用贝叶斯网络估计辅助化疗对老年患者的治疗效果,患有第三阶段结肠癌
Melle Sieswerda1,2, Ruby van Rossum1, Inigo Bermejo2
1Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands.
JCO clinical cancer informatics
|September 25, 2023
概括
老年结肠癌患者的辅助化疗显示出生存益处. 添加oxaliplatin加capecitabine单一治疗并没有改善结果,应该避免在这个人群中使用.
科学领域:
- 在瘤学瘤学.
- 临床试验 临床试验
- 生物统计学 生物统计学
背景情况:
- 在临床试验中,老年患者在第三阶段结肠癌的临床试验中代表性不足.
- 对老年人辅助化疗的观察数据容易产生偏见,例如因指示而混.
- 使用贝叶斯网络 (BNs) 的因果建模可以帮助解决这些偏见.
研究的目的:
- 使用BN构建因果模型,以估计辅助化疗对老年结肠癌患者的影响.
- 在比较capecitabine和oxaliplatin (CAPOX) 与capecitabine单疗法 (CapMono) 中识别潜在的混因素.
- 评估70岁及以上患者的辅助治疗与存活率之间的关联.
主要方法:
- 利用贝叶斯网络 (BNs) 与基于约束,基于分数和混合算法对来自荷兰癌症登记处的982名老年患者 (≥70岁) 的数据.
- 通过从BN中获得的因果图来确定潜在的混因素.
- 采用考克斯模型,调整混因子和倾向分数,以分析生存结果.
主要成果:
- 在将辅助治疗与单独手术进行比较时,病理性淋巴结分类,身体状况和年龄被确定为混因素.
- 辅助治疗与改善的生存率显著相关 (危险比率为0.39-0.45).
- 在BNs和Cox模型中,CAPOX与CapMono治疗选择和生存率之间没有显著的关联,这表明没有混效应.
结论:
- 贝叶斯网络在这个群体中有效地整合了临床知识用于因果建模.
- 虽然辅助疗法显著改善了生存率,但在老年患者中,添加氧沙与capecitabine并没有提供额外的益处.
- 在接受辅助治疗的老年结肠癌患者中,应避免使用牛利,因为缺乏证明的益处和潜在的毒性.
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