Survival nomograms for stage III colorectal cancer
Survival nomograms for stage III colorectal cancer
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DOI：
10.1097/md.0000000000013239
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发表时间：
2018-12-01
期刊：
影响因子：
1.6
通讯作者：
Pei, Haiping
中科院分区：
文献类型：
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作者：
Li, Chenglong;Pei, Qian;Pei, Haiping
III期结直肠癌（CRC）患者的术后生存率差异明显。我们试图开发新的列线图来预测这些患者在根治性手术和术后化疗后的生存率。回顾性收集了2009年1月至2015年12月期间接受根治性切除和术后化疗的620例III期CRC患者，并随机分配到训练队列（n=372）或验证队列（n=248）。收集并分析临床病理因素。基于训练集中372例患者的数据，使用多变量考克斯回归确定总生存期（OS）和无病生存期（DFS）的预测因素，并用于构建列线图。通过一致性指数（C指数）和校准图评估列线图的预测性能。248例患者的外部队列用于验证列线图。多因素分析显示肿瘤分化程度、淋巴结转移率、血管内栓塞（IVE）、术前血清癌胚抗原（CEA）水平、白蛋白/球蛋白比值（AGR）、T分期和N分期是影响OS的重要预后因素;而肿瘤分化程度、淋巴结转移率、IVE、AGR和N分期对DFS有显著影响。建立了预测3年和5年OS和DFS的列线图，表现良好（OS预测的C指数为0.734 [95% CI，0.691-0.779]，DFS预测的C指数为0.699 [95% CI，0.657-0.740]），验证队列证实了列线图的准确性。模型比较表明，该诺模图对III期结直肠癌的T、N分期具有上级优势，并提出了2种实用的III期结直肠癌诺模图，可更准确地预测患者的预后，有助于指导患者的个体化治疗和术后监测。
The postoperative survival of patients with stage III colorectal cancer (CRC) various obviously. We sought to develop novel nomograms for predicting the survival of these patients after radical surgery and postoperative chemotherapy.A total of 620 consecutive patients with stage III CRC who underwent curative resection and postoperative chemotherapy between January 2009 and December 2015 were retrospectively collected and randomly allocated to the training (n=372) or validation cohort (n=248). Clinicopathological factors were collected and analyzed. On the basis of data from 372 patients in the training set, predictive factors for overall survival (OS) and disease-free survival (DFS) were identified using multivariate Cox regression and used to construct nomograms. The predictive performance of the nomograms was assessed by concordance index (C-index) and calibration plots. An external cohort of 248 patients was used to validate the nomograms. Furthermore, nomogram performance was compared with the performance of T and N stage stratification.Tumor differentiation grade, lymph node metastasis ratio, intravascular emboli (IVE), preoperative serum carcinoembryonic antigen (CEA) level, albumin to globulin ratio (AGR), T stage and N stage were significant prognostic factors for OS on multivariate analysis; whereas, Tumor differentiation grade, lymph node metastasis ratio, IVE, AGR and N stage were significant for DFS. Nomograms to predict 3- and 5-year OS and DFS were established that performed well (C-indexes of 0.734 [95% CI, 0.691-0.779] for OS and 0.699 [95% CI, 0.657-0.740] for DFS prediction), and nomogram accuracy was confirmed in the validation cohort. Furthermore, model comparison proved that the nomograms were superior to risk stratification by T and N stage for stage III CRC.We propose 2 practical nomograms for stage III CRC patients that provide more accurate prognostic predictions and should be helpful for guiding individualized treatment and postoperative surveillance.