未转移结直肠癌患者术后转移风险预测列线图的构建

Construction of a prognostic nomogram for predicting the postoperative metastasis risk of patients with non-metastatic colorectal cancer

目的构建结直肠(colorectal cancer,CRC)患者预后列线图预测模型,并验证其准确性。方法回顾性分析就诊于苏州大学第三附属医院的438例CRC患者的临床病理资料。建立COX单因素、多因素回归模型确定预后的独立危险因素。用R软件建立列线图,绘制术后3年、5年无病生存率(disease free survival,DFS)校准图线并与实际观察情况比较。用Bootstrap法进行内部验证,计算一致性指数(C-index)评估模型准确性。分析时间依赖的ROC曲线比较其与第7版美国癌症联合委员会(American Joint Committee On Cancer,AJCC)分期系统(TNM系统)在预测术后的3年、5年的DFS的敏感性和特异性。结果438例CRC患者中233例患者出现转移,其中肝脏转移105例,肺转移57例。COX回归模型分析示肿瘤分化程度,肿瘤TNM分期,癌胚抗原(CEA)水平,糖类抗原19-9(CA19-9)水平,中性粒细胞与淋巴细胞之比(Neutrophil lymphocyte radio,NLR),抑癌基因P53是患者预后的独立影响因素。列线图用于预测生存的C指数为0.678。校正曲线表明预测的3年、5年DFS与实际观察情况高度符合。时间依赖的ROC曲线结果表明,相较于传统AJCC-TNM分期,列线图预后模型在预测术后3年和5年的DFS具有更高的敏感性和特异性。结论列线图可较准确预测个体CRC患者的预后,利于临床工作者对其随访或及时开展对患者有益治疗。

Objective To construct a prognostic nomogram for predicting the prognosis of patients with colorectal cancer（ CRC）,and verify its accuracy. Methods The clinical pathologic data from 438 CRC patients hospitalized in the Third Affiliated Hospital of Soochow University during January 2006 and May 2013 were retrospectively analyzed. The independent risk factors for predicting the prognosis of CRC were determined by the univariate and multivariate regression model. The prognostic nomogram was established by the Rlanguage software. Then,the nomograms of postoperative 3-year and 5-year disease free survivals（ DFS） were drawn,and compared with the actual status. The internal validation and accuracy of the nomogram were determined by the Bootstrap method and the calculated concordance index（ C-index）,respectively. The sensitivity and specificity of the nomogram for predicting the 3-year and 5-year DFS were compared with those of TNM system established by the American Joint Committee On Cancer（ AJCC）（ 7 thed.） by using the timedependent ROC curve. Results Among 438 CRC patients,the metastasis of CRC occurred in 233 patients,including 105 liver metastasis and 57 lung metastasis. Multivariate COX regression analysis showed that tumor differentiation degree,TNM stage,serum CEA level,serum CA19-9 level,neutrophil lymphocyte ratio（ NLR） and P53 level were the independent risk factors of CRC. The C-index of the constructed nomogram for predicting the survival rate of CRC patients was 0.678. The predicted 3-year and 5-year DFS by the nomogram were highly coincident with the actual status. The analysis results of the time-dependent ROC curve showed that the sensitivity and specificity of the established nomogram for predicting the postoperative 3-year and 5-year DFS were higher than those of AJCC-TNM stage.Conclusion The established nomogram may accurately predict the prognosis of CRC patients,which may be helpful for clinicians to follow up or make beneficial treatment for CRC patients.