Novel nomograms to predict lymph node metastasis and liver metastasis in patients with early colon carcinoma
Novel nomograms to predict lymph node metastasis and liver metastasis in patients with early colon carcinoma
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预测早期结肠癌患者淋巴结转移和肝转移的新型列线图
DOI：
10.1186/s12967-019-1940-1
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发表时间：
2019-06-10
影响因子：
7.4
通讯作者：
Xiao, Zhiyu
中科院分区：
文献类型：
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作者：
Yan, Yongcong;Liu, Haohan;Xiao, Zhiyu
背景：淋巴结状态和肝转移（LIM）是决定早期结肠癌预后的重要因素。我们试图发展和验证nomographic来预测早期结肠癌患者的淋巴结转移（LNM）和LIM。方法根据SEER数据库中的记录，共有32,819例接受pT1或pT2结肠癌手术的患者被纳入研究。基于单因素和多因素二元logistic回归评估LNM和LIM的危险因素。采用c指数和标定图评价LNM和LIM模型的判别性。采用决策曲线分析方法对图的预测精度和临床应用价值进行分析。预测图在内部测试集中进一步验证。结果由7个特征组成的线性神经网络图与5个特征组成的线性神经网络图具有相同的预测效果。标定曲线显示nomogram预测值与实际观测值完全吻合。决策曲线显示预测图的临床实用性。接收者工作特征曲线在训练集（曲线下面积[AUC] = 0.667, 95% CI 0.661-0.673）和测试集（AUC = 0.658, 95% CI 0.649-0.667）中表现良好，在训练集（AUC = 0.766, 95% CI 0.760-0.771）和测试集（AUC = 0.825, 95% CI 0.818-0.832）中表现良好。结论新型的经验证的早期结肠癌nomographic可有效预测LNM和LIM的个体化风险，并可帮助医生制定适合的个体化治疗方案。
BackgroundLymph node status and liver metastasis (LIM) are important in determining the prognosis of early colon carcinoma. We attempted to develop and validate nomograms to predict lymph node metastasis (LNM) and LIM in patients with early colon carcinoma.MethodsA total of 32,819 patients who underwent surgery for pT1 or pT2 colon carcinoma were enrolled in the study based on their records in the SEER database. Risk factors for LNM and LIM were assessed based on univariate and multivariate binary logistic regression. The C-index and calibration plots were used to evaluate LNM and LIM model discrimination. The predictive accuracy and clinical values of the nomograms were measured by decision curve analysis. The predictive nomograms were further validated in the internal testing set.ResultsThe LNM nomogram, consisting of seven features, achieved the same favorable prediction efficacy as the five-feature LIM nomogram. The calibration curves showed perfect agreement between nomogram predictions and actual observations. The decision curves indicated the clinical usefulness of the prediction nomograms. Receiver operating characteristic curves indicated good discrimination in the training set (area under the curve [AUC] = 0.667, 95% CI 0.661–0.673) and the testing set (AUC = 0.658, 95% CI 0.649–0.667) for the LNM nomogram and encouraging performance in the training set (AUC = 0.766, 95% CI 0.760–0.771) and the testing set (AUC = 0.825, 95% CI 0.818–0.832) for the LIM nomogram.ConclusionNovel validated nomograms for patients with early colon carcinoma can effectively predict the individualized risk of LNM and LIM, and this predictive power may help doctors formulate suitable individual treatments.