结直肠癌患者术后预后模型的构建

Construction of postoperative prognosis model for patients with colorectal cancer

目的筛选接受结直肠癌(CRC)根治性切除术后患者总生存期(OS)的影响因素,构建CRC根治性切除术后患者OS的预后模型。方法回顾性收集2017年3月至2019年12月于武汉大学人民医院接受根治性切除术的350例Ⅰ~Ⅳ期CRC患者的基线资料。根据术前全身炎症评分(SIS)不同将患者分为0分组(n=70)、1分组(n=172)、2分组(n=108)。分析不同SIS、中性粒细胞与淋巴细胞比值(NLR)、淋巴细胞与单核细胞比值(LMR)、全身免疫炎症指数(SII)与接受根治性手术CRC患者预后的关系,采用Cox回归模型对影响患者预后的因素进行单因素和多因素分析,根据多因素分析结果构建列线图模型。结果截至随访截止日期,350例CRC患者死亡80例,5年OS率为77.14%。SIS 0分组、1分组、2分组患者5年OS率分别为95.71%、79.65%、61.11%,差异有统计学意义(χ^(2)=30.19,P<0.001)。SIS 0分组、1分组、2分组患者间年龄(χ^(2)=19.40,P<0.001)、肿瘤部位(χ^(2)=8.18,P=0.017)、T分期(χ^(2)=10.01,P=0.007)、TNM分期(χ^(2)=14.80,P=0.001)、肿瘤直径(χ^(2)=13.91,P=0.001)及癌胚抗原(CEA)水平(χ^(2)=10.12,P=0.006)差异均有统计学意义;低NLR组与高NLR组患者5年OS率分别为82.67%、56.16%,差异有统计学意义(χ^(2)=24.96,P<0.001);低LMR组与高LMR组患者5年OS率分别为66.85%、88.17%,差异有统计学意义(χ^(2)=22.45,P<0.001);低SII组与高SII组患者5年OS率分别为86.14%、69.02%,差异有统计学意义(χ^(2)=14.76,P<0.001)。单因素分析显示,年龄(HR=2.58,95%CI为1.54~4.32,P<0.001)、T分期(HR=2.41,95%CI为1.24~4.68,P=0.009)、N分期(HR=3.03,95%CI为1.85~4.94,P<0.001)、TNM分期(HR=3.61,95%CI为2.15~6.04,P<0.001)、神经侵犯(HR=1.97,95%CI为1.27~3.08,P=0.002)、脉管侵袭(HR=2.31,95%CI为1.49~3.59,P<0.001)、术前SIS 1分(HR=5.09,95%CI为1.57~16.56,P=0.007)、SIS 2分(HR=11.05,95%CI为3.42~35.65,P<0.001)、NLR(HR=2.97,95%CI为1.90~4.64,P<0.001)、LMR(HR=0.31,95%CI为0.19~0.52,P<0.001)、SII(HR=2.50,95%CI为1.54~4.06,P<0.001)均为接受根治性手术CRC患者术后预后的独立影响因素;多因素分析显示,年龄>60岁(HR=2.27,95%CI为1.31~3.91,P=0.003)、TNM分期为Ⅲ~Ⅳ期(HR=7.08,95%CI为1.89~26.59,P=0.004)、术前SIS 2分(HR=4.02,95%CI为1.09~14.83,P=0.037)均为接受根治性手术CRC患者术后预后的独立危险因素。根据筛选出的变量所构建的列线图模型具有较高的预测准确性:列线图的C-index为0.75。结论年龄>60岁、TNM分期为Ⅲ~Ⅳ期、术前SIS 2分均为CRC患者术后预后的独立危险因素,以此构建出的列线图模型具有较高的预测准确性。

Objective To screen the factors influencing overall survival(OS)of patients undergoing radical resection for colorectal cancer(CRC)and to construct a prognostic model for OS of patients after CRC.Methods The clinical data of 350 patients with stageⅠ-ⅣCRC who underwent radical resection in the People's Hospital of Wuhan University from March 2017 to December 2019 were collected retrospectively.Patients were divided into subgroups 0(n=70),1(n=172),and 2(n=108)according to different preoperative systemic inflammation score(SIS).The relationship between different SIS,neutrophil to lymphocyte ratio(NLR),lymphocyte to monocyte ratio(LMR),systemic immune inflammation index(SII)and prognosis of CRC patients undergoing radical surgical resection were analyzed,and Cox regression models were used to perform univariate and multifactorial analyses of factors affecting patient prognosis,and column line graph models were constructed based on the results of multifactorial analyses.Results By the deadline of follow-up,80 of 350 CRC patients died,and the 5-year OS rate was 77.14%.The 5-year survival rates of patients in SIS group 0,group 1 and group 2 were 95.71%,79.65%and 61.11%respectively,with a statistically significant difference(χ^(2)=30.19,P<0.001).Statistically significant differences in age(χ^(2)=19.40,P<0.001),tumor site(χ^(2)=8.18,P=0.017),T stage(χ^(2)=10.01,P=0.007),TNM stage(χ^(2)=14.80,P=0.001),tumor diameter(χ^(2)=13.91,P=0.001)and carcino-embryonic antigen(CEA)level(χ^(2)=10.12,P=0.006)among patients in SIS group 0,group 1 and group 2.The 5-year OS rates of patients in the low NLR and high NLR groups were 82.67%and 56.16%respectively,with a statistically significant difference(χ^(2)=24.96,P<0.001);the 5-year OS rates of patients in the low LMR and high LMR groups were 66.85%and 88.17%respectively,with a statistically significant difference(χ^(2)=22.45,P<0.001);the 5-year OS rates of patients in the low SII and high SII groups were 86.14%and 69.02%respectively,with a statistically significant difference(χ^(2)=14.76,P<0.001).Univariate analysis showed that age(HR=2.58,95%CI:1.54-4.32,P<0.001),T stage(HR=2.41,95%CI:1.24-4.68,P=0.009),N stage(HR=3.03,95%CI:1.85-4.94,P<0.001),TNM stage(HR=3.61,95%CI:2.15-6.04,P<0.001),nerve invasion(HR=1.97,95%CI:1.27-3.08,P=0.002),vascular invasion(HR=2.31,95%CI:1.49-3.59,P<0.001),preoperative SIS 1 score(HR=5.09,95%CI:1.57-16.56,P=0.007),SIS 2 score(HR=11.05,95%CI:3.42-35.65,P<0.001),NLR(HR=2.97,95%CI:1.90-4.64,P<0.001),LMR(HR=0.31,95%CI:0.19-0.52,P<0.001),and SII(HR=2.50,95%CI:1.54-4.06,P<0.001)were all independent influence factors affecting the postoperative prognosis of CRC patients undergoing radical surgical resection;multivariate analysis showed that age>60 years(HR=2.27,95%CI:1.31-3.91,P=0.003),TNM stageⅢ-Ⅳ(HR=7.08,95%CI:1.89-26.59,P=0.004),and preoperative SIS 2 score(HR=4.02,95%CI:1.09-14.83,P=0.037)were all independent risk factors affecting the postoperative prognosis of CRC patients undergoing radical surgical resection.The nomogram model built based on the screened variables has high prediction accuracy:the C-index of the nomogram was 0.75.Conclusion Age>60 years old,TNM stageⅢ-Ⅳ,SIS 2 score are all independent risk factors for postoperative prognosis of colorectal cancer.The nomograph model constructed by this method has high prediction accuracy.