Risk factors and predictors of lymph nodes metastasis and distant metastasis in newly diagnosed T1 colorectal cancer
Risk factors and predictors of lymph nodes metastasis and distant metastasis in newly diagnosed T1 colorectal cancer
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DOI：
10.1002/cam4.3114
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发表时间：
2020-05-29
期刊：
影响因子：
4
通讯作者：
Ruan, Shanming
中科院分区：
文献类型：
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作者：
Guo, Kaibo;Feng, Yuqian;Ruan, Shanming
淋巴结转移（LNM）和远处转移（DM）是结直肠癌（CRC）的重要预后因素，并决定了后续的治疗方法。我们旨在寻找与LNM和DM相关的临床病理因素，并分析T1期CRC患者的预后。方法基于2004-2016年监测、流行病学和最终结果（SEER）数据库，回顾性纳入17 516例符合条件的T1型结直肠癌患者。采用Logistic回归分析确定LNM和DM的危险因素。采用未调整和调整的Cox比例风险模型确定影响总生存的预后因素。我们使用累积发生率函数（CIF）来进一步确定LNM和DM在结直肠癌特异性死亡（CCSD）中的预后作用。在此基础上构建LNM、DM和OS态图，分别用c指数和标定图对识别度和准确度进行评价。通过决策曲线分析（DCAs）和不同风险评分的亚组来衡量nomogram临床应用价值。结果肿瘤分级、粘液腺癌和年龄在LNM nomogram评分中所占比例居前三位（均P < 0.001）， DM nomogram评分中N分期、癌胚抗原（CEA）和肿瘤大小所占比例居前三位（均P < 0.001）。制定OS图直观地预测T1期结直肠癌患者的3年、5年和10年总生存率。校正曲线对预测模态图具有较好的预测精度，c指数分别为0.666、0.874和0.760，具有较好的判别性。dca和风险亚组显示了这些图的临床有效性。结论新型基于人群的T1期结直肠癌nomographic可以客观准确地预测LNM和DM的风险，以及不同分期的OS。这些预测工具可以帮助临床医生在临床管理之前做出个人临床决策。
Background Lymph nodes metastasis (LNM) and distant metastasis (DM) are important prognostic factors in colorectal cancer (CRC) and determine the following treatment approaches. We aimed to find clinicopathological factors associated with LNM and DM, and analyze the prognosis of CRC patients with T1 stage.Methods A total of 17 516 eligible patients with T1 CRC were retrospectively enrolled in the study based on the Surveillance, Epidemiology, and End Results (SEER) database during 2004-2016. Logistic regression analysis was performed to identify risk factors for LNM and DM. Unadjusted and adjusted Cox proportional hazard models were used to identify prognostic factors for overall survival. We performed the cumulative incidence function (CIF) to further determine the prognostic role of LNM and DM in colorectal cancer-specific death (CCSD). LNM, DM, and OS nomogram were constructed based on these models and evaluated by the C-index and calibration plots for discrimination and accuracy, respectively. The clinical utility of the nomograms was measured by decision curve analyses (DCAs) and subgroups with different risk scores.Results Tumor grade, mucinous adenocarcinoma, and age accounted for the first three largest proportion among the LNM nomogram scores (all, P < .001), whereas N stage, carcinoembryonic antigen (CEA), and tumor size occupied the largest percentage in DM nomogram (all, P < .001). OS nomogram was formulated to visually to predict 3-, 5-, and 10- year overall survivals for patients with T1 CRC. The calibration curves showed an effectively predictive accuracy of prediction nomograms, of which the C-index were 0.666, 0.874, and 0.760 for good discrimination, respectively. DCAs and risk subgroups revealed the clinical effectiveness of these nomograms.Conclusions Novel population-based nomograms for T1 CRC patients could objectively and accurately predict the risk of LNM and DM, as well as OS for different stages. These predictive tools may help clinicians to make individual clinical decisions, before clinical management.