Predictive models of adjuvant chemotherapy for patients with stage ii colorectal cancer: A retrospective study.
Predictive models of adjuvant chemotherapy for patients with stage ii colorectal cancer: A retrospective study.
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II 期结直肠癌患者辅助化疗的预测模型：回顾性研究
DOI：
10.4103/0366-6999.213432
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发表时间：
2017-09-05
影响因子：
6.1
通讯作者：
Wei HB
中科院分区：
文献类型：
--
作者：
Wei B;Zheng XM;Lei PR;Huang Y;Zheng ZH;Chen TF;Huang JL;Fang JF;Liang CH;Wei HB
背景：II期结直肠癌患者根治性切除后是否能受益于辅助化疗仍存在争议。本研究的目的是建立两个数学模型来确定适合辅助化疗的患者。方法：本研究分为两个步骤。第一步，选取2006年6月至2015年12月在中山大学附属第三医院接受手术治疗的II期结直肠癌患者353例，随访6-120个月。他们的临床资料被收集并录入数据库。我们通过单因素和多因素Cox回归分析建立了两个数学模型来确定目标患者；第二步，选取2012年1月至2016年12月同一标准下的230例患者，随访3-62个月，验证两种模型的有效性。结果：第一步，340例II期结直肠癌手术患者最终入组。统计分析显示，肿瘤分化（TD） （P < 0.001）、淋巴血管侵袭（LVI） （P < 0.001）、不确定或阳性切缘（UPM） （P < 0.001）、淋巴结数（LNs） （<12） （P < 0.001）与总生存期（OS）和无病生存期（DFS）相关。我们得到两个模型：(1)OS风险评分= 1.116 × TD + 2.202 × LVI + 3.676 × UPM + 1.438 × LN - 0.493；(2) DFS风险评分= 0.789 × TD + 2.074 × LVI + 3.183 × UPM + 1.329 × LN - 0.432。根据模型和截止点[分别为（0.07,1.33）和（- 0.04,1.30）]将患者分为低危、中危、高危三组。此外，高危组患者可以从辅助化疗中获益。第二步，最终选取221例患者验证模型的有效性。结果证明模型准确、可行（P < 0.05）。结论：根据预测模型，强烈建议高危组II期结直肠癌患者进行辅助化疗，便于个体化、精准化治疗。
Background: It remains controversial whether patients with Stage II colorectal cancer would benefit from adjuvant chemotherapy after radical resection. The aim of this study was to establish two mathematical models to identify the suitable patients for adjuvant chemotherapy. Methods: The current study comprised of two steps. In the first step, 353 patients with Stage II colorectal cancer who underwent surgical procedures at the Third Affiliated Hospital of Sun Yat-sen University between June 2006 and December 2015 were entered and followed up for 6–120 months. Their clinical data were collected and enrolled into the database. We established two mathematical models by univariate and multivariate Cox regression analysis to identify the target patients; in the second step, 230 patients under the same standard between January 2012 and December 2016 were entered and followed up for 3–62 months to verify the two models’ validation. Results: In the first step, totally 340 surgical patients with Stage II colorectal cancer were finally enrolled in this study. Statistical analysis showed that tumor differentiation (TD) (P < 0.001), lymphovascular invasion (LVI) (P < 0.001), uncertain or positive margins (UPM) (P < 0.001), and fewer lymph nodes (LNs) (<12) retrieved (P < 0.001) were correlated with the overall survival (OS) and disease free survival (DFS). We obtained two models: (1) OS risk score = 1.116 × TD + 2.202 × LVI + 3.676 × UPM + 1.438 × LN − 0.493; (2) DFS risk score = 0.789 × TD + 2.074 × LVI + 3.183 × UPM + 1.329 × LN − 0.432. According to the models and cutoff points [(0.07, 1.33) and (−0.04, 1.30), respectively], patients can be divided into three groups: low-risk, moderate-risk, and high-risk. Moreover, the high-risk group patients could benefit from adjuvant chemotherapy. In the second step, totally 221 patients were finally used to verify the models’ validation. The results proved that the models were accurate and feasible (P < 0.05). Conclusions: According to the predictive models, patients with Stage II colorectal cancer in the high-risk group are strongly recommended for adjuvant chemotherapy, thus facilitating the individualized and precise treatment.