直肠癌中青年患者术后异时性肝转移的Nomogram模型构建和预测能力验证

Establishment of a nomogram model for prediction of postoperative heterochronous liver metastasis in young and middle-aged patients with rectal cancer

背景直肠癌发病率逐年升高,临床常采用根治性手术治疗,但术后肝转移已成为病死率升高的重要原因,因而建立模型早期预测异时性肝转移趋势已成为研究重点,Nomogram模型已被广泛用于医学领域,但直肠癌术后异时性肝转移Nomogram模型尚未统一.目的基于直肠癌中青年患者术后异时性肝转移的危险因素构建Nomogram模型,评价该模型对术后异时性肝转移风险的预测效能,为临床防治提供一定指导.方法选取2019-03/2022-02期间本院收治的120例中青年直肠癌患者作为研究对象,观察患者术后异时性肝转移发生情况.单因素、多因素Logistic回归分析术后异时性肝转移的危险因素,进一步构建Nomogram模型.利用受试者工作特征(receiver operating characteristic,ROC)曲线、决策曲线、校正曲线验证Nomogram模型对术后异时性肝转移的预测价值及临床效用.结果120例中青年直肠癌患者术后1年异时性肝转移发生率为23.33%;低分化、淋巴结转移、浸润深度T3/T4、原发癌切缘宽度<2 cm、外周血端粒酶逆转录酶(human telomerase reverse transcriptase,hTERT)高表达及血清癌胚抗原(carcinoembryonic antigen,CEA)、血管内皮生长因子(vascular endothelial growth factor,VEGF)、狐猴酪氨酸激酶-3(lemur tyrosine kinase-3,LMTK3)、鳞状细胞癌相关抗原(squamous cell carcinoma associated antigen,SCC-Ag)、神经轴突导向因子-1(neuroaxon guidance factor-1,Netrin-1)水平升高是术后异时性肝转移的危险因素(P<0.05);Nomogram模型一致性指数(consistency index,C-index)、AUC分别为0.860、0.957,且净获益值较高(P<0.05).结论低分化、淋巴结转移、浸润深度T3/T4、原发癌切缘宽度<2 cm、外周血hTERT高表达及血清CEA、VEGF、LMTK3、SCC-Ag、Netrin-1水平升高是直肠癌中青年患者术后异时性肝转移的危险因素,基于上述危险因素构建Nomogram模型,该模型对术后异时性肝转移具有一定预测效能,可为临床制定干预措施提供参考.

BACKGROUND The incidence of rectal cancer is increasing year by year.Radical surgery is often used for the treatment of rectal cancer in clinical practice,but postoperative liver metastasis has become an important reason for the increase in mortality.Therefore,establishing a model to predict the trend of metachronous liver metastasis has become a research focus.Nomogram model has been widely used in the medical field,but there has been no widely accepted nomogram model available for prediction of metachronous liver metastasis after rectal cancer surgery.AIM To constuct a nomogram model based on the risk factors for postoperative metachronous liver metastasis in young and middle-aged patients with rectal cancer,and to evaluate the performance of the model for predicting the risk of postoperative metachronous liver metastasis,so as to provide some guidance for clinical prevention and treatment.METHODS A total of 120 young and middle-aged patients with rectal cancer admitted to our hospital from March 2019 to February 2022 were selected as research subjects to observe the incidence of postoperative heterochronous liver metastasis.Univariate and multivariate Logistic regression analyses were performed to identify the risk factors for postoperative heterochronous liver metastasis and to construct a nomogram model.ROC curve,decision curve,and correction curve analyses were used to verify the value of nomogram model for the prediction of postoperative heterochronous liver metastasis.RESULTS The incidence of anomalous liver metastasis 1 year after surgery was 23.33%in 120 young and middle-aged patients with rectal cancer.Low differentiation,lymph node metastasis,depth of invasion(T3/T4),margin width of primary cancer<2 cm,high expression of peripheral blood telomerase reverse transcriptase(hTERT),and elevated serum levels of carcinoembryonic antigen(CEA),vascular endothelial growth factor(VEGF),lemur tyrosine kinase-3(LMTK3),squamous cell carcinoma-associated antigen(SCC-Ag),and axon-guided factor-1(Netrin-1)were identified to be risk factor for postoperative hetero-chronic liver metastasis(P<0.05).The C-index and area under the curve of the nomogram model were 0.860 and 0.957,respectively,and the net benefit value was high(P<0.05).CONCLUSION Low differentiation,lymph node metastasis,depth of invasion(T3/T4),margin width of primary cancer<2 cm,high expression of hTERT in peripheral blood,and elevated levels of serum CEA,VEGF,LMTK3,SC-AG and Netrin-1 are risk factors for postoperative xenotemporal liver metastasis in young and middle-aged patients with rectal cancer.Based on the above risk factors,a nomogram model has been established to predict postoperative hetero-chronous liver metastasis in such patients.