摘要
目的探讨T_(1)期结直肠肿瘤肝转移患者的危险因素并构建预后模型。方法纳入2004年1月1日至2019年12月31日期间,监测、流行病学和最终结果(SEER)数据库中的T_(1)期结直肠肿瘤患者的临床病理资料,采用χ2检验、Wilcoxon秩和检验以及多因素Logistic回归分析比较发生肝转移与未发生肝转移患者临床病理特征的差异,采用Kaplan-Meier法绘制生存曲线,Log-Rank检验比较两组患者的生存差异,采用Cox比例风险回归模型进行预后因素的单因素和多因素分析。并将患者按6∶4比例采用简单随机抽样法随机分为训练集和验证集,基于多因素Cox回归分析结果中的独立预后因素建立列线图模型,采用时间依赖性受试者操作特征(ROC)曲线、校准曲线评价模型的预测能力。结果共纳入28258例T_(1)期结直肠肿瘤患者。对是否发生肝转移进行多因素Logistic回归分析,结果显示,神经内分泌肿瘤、癌胚抗原(CEA)升高、更大的肿瘤最大径、淋巴结转移阳性以及存在癌结节这5个因素差异均具有统计学意义(P<0.05);对于已发生肝转移的T_(1)期结直肠肿瘤患者,多因素Cox回归分析结果表明,年龄、原发部位、人种、化疗以及手术治疗是独立预后因素(P<0.05),基于此5个预后因素构建的列线图,预测训练集1、3、5年生存率的时间依赖ROC曲线下面积分别为0.758、0.797、0.729,在验证集中分别为0.749、0.857、0.871;列线图在训练集和验证集中的校准曲线均位于45°斜线附近。结论神经内分泌肿瘤、CEA升高、更大的肿瘤最大径、淋巴结转移阳性以及存在癌结节是T_(1)期结直肠肿瘤发生肝转移的独立危险因素;年龄、原发部位、人种、化疗以及手术治疗是独立预后因素,基于以上临床特征构建的列线图具有良好的区分度和校准度。
Objective To explore the risk factors associated with liver metastasis in T_(1)stage colorectal neoplasms patients and establish a prognostic model.Methods Clinicopathological data of T_(1)stage colorectal neoplasms patients from the Surveillance,Epidemiology,and End Results(SEER)database between January 1,2004,and December 31,2019 were included.The differences in clinicopathological characteristics between patients with and without liver metastasis were compared using Chi-square test,Wilcoxon rank-sum test,and multivariate Logistic regression analysis.Survival curves were plotted using Kaplan-Meier method,and the Log-Rank test was used to compare survival differences between the two groups.Univariate and multivariate analysis of prognostic factors were performed using the proportional Cox regression hazards regression model.Patients were randomly divided into training set and validation set at a ratio of 6∶4 using simple random sampling method.A nomogram model was established based on independent prognostic factors based on the results of the multivariate Cox regression analysis.The predictive ability of the model was evaluated using time-dependent receiver operating characteristic(ROC)curves and calibration curves.Results A total of 28258 T_(1)stage colorectal neoplasms patients were included in the study.The multivariate Logistic regression analysis for liver metastasis occurrence indicated that the neuroendocrine neoplasms,elevated carcinoembryonic antigen(CEA)levels,larger neoplasms size,positive lymph node metastasis,and presence of cancer nodules were statistically significant differences(P<0.05).For T_(1)stage colorectal neoplasms patients with liver metastasis,the results of the multivariate Cox regression analysis showed that age,primary site,ethnicity,chemotherapy,and surgical treatment were independent prognostic factors(P<0.05).The nomogram constructed based on these five prognostic factors had time-dependent ROC areas under the curve of 0.758,0.797 and 0.729 for 1-year,3-year,and 5-year survival r
作者
杨小宝
靖超
顾晓哲
杨鋆
Yang Xiaobao;Jing Chao;Gu Xiaozhe;Yang Yun(Department of General Surgery,Beijing Friendship Hospital,Capital Medical University State Key Lab of Digestive Health National Clinical Research Center for Digestive Diseases)
出处
《国际外科学杂志》
2023年第10期697-703,F0003,共8页
International Journal of Surgery
基金
北京市自然科学基金海淀原始创新联合基金(L222149)
北京市医院管理中心"青苗"计划专项经费资助(QML20230122)
北京市属医院科研培育项目(PX2022002)
首都医科大学附属北京友谊医院科研启动基金(YYQDKT2019-21)。
关键词
结直肠肿瘤
肿瘤转移
列线图
预后
Colorectal neoplasms
Neoplasm metastasis
Nomograms
Prognosis
