初始不可切除结直肠癌肝转移患者转化治疗结局的影响因素及风险预测模型构建

The Influencing Factors and Risk Prediction Model Construction of Conversion Therapy Outcomes in Patients with Initial Unresectable Colorectal Cancer Liver Metastasis

目的探讨初始不可切除结直肠癌肝转移患者转化治疗结局的影响因素,并构建风险预测模型。方法采用回顾性研究,选取转化治疗失败的50例初始不可切除结直肠癌肝转移患者作为转化失败组,另选取同期转化治疗成功的81例患者作为转化成功组。收集两组患者的基线资料及相关临床指标,采用Logistic回归性分析检验影响初始不可切除结直肠癌肝转移患者转化治疗结局的影响因素,依据回归结果构建风险预测模型,再绘制受试者工作曲线(ROC)分析风险预测模型效能。结果两组患者在肿瘤原发部位、肝转移灶数量、是否侵犯门静脉、血清白蛋白、是否贫血方面比较,差异有统计学意义(P<0.05)。经Logistic回归性分析显示肿瘤位于右半结肠,转移灶数量≥5个,侵犯门静脉,血清白蛋白<36 g/L,贫血是影响初始不可切除结直肠癌肝转移患者转化治疗结局的影响因素(P<0.05)。构建风险预测模型,ROC内部验证显示曲线下面积(AUC)为0.784,AUC的95%CI为:0.703~0.864、P<0.001、特异度:0.654,敏感度:0.880,约登指数:0.534。外部验证:AUC为0.793,AUC的95%CI为0.714~0.873、P<0.001、特异度:0.654,敏感度:0.880,约登指数:0.534。结论肿瘤原发部位、侵犯门静脉、血清白蛋白、贫血及肝转移灶数量是影响初始不可切除结直肠癌肝转移患者转化治疗结局的影响因素,基于上述因素构建的风险预测模型对转化治疗效果具有中等预测价值。

Objective To explore the influencing factors of conversion therapy outcomes in patients with initial unresectable colorectal cancer liver metastasis,and construct a risk prediction model.Methods A retrospective study was conducted,selecting 50 patients with initial unresectable colorectal cancer liver metastasis who failed conversion therapy as the conversion failure group,and 81 patients who successfully converted treatment during the same period as the conversion success group.The baseline data and related clinical indicators of the 2 groups of patients were collected.Logistic regression analysis was used to test the influencing factors affecting the outcome of conversion therapy in patients with initial unresectable colorectal cancer liver metastasis.Based on the regression results,a risk prediction model was constructed,and then the receiver operating curve(ROC)was drawn to analyze the efficacy of the risk prediction model.Results There was a statistical significant difference between the 2 groups of patients in terms of tumor primary site,number of liver metastases,invasion of portal vein,serum albumin,and anemia(P<0.05).Logistic regression analysis showed that the tumor was located in the right colon,with≥5 metastatic lesions,invasion of the portal vein,serum albumin<36 g/L,and anemia as influencing factors for the outcome of conversion therapy in patients with initial unresectable colorectal cancer liver metastasis(P<0.05).The risk prediction model was constructed.The ROC internal validation showed that the area under the curve(AUC)was 0.784,the 95%CI of AUC was 0.703~0.864,P<0.001,the specificity was 0.654,the sensitivity was 0.880,and the Youden's J statistic index was 0.534.External validation:AUC was 0.793,95%CI of AUC was 0.714~0.873,P<0.001,specificity:0.654,sensitivity:0.880,Youden's J statistic index:0.534.Conclusion The primary site of the tumor,invasion of the portal vein,serum albumin,anemia,and the number of liver metastases are factors that affect the outcome of conversion therapy in patients with initial unresectable colorectal cancer liver metastasis.The risk prediction model constructed based on these factors has moderate predictive value for the effectiveness of conversion therapy.