Mapping the EORTC QLQ-C30 and QLQ H&N35 to the EQ-5D-5L and SF-6D for papillary thyroid carcinoma.

PURPOSE: Empirical evidence for the EORTC QLQ C30 scale in thyroid cancer mapping algorithms has not been found in China, which limits the cost-utility analysis of patients with papillary thyroid carcinoma (PTC) population. We developed mapping algorithms that use the EORTC QLQ-C30 and QLQ H&N35 to predict EQ-5D-5L and SF-6D health utility scores for PTC patients. METHODS: Data from 1050 Chinese PTC patients who completed the EORTC QLQ-C30, QLQ H&N35, EQ-5D-5L and SF-6D instruments were collected. Direct mapping (OLS, Tobit, Betamix) and indirect mapping functions (Order Probit) were used to estimate algorithms. The goodness-of-fit of mapping performance was assessed by MAE, RMSE, AIC, BIC, AE, and ICC. A fivefold cross-validation and random sample validation approach were used to test the stability of the models. RESULTS: The mean EQ-5D-5L and SF-6D utility scores were 0.8704 and 0.6368, respectively. We recommend the Betamix model for the EQ-5D-5L (MAE = 0.0363, RMSE = 0.0505, AIC = -3458.73, BIC = -3096.91, AE > 0.05(%) = 48.38, AE > 0.1(%) = 8.67, ICC = 0.8288 for the full sample dataset) and the Betamix model for the SF-6D (MAE = 0.0328, RMSE = 0.0417, AIC = -2788.91, BIC = -2605.51, AE > 0.05(%) = 42.76, AE > 0.1(%) = 3.62, ICC = 0.8657 for the full sample dataset), with EORTC QLQ-C30 all items, QLQ H&N35 all items, age and gender as the predicted variables showing the best performance. CONCLUSION: In the absence of preference-based quality of life tools, the mapping algorithms reported here are effective alternative for predicting the health utility of PTC patients, contributing to the cost-utility analysis studies.

Development of algorithms to estimate the EQ-5D-5L from the FACT-L in patients with lung cancer: a mapping study.

OBJECTIVE: This study aimed to develop a mapping algorithm to evaluate the EQ-5D-5L according to the FACT-L when the EQ-5D-5L is not available. METHODS: EQ-5D-5L and FACT-L data were collected from patients with lung cancer in Departments of Thoracic Surgery, Medical Oncology, Radiation Oncology, Sichuan Cancer Hospital. We used the ordinary least squares model (OLS), Tobit model (Tobit), two-part model (TPM), beta mixture regression (BM), and censored least absolute deviation model (CLAD) to map the results of the FACT-L according to EQ-5D-5L scores. To establish these models, the total score, dimension scores, squared items, and interaction items were introduced. Performance metrics including Adjusted R2, root mean square error (RMSE), and mean absolute error (MAE) were used to select the optimized model. RESULTS: The model with the best mapping performance was the BM model (BETAMIX4) with the PWB (physical well-being) dimension, FWB (functional well-being) dimension, the squared term of the PWB dimension, and the squared term of the FWB dimension as covariates. The final prediction metrics were Adjusted R2 = 0.695, RMSE = 0.206, and MAE = 0.109. Fivefold cross-validation (CV) results also demonstrated that the BM model had the best mapping power. CONCLUSIONS: This study developed an optimized mapping algorithm to predict the utility index from the FACT-L to the EQ-5D-5L, which provides an effective alternative reference for EQ-5D-5L estimation when the preference-based health utility values were unavailable.

Obtaining SF-6D utilities from FACT-H&N in thyroid carcinoma patients: development and results from a mapping study.

Objective: There is limited evidence for mapping clinical tools to preference-based generic tools in the Chinese thyroid cancer patient population. The current study aims to map the FACT-H&N (Functional Assessment of Cancer Therapy-Head and Neck Cancer) to the SF-6D (Short Form Six-Dimension), which will inform future cost-utility analyses related to thyroid cancer treatment. Methods: A total of 1050 participants who completed the FACT-H&N and SF-6D questionnaires were included in the analysis. Four methods of direct and indirect mapping were estimated: OLS regression, Tobit regression, ordered probit regression, and beta mixture regression. We evaluated the predictive performance in terms of root mean square error (RMSE), mean absolute error (MAE), concordance correlation coefficient (CCC), Akaike information criterion (AIC) and Bayesian information criterion (BIC) and the correlation between the observed and predicted SF-6D scores. Results: The mean value of SF-6D was 0.690 (SD = 0.128). The RMSE values for the fivefold cross-validation as well as the 30% random sample validation for multiple models in this study were 0.0833-0.0909, MAE values were 0.0676-0.0782, and CCC values were 0.6940-0.7161. SF-6D utility scores were best predicted by a regression model consisting of the total score of each dimension of the FACT-H&N, the square of the total score of each dimension, and covariates including age and gender. We proposed to use direct mapping (OLS regression) and indirect mapping (ordered probit regression) to establish a mapping model of FACT-H&N to SF-6D. The mean SF-6D and cumulative distribution functions simulated from the recommended mapping algorithm generally matched the observed ones. Conclusions: In the absence of preference-based quality of life tools, obtaining the health status utility of thyroid cancer patients from directly mapped OLS regression and indirectly mapped ordered probit regression is an effective alternative.

Resected lymph nodes and survival of patients with esophageal squamous cell carcinoma: an observational study.

BACKGROUND: The incidence and mortality of esophageal cancer are high. Therefore, the authors aimed to investigate how the number of dissected lymph nodes (LNs) during esophagectomy for esophageal squamous cell carcinoma impacts overall survival (OS), particularly that of patients with positive LNs. MATERIALS AND METHODS: Data from 2010 to 2017 were obtained from the Sichuan Cancer Hospital and Institute Esophageal Cancer Case Management Database. Participants were divided into two groups: patients with negative lymph nodes (N0) and patients with positive lymph nodes (N+). The median number of resected LNs during surgery was 24; therefore, patients with 15-23 and those with 24 or more resected LNs were assigned to subgroups A and B, respectively. RESULTS: After a median follow-up of 60.33 months, 1624 patients who underwent esophagectomy were evaluated; 60.53 and 39.47% had a pathological diagnosis of N+ or N0, respectively. The median OS was 33.9 months for the N+ group; however, the N0 group did not achieve the median OS. The mean OS was 84.9 months. In the N+ group, the median OS times of subgroups A and B were 31.2 and 37.1 months, respectively. The OS rates at 1, 3, and 5 years were 82, 43, and 34%, respectively, for subgroup A of the N+ group; they were 86, 51, and 38%, respectively, for subgroup B of the N+ group. Subgroups A and B of the N0 group exhibited no statistically significant differences. CONCLUSION: Increasing the number of LNs harvested during surgery to 24 or more could improve the OS of patients with positive LNs but not that of patients with negative LNs.

Mapping of Lymph Node Metastasis and Efficacy Index in Thoracic Esophageal Squamous Cell Carcinoma: A Large-Scale Retrospective Analysis.

BACKGROUND: Esophageal squamous cell carcinoma has a high mortality rate in China. The metastatic pattern in the lymph nodes and the value of their dissection on the overall survival of these patients remain controversial. The primary aim of this study was to provide a basis for accurate staging of esophageal cancer and to identify the relationship between esophageal cancer surgery, lymph node dissection, and overall survival rates. METHODS: We utilized our hospital database to retrospectively review the data of 1727 patients with esophageal cancer who underwent R0 esophagectomy from January 2010 to December 2017. The lymph nodes were defined according to Japanese Classification of Esophageal Cancer, 11th Edition. The Efficacy Index (EI) was calculated by multiplying the frequency (%) of metastases to a zone and the 5-year survival rate (%) of patients with metastases to that zone, and then dividing by 100. RESULTS: The EI was high in the supraclavicular and mediastinal zones in patients with upper esophageal tumors, and the EI of 101R was 17.39, which was the highest among the lymph node stations. In patients with middle esophageal tumors, the EI was highest in the mediastinal zone, followed by the celiac and supraclavicular zones. Furthermore, the EI was highest in the celiac zone, followed by the mediastinal zones in patients with lower esophageal tumors. CONCLUSIONS: The EI of resected lymph nodes was found to vary between stations and was related to the primary location of the tumor.

Impact of two­field or three­field lymphadenectomy on overall survival in middle and lower thoracic esophageal squamous cell carcinoma: A single­center retrospective analysis.

Squamous cell carcinoma is the main subtype of esophageal cancer in East Asia. The effect of the number of lymph nodes (LNs) removed to treat middle and lower thoracic esophageal squamous cell carcinoma (ESCC) in China remains controversial. Therefore, the present study aimed to investigate the impact of the number of LNs removed during lymphadenectomy on the survival of patients with middle and lower thoracic ESCC. Data were obtained from the Sichuan Cancer Hospital and Institute Esophageal Cancer Case Management Database from January 2010 to April 2020. Either three-field systematic lymphadenectomy (3F group) or two-field systematic lymphadenectomy (2F group) was performed for ESCC cases with or without suspicious tumor-positive cervical LNs, respectively. Subgroups were designed for further analysis based on the quartile number of resected LNs. After 50.7 months of median follow-up, 1,659 patients who underwent esophagectomy were enrolled. The median overall survival (OS) of the 2F and 3F groups was 50.0 months and 58.5 months, respectively. The OS rates at 1, 3 and 5 years were 86, 57 and 47%, respectively, in the 2F group, and 83, 52 and 47%, respectively, in the 3F group (P=0.732). The average OS of the 3F B and D groups was 57.7 months and 30.2 months, respectively (P=0.006). In the 2F group, the OS between subgroups was not significantly different. In conclusion, resection of >15 LNs during two-field dissection in patients with ESCC undergoing esophagectomy did not affect their survival outcomes. In three-field lymphadenectomy, the extent of LNs removed could lead to different survival outcomes.

Mapping study of papillary thyroid carcinoma in China: Predicting EQ-5D-5L utility values from FACT-H&N.

Objective: To develop a mapping algorithm that can be used to predict EQ-5D-5L health utility scores from FACT-H&N and obtain health utility parameters for Chinese patients with papillary thyroid carcinoma (PTC), which can be used for cost-utility analysis in health economic. Methods: A total of 1,050 patients with PTC from a tertiary hospital in China were included, and they completed FACT-H&N and EQ-5D-5L. Four mapping algorithms of direct mapping functions were used to derive the models: Ordinary least squares (OLS), Tobit model (Tobit), Two-part model (TPM), and Beta mixture regression model (Beta). The goodness-of-fit of models was assessed by the mean absolute error (MAE), root mean square error (RMSE), Akaike information criteria (AIC), Bayesian information criteria (BIC), and absolute error (AE). A fivefold cross-validation method was used to test the stability of the models. Results: The mean utility value of the EQ-5D-5L was 0.870 ± 0.094. The mean EQ-VAS score was 76.5 ± 13.0. The Beta mixture regression model mapping FACT-H&N to EQ-5D-5L achieved the best performance [fivefold cross-validation MAE = 0.04612, RMSE = 0.06829, AIC = -2480.538, BIC = -2381.137, AE > 0.05 (%) = 32.48, AE > 0.1 (%) = 8.95]. The independent variables in this model were Physical Well-Being (PWB), Emotional Well-Being (EWB), Head & Neck Cancer Subscale (HNCS) scores and its square term and interaction term scores. Conclusions: This study calculated the health utility score of Chinese patients with PTC. The reported algorithms can be used to map the FACT-H&N into the EQ-5D-5L, which can be applied in the cost-utility related study of patients with PTC.

Peripheral T lymphocyte and immunocyte subset dynamics: markers of neoadjuvant therapy outcomes in esophageal squamous cell carcinoma.

Purpose: In patients with resectable esophageal squamous cell carcinoma (ESCC), neoadjuvant therapy increased the curative resection rate, disease-free survival, and overall survival for patients with resectable ESCC. However, the efficacy of neoadjuvant therapy varies among different patients. We aim to compare the differences in the characteristics of peripheral blood T lymphocyte subsets before and after neoadjuvant therapy in patients with different curative efficacy. Method: This study enrolled 266 ESCC patients who received neoadjuvant therapy and esophagectomy from August 2018 to August 2022. The postoperative pathological results divided patients into the major pathological response (MPR) and non-MPR groups. Compare the differences in peripheral blood T lymphocyte subsets and analyze the trend of changes in T lymphocyte subsets at different phases of treatment. Propensity score matching was used to reduce the influence of potential confounding factors. Results: Prior to the neoadjuvant therapy, particularly before the second cycle, the MPR group exhibited significantly higher ratios of CD4/CD8 (P=0.009) and helper T cells (TH ratio, P=0.030) compared to the non-MPR group. In contrast, the suppressor T cell ratio (TS ratio) was lower (P=0.016) in the MPR group. The difference in peripheral blood lymphocyte subsets between the two groups of patients who underwent neoadjuvant chemoradiotherapy is significant. Conclusion: In peripheral blood, T lymphocyte subsets varied significantly based on the effectiveness of neoadjuvant treatment. Prior to the second cycle of neoadjuvant therapy, a higher CD4/CD8 and TH ratio, coupled with a decreased TS ratio, might suggest enhanced treatment outcomes.