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Martinez-Zayas G, Almeida FA, Yarmus L, et al. Predicting Lymph Node Metastasis in Non-small Cell Lung Cancer: Prospective External and Temporal Validation of the HAL and HOMER Models. Chest. 2021;160(3):1108-1120doi: 10.1016/j.chest.2021.04.048.
Martinez-Zayas, G., Almeida, F. A., Yarmus, L., Steinfort, D., Lazarus, D. R., Simoff, M. J., Saettele, T., Murgu, S., Dammad, T., Duong, D. K., Mudambi, L., Filner, J. J., Molina, S., Aravena, C., Thiboutot, J., Bonney, A., Rueda, A. M., Debiane, L. G., Hogarth, D. K., Bedi, H., Deffebach, M., Sagar, A. S., Cicenia, J., Yu, D. H., Cohen, A., Frye, L., Grosu, H. B., Gildea, T., Feller-Kopman, D., Casal, R. F., Machuzak, M., Arain, M. H., Sethi, S., Eapen, G. A., Lam, L., Jimenez, C. A., Ribeiro, M., Noor, L. Z., Mehta, A., Song, J., Choi, H., Ma, J., Li, L., & Ost, D. E. (2021). Predicting Lymph Node Metastasis in Non-small Cell Lung Cancer: Prospective External and Temporal Validation of the HAL and HOMER Models. Chest, 160(3), 1108-1120. https://doi.org/10.1016/j.chest.2021.04.048
Martinez-Zayas, Gabriela, et al. "Predicting Lymph Node Metastasis in Non-small Cell Lung Cancer: Prospective External and Temporal Validation of the HAL and HOMER Models." Chest vol. 160,3 (2021): 1108-1120. doi: https://doi.org/10.1016/j.chest.2021.04.048
Martinez-Zayas G, Almeida FA, Yarmus L, Steinfort D, Lazarus DR, Simoff MJ, Saettele T, Murgu S, Dammad T, Duong DK, Mudambi L, Filner JJ, Molina S, Aravena C, Thiboutot J, Bonney A, Rueda AM, Debiane LG, Hogarth DK, Bedi H, Deffebach M, Sagar AS, Cicenia J, Yu DH, Cohen A, Frye L, Grosu HB, Gildea T, Feller-Kopman D, Casal RF, Machuzak M, Arain MH, Sethi S, Eapen GA, Lam L, Jimenez CA, Ribeiro M, Noor LZ, Mehta A, Song J, Choi H, Ma J, Li L, Ost DE. Predicting Lymph Node Metastasis in Non-small Cell Lung Cancer: Prospective External and Temporal Validation of the HAL and HOMER Models. Chest. 2021 Sep;160(3):1108-1120. doi: 10.1016/j.chest.2021.04.048. Epub 2021 Apr 28. PMID: 33932466.
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Chest. 2021 Sep;160(3):1108-1120. doi: 10.1016/j.chest.2021.04.048. Epub 2021 Apr 28.

Predicting Lymph Node Metastasis in Non-small Cell Lung Cancer: Prospective External and Temporal Validation of the HAL and HOMER Models.

Chest

Gabriela Martinez-Zayas, Francisco A Almeida, Lonny Yarmus, Daniel Steinfort, Donald R Lazarus, Michael J Simoff, Timothy Saettele, Septimiu Murgu, Tarek Dammad, D Kevin Duong, Lakshmi Mudambi, Joshua J Filner, Sofia Molina, Carlos Aravena, Jeffrey Thiboutot, Asha Bonney, Adriana M Rueda, Labib G Debiane, D Kyle Hogarth, Harmeet Bedi, Mark Deffebach, Ala-Eddin S Sagar, Joseph Cicenia, Diana H Yu, Avi Cohen, Laura Frye, Horiana B Grosu, Thomas Gildea, David Feller-Kopman, Roberto F Casal, Michael Machuzak, Muhammad H Arain, Sonali Sethi, George A Eapen, Louis Lam, Carlos A Jimenez, Manuel Ribeiro, Laila Z Noor, Atul Mehta, Juhee Song, Humberto Choi, Junsheng Ma, Liang Li, David E Ost

Affiliations

  1. Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
  2. Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, OH.
  3. Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, MD.
  4. Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia.
  5. Department of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, TX.
  6. Department of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI.
  7. Department of Pulmonary Disease and Critical Care Medicine, Saint Luke's Hospital of Kansas City, Kansas City, MO.
  8. Division of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL.
  9. Department of Pulmonary Medicine, University of New Mexico, Albuquerque, NM; Department of Pulmonary and Critical Care Medicine, CHRISTUS St. Vincent Medical Center, Santa Fe, NM.
  10. Department of Pulmonary, Allergy and Critical Care Medicine, Stanford University Medical Center and School of Medicine, Stanford, CA.
  11. Division of Pulmonary and Critical Care, VA Portland Health Care System, Oregon Health and Science University, Portland, OR.
  12. Department of Pulmonary Medicine, Northwest Permanente and The Center for Health Research, Kaiser Permanente Northwest, Portland, OR.
  13. Department of Respiratory Diseases, Pontificia Universidad Catolica de Chile, Santiago, Chile.
  14. Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Australia.
  15. Department of Pulmonary Medicine, Banner MD Anderson Cancer Center, Gilbert, AZ.
  16. Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA.
  17. Division of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin, Madison, WI.
  18. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX.
  19. Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX. Electronic address: [email protected].

PMID: 33932466 DOI: 10.1016/j.chest.2021.04.048

Abstract

BACKGROUND: Two models, the Help with the Assessment of Adenopathy in Lung cancer (HAL) and Help with Oncologic Mediastinal Evaluation for Radiation (HOMER), were recently developed to estimate the probability of nodal disease in patients with non-small cell lung cancer (NSCLC) as determined by endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA). The objective of this study was to prospectively externally validate both models at multiple centers.

RESEARCH QUESTION: Are the HAL and HOMER models valid across multiple centers?

STUDY DESIGN AND METHODS: This multicenter prospective observational cohort study enrolled consecutive patients with PET-CT clinical-radiographic stages T1-3, N0-3, M0 NSCLC undergoing EBUS-TBNA staging. HOMER was used to predict the probability of N0 vs N1 vs N2 or N3 (N2|3) disease, and HAL was used to predict the probability of N2|3 (vs N0 or N1) disease. Model discrimination was assessed using the area under the receiver operating characteristics curve (ROC-AUC), and calibration was assessed using the Brier score, calibration plots, and the Hosmer-Lemeshow test.

RESULTS: Thirteen centers enrolled 1,799 patients. HAL and HOMER demonstrated good discrimination: HAL ROC-AUC = 0.873 (95%CI, 0.856-0.891) and HOMER ROC-AUC = 0.837 (95%CI, 0.814-0.859) for predicting N1 disease or higher (N1|2|3) and 0.876 (95%CI, 0.855-0.897) for predicting N2|3 disease. Brier scores were 0.117 and 0.349, respectively. Calibration plots demonstrated good calibration for both models. For HAL, the difference between forecast and observed probability of N2|3 disease was +0.012; for HOMER, the difference for N1|2|3 was -0.018 and for N2|3 was +0.002. The Hosmer-Lemeshow test was significant for both models (P = .034 and .002), indicating a small but statistically significant calibration error.

INTERPRETATION: HAL and HOMER demonstrated good discrimination and calibration in multiple centers. Although calibration error was present, the magnitude of the error is small, such that the models are informative.

Copyright © 2021. Published by Elsevier Inc.

Keywords: endobronchial ultrasound; lung cancer; lung cancer staging; mediastinal adenopathy

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