index (BMI), smoking, cardiac comorbidity, chronic obstructive pulmonary disease, histology, cT/N) and dosimetric variables (absolute/relative lung/heart volumes receiving or spared from xGy, mean doses, planning target volume) for the presence of pulmonary complications, cardiac complications and one-year mortality. Model validation was performed using a nonrandom split-sample of 90 patients. Model performance was assessed by AUC and calibration plots. Results: Respectively 144/601 (24.0%) and 165/601 (27.5%) patients developed a pulmonary or cardiac complication. For pulmonary complications, an NTCP model with optimism-corrected AUC of 0.75 (95%CI = 0.73–0.76) was obtained. The model contained mean lung dose (OR = 1.15, 95%CI = 1.09–1.22, p < 0.001), increasing age (OR = 1.03, 95%CI = 1.01–1.06, p = 0.002), BMI (OR = 1.04, 95%CI = 0.99–1.08, p = 0.084) and squamous cell carcinoma (OR = 3.22, 95%CI = 1.97–5.24, p < 0.001) as predictors. In validation, AUC of 0.79 was obtained (calibration slope 1.26). For cardiac complications, only age (OR = 1.06, 95%CI = 1.04–1.09, p < 0.001) with optimism-corrected AUC of 0.67 (95%CI = 0.65–0.68) was selected. For one-year mortality, an NTCP model with optimism-corrected AUC of 0.63 (95%CI = 0.58–0.66) was obtained. Lung absolute V35 (OR = 1.0016, 95%CI = 1.0007–1.0026, p = 0.001), cN (OR = 2.45, 95%CI = 1.18–5.09, p = 0.017), cT4 (OR = 2.51, 95%CI = 1.10–5.74, p = 0.029) and cardiac comorbidity (OR = 2.91, 95%CI = 1.46–5.77, p = 0.002) were selected as predictors. At validation, AUC of 0.57 was obtained (calibration slope 0.75). Conclusion: We were able to build and validate NTCP models for the presence of a postoperative pulmonary complication and for one-year mortality after trimodality treatment in oesophageal cancer.
AB - Purpose/Objectives: To develop normal tissue complication probability (NTCP) models for postoperative pulmonary and cardiac complications and one-year mortality after preoperative chemoradiotherapy and surgery in oesophageal cancer patients. Methods: 691 patients from two institutions (2002–2017) were included; 134 treated with protons. Multivariable logistic regression analyses on 601 patients studied the predictive value of clinical/treatment-related (gender, age, body mass index (BMI), smoking, cardiac comorbidity, chronic obstructive pulmonary disease, histology, cT/N) and dosimetric variables (absolute/relative lung/heart volumes receiving or spared from xGy, mean doses, planning target volume) for the presence of pulmonary complications, cardiac complications and one-year mortality. Model validation was performed using a nonrandom split-sample of 90 patients. Model performance was assessed by AUC and calibration plots. Results: Respectively 144/601 (24.0%) and 165/601 (27.5%) patients developed a pulmonary or cardiac complication. For pulmonary complications, an NTCP model with optimism-corrected AUC of 0.75 (95%CI = 0.73–0.76) was obtained. The model contained mean lung dose (OR = 1.15, 95%CI = 1.09–1.22, p < 0.001), increasing age (OR = 1.03, 95%CI = 1.01–1.06, p = 0.002), BMI (OR = 1.04, 95%CI = 0.99–1.08, p = 0.084) and squamous cell carcinoma (OR = 3.22, 95%CI = 1.97–5.24, p < 0.001) as predictors. In validation, AUC of 0.79 was obtained (calibration slope 1.26). For cardiac complications, only age (OR = 1.06, 95%CI = 1.04–1.09, p < 0.001) with optimism-corrected AUC of 0.67 (95%CI = 0.65–0.68) was selected. For one-year mortality, an NTCP model with optimism-corrected AUC of 0.63 (95%CI = 0.58–0.66) was obtained. Lung absolute V35 (OR = 1.0016, 95%CI = 1.0007–1.0026, p = 0.001), cN (OR = 2.45, 95%CI = 1.18–5.09, p = 0.017), cT4 (OR = 2.51, 95%CI = 1.10–5.74, p = 0.029) and cardiac comorbidity (OR = 2.91, 95%CI = 1.46–5.77, p = 0.002) were selected as predictors. At validation, AUC of 0.57 was obtained (calibration slope 0.75). Conclusion: We were able to build and validate NTCP models for the presence of a postoperative pulmonary complication and for one-year mortality after trimodality treatment in oesophageal cancer.
KW - NTCP
KW - Oesophageal cancer
KW - Postoperative complications
KW - Prediction model
KW - Survival
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U2 - 10.1016/j.radonc.2019.09.015
DO - 10.1016/j.radonc.2019.09.015
M3 - Article
C2 - 31630867
AN - SCOPUS:85073811760
SN - 0167-8140
VL - 141
SP - 33
EP - 40
JO - Radiotherapy and Oncology
JF - Radiotherapy and Oncology
ER -