Value of incorporating newly identified risk factors into risk prediction for chemotherapy-induced febrile neutropenia
| Autor: | Yanli Li, Lie H. Chen, Zandra Klippel, John H Page, Lanfang Xu, Chun Chao, Leila Family |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Adult
Male Oncology Cancer Research medicine.medical_specialty medicine.medical_treatment Chemotherapy-Induced Febrile Neutropenia Comorbidity chemotherapy comorbidities Risk Assessment California 03 medical and health sciences 0302 clinical medicine Risk Factors Internal medicine Antineoplastic Combined Chemotherapy Protocols Odds Ratio medicine Humans Radiology Nuclear Medicine and imaging 030212 general & internal medicine Original Research Aged Risk level Chemotherapy Receiver operating characteristic business.industry Cancer Retrospective cohort study Middle Aged medicine.disease prediction model febrile neutropenia 030220 oncology & carcinogenesis Cohort Female business Cancer Prevention Febrile neutropenia SEER Program |
| Zdroj: | Cancer Medicine |
| ISSN: | 2045-7634 |
| DOI: | 10.1002/cam4.1580 |
| Popis: | Several comorbidities have recently been shown to affect risk of chemotherapy‐induced febrile neutropenia (FN). Here, we evaluated the added predictive value of these comorbidities beyond established FN risk factors. A retrospective cohort study was conducted among adult patients diagnosed with cancer and treated with chemotherapy at Kaiser Permanente Southern California between 2000 and 2009. The study cohort was equally split into training and validation datasets to develop and evaluate the performance of FN risk prediction models in the first chemotherapy cycle. A reference model was developed based on the model proposed by Lyman et al (Cancer 2011;117:1917). A new model was developed by incorporating the newly identified comorbidities such as rheumatoid conditions and thyroid disorders into the reference model. Area under the receiver operating characteristic curve (AUROCC), risk reclassification, and integrated discrimination improvement (IDI) were used to evaluate the potential improvement of FN risk prediction by incorporating comorbidities. A total of 15 279 patients were included; 4.2% experienced FN in the first chemotherapy cycle. Including comorbidities in FN risk prediction did not improve AUROCC (reference model 0.71 vs new model 0.72). A significant improvement in individual‐level FN risk prediction was indicated by IDI (P = .02). However, significant improvement in risk reclassification was not observed overall (although 6% of all patients were more accurately classified for their FN risk level, 5% were less accurately classified) or when examining predicted FN risk among patients who did and did not develop FN. Incorporating several new comorbidities into FN prediction led to improved FN risk prediction in the first chemotherapy cycle, although the observed improvements were small and might not be clinically relevant. |
| Databáze: | OpenAIRE |
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