VA HEARS模型用于预测接受顺铂放化疗成人的听力图变化

文献信息

中文摘要

目的： 开发并验证一个模型，用于预测个体患者的完整听力图，同时支持使用任何现有诊断和分类标准进行顺铂耳毒性预测和早期识别。
研究设计： 前瞻性观察性研究。
地点： 退伍军人事务部医院癌症门诊护理。
患者： 131名接受顺铂化疗或放化疗的退伍军人。
主要结局指标： 预测双耳0.5至8 kHz听力图阈值。听力变化根据预测听力图，使用美国言语-语言-听力协会（ASHA）和不良事件通用术语标准（CTCAE）标准得出。
结果： VA听力损失评估和风险筛查器（VA HEARS）是一种贝叶斯多变量线性混合模型，基于2010-2022年收集的顺铂患者听力图进行训练，并使用2019-2024年的数据进行验证。听力图阈值根据治疗前听力图、患者年龄和处方顺铂放化疗进行条件预测。每位患者在癌症治疗前、治疗中和治疗后进行了1至8次听力图测量。47%的患者接受了同期耳蜗放疗。预测阈值在各频率的平均预测误差为5.2至10.6 dB。在验证数据中，ASHA和CTCAE 1级预测的耳朵听力变化诊断准确，受试者工作特征曲线下面积分别为0.79和0.78。在累积顺铂280 mg/m²后，8 kHz阈值平均增加12 dB（同期放疗）对比8 dB（无放疗）。
结论： VA HEARS是首个经过验证的模型，用于预测成人癌症患者顺铂相关听力图变化，并同时输出多种耳毒性分类标准。该模型旨在个性化治疗前咨询，并指导接受耳毒性药物治疗患者的及时干预。

英文摘要

OBJECTIVE: Develop and validate a model for predicting complete audiograms of individual patients that also supports cisplatin-ototoxicity forecasting and early identification using any existing diagnostic and classification criteria.
STUDY DESIGN: Prospective observational study.
SETTING: Veterans Administration hospital cancer ambulatory care.
PATIENTS: One hundred thirty-one Veterans undergoing cisplatin chemotherapy or chemoradiation.
MAIN OUTCOME MEASURES: Predicted 0.5 to 8 kHz audiogram thresholds in both ears. Hearing changes were derived from the predicted audiograms using American Speech-Language Hearing Association (ASHA) and Common Terminology Criteria for Adverse Events (CTCAE) criteria.
RESULTS: The VA Hearing Loss Evaluation and Risk Screener (VA HEARS) is a Bayesian multivariate linear mixed model trained on cisplatin patient audiograms collected from 2010-2022 and validated with data from 2019-2024. Audiogram thresholds are forecast conditional on the pretreatment audiogram, patient age, and prescribed cisplatin chemoradiation.Each patient had 1 to 8 audiograms measured before, during, and after cancer treatment. Forty-seven percent of patients received concurrent cochlear radiation.Forecasted thresholds achieved average prediction errors of 5.2 to 10.6 dB across frequencies. Ears were accurately diagnosed as having changed hearing with an area under the receiver operating characteristic curves of 0.79 and 0.78 for ASHA and CTCAE grade 1 predictions in validation data. After 280 mg/m² cumulative cisplatin, 8 kHz thresholds increase by an average of 12 dB with concurrent radiation versus 8 dB without.
CONCLUSION: The VA HEARS is the first validated model for forecasting cisplatin-related audiogram changes in adult cancer patients and to output multiple ototoxicity classification criteria simultaneously. This model is intended to personalize pretreatment counseling and guide timely interventions for patients receiving ototoxic medications.