摘要
目的分析影响结直肠癌异时性腹膜转移患者远期预后的因素,并建立风险预测模型。方法回顾性分析90例接受肿瘤细胞减灭术及腹腔热灌注化疗治疗的结直肠癌异时性腹膜转移患者临床资料,依据随访3年期间预后情况将患者分为病死组(n=65)和存活组(n=25)。采用Cox回归分析影响结直肠癌异时性腹膜转移患者远期预后的因素,依据回归分析结果构建风险预测模型,并绘制受试者工作特征(ROC)曲线评估风险模型的预测效能。结果病死组中年龄≥60岁、原发灶T4分期、出院时癌胚抗原(CEA)≥5μg/L、腹膜癌指数≥20分、肿瘤细胞低分化程度的患者占比均高于存活组,差异有统计学意义(P<0.05);经Cox回归分析显示,年龄≥60岁、原发灶分期为T4分期、出院时CEA≥5μg/L、腹膜癌指数≥20分、肿瘤细胞低分化程度为影响结直肠癌异时性腹膜转移患者远期预后病死的危险因素(P<0.05)。绘制列线图构建结直肠癌异时性腹膜转移远期预后病死风险预测模型,验证模型区分度显示C-index值=0.762,具有良好的区分度;绘制标准曲线显示,校准曲线和Y-X直线相近,模型准确度良好;对模型预测效能进行验证,结果显示,风险模型评估结直肠癌异时性腹膜转移患者远期预后病死的曲线下面积(AUC)为0.762,95%CI为:0.636~0.887、P<0.001。结论年龄、出院时CEA水平、原发灶分期、腹膜癌指数及肿瘤细胞分化程度为结直肠癌异时性腹膜转移患者远期预后的影响因素,基于以上因素构建的风险预测模型对结直肠癌异时性腹膜转移患者远期预后具有一定评估价值。
Objective To analyze the factors affecting the long-term prognosis of patients with metachronous peritoneal metastasis of colorectal cancer and establish a risk prediction model.Methods A retrospective analysis was conducted on the clinical data of 90 patients with metachronous peritoneal metastasis of colorectal cancer who underwent tumor cell reduction surgery and intraperitoneal thermal perfusion chemotherapy.The data were divided into a death group(n=65)and a survival group(n=25)based on the prognosis during a 3-year follow-up period.Cox regression analysis was used to analyze the factors that affect the long-term prognosis of patients with metachronous peritoneal metastasis of colorectal cancer.A risk prediction model was constructed based on the results of the regression analysis,and the predictive efficacy of the risk model was evaluated by drawing a receiver operating characteristic(ROC)curve.Results The proportion of patients with age≥60 years,T4 stage of primary focus,carcinoembryonic antigen(CEA)≥5μg/L,peritoneal cancer index≥20 points,and low differentiation of tumor cells in the death group was higher than that in the survival group,with a statistical significant difference(P<0.05).Cox regression analysis showed that age≥60 years old,primary lesion staging as T4 staging,CEA≥5μg/L at discharge,peritoneal cancer index≥20 points,and low differentiation of tumor cells were risk factors for long-term prognosis and mortality in patients with metachronous peritoneal metastasis of colorectal cancer(P<0.05).A nomogram was drawn to construct a risk prediction model for long-term prognosis of colorectal cancer with metachronous peritoneal metastasis.The discrimination of the model showed that C-index value=0.762,with good discrimination.The standard curve showed that the calibration curve was similar to the Y-X straight line,and the model accuracy was good.The validation of the predictive performance of the model showed that the area under the curve(AUC)for long-term prognosis and mortality in pat
作者
郎杉
林素红
崔华
王蝶
LANG Shan;LIN Suhong;CUI Hua(The First Affiliated Hospital of Zhengzhou University,Zhengzhou,450052)
出处
《实用癌症杂志》
2024年第6期992-996,共5页
The Practical Journal of Cancer
关键词
结直肠癌异时性腹膜转移
远期预后
影响因素
风险预测模型
Metachronous peritoneal metastasis of colorectal cancer
Long-term prognosis
Influencing factors
Risk prediction model
