Improved prediction of recurrence after curative resection of XXXX using tree-based risk stratification.

@entity1 @entity5 @entity3 @entity14 @entity694
BACKGROUND: @entity1 who are at high risk of recurrence after undergoing curative (R0) resection for @entity694 may benefit most from adjuvant treatment and from intensive follow-up for early detection and treatment of recurrence. However, in light of new clinical evidence, there is a need for continuous improvement in the calculation of the risk of recurrence. METHODS: Six hundred forty-one @entity1 with R0-resected @entity694 who underwent surgery between January 1, 1984 and December 31, 1996 were recruited from the Erlangen Registry of @entity14 . The study end point was time until first locoregional or distant recurrence. The factors analyzed were: age, gender, site in colon, International Union Against @entity5 (UICC) pathologic @entity5 classification (pT), UICC pathologic lymph node classification, histologic @entity5 type, malignancy grade, lymphatic invasion, @entity3 , number of examined lymph nodes, number of lymph node @entity3 , emergency presentation, intraoperative @entity5 cell spillage, surgeon, and time period. The resulting prognostic tree was evaluated by means of an independent sample using a measure of predictive accuracy based on the Brier score for censored data. Predictive accuracy was compared with several proposed stage groupings. RESULTS: The prognostic tree contained the following variables: pT, the number of lymph node @entity3 , @entity3 , and emergency presentation. Predictive accuracy based on the validation sample was 0.230 (95% confidence interval [95% CI], 0.227-0.233) for the prognostic tree and 0.212 (95% CI, 0.209-0.215) for the UICC TNM sixth edition stage grouping. CONCLUSIONS: The prognostic tree showed superior predictive accuracy when it was validated using an independent sample. It is interpreted easily and may be applied under clinical circumstances. Provided that their classification system can be validated successfully in other centers, the authors propose using the prognostic tree as a starting point for studies of adjuvant treatment and follow-up strategies.
