背景与目的探讨结直肠癌肝转移瘤(colorectal cancer liver metastases,CCLM)切除术后肝内早期复发的影响因素,建立列线图模型预测复发风险。方法回顾性分析2015年1月至2021年2月,行手术或(和)射频消融治疗肝转移瘤的258例结直肠癌伴肝...背景与目的探讨结直肠癌肝转移瘤(colorectal cancer liver metastases,CCLM)切除术后肝内早期复发的影响因素,建立列线图模型预测复发风险。方法回顾性分析2015年1月至2021年2月,行手术或(和)射频消融治疗肝转移瘤的258例结直肠癌伴肝转移患者的临床和病理资料,采用单因素Cox回归、LASSO回归及多因素Cox回归分析导致早期肝内复发的危险临床病理因素,并构建累计事件发生概率线图,建立列线图模型预测患者早期肝内复发风险,并采用一致性指数(index of concordance,C-index)、受试者工作特征曲线(receiver operating characteristic,ROC)、校准曲线及决策分析曲线(decision curve analysis,DCA)全方位评估模型的预测效能。结果单因素Cox分析显示,肝转移瘤数量[风险比(hazard ratio,HR)=1.305,95%置信区间(confidence interval,CI):1.165-1.461,P<0.001]、肝转移瘤最大直径(HR=1.664,95%CI:1.154-2.397,P=0.006)、原发肿瘤N1分期(HR=1.531,95%CI:0.974-2.406,P=0.065)、原发肿瘤有远处转移(HR=1.429,95%CI:0.965-2.115,P=0.075)、原发肿瘤位置为右半结肠(HR=1.759,95%CI:1.213-2.551,P=0.003)、CRS评分大于3分(HR=1.616,95%CI:1.126-2.319,P=0.009)、KRAS基因突变(HR=2.845,95%CI:1.97-4.108,P<0.001)、未行新辅助化疗(HR=1.415,95%CI:0.966-2.073,P=0.074)是肝内早期复发的危险因素,而原发肿瘤T4分期(HR=0.426,95%CI:0.169-1.071,P=0.070)、未行靶向治疗(HR=0.713,95%CI:0.497-1.023,P=0.066)是复发的预防因素,上述变量继续用LASSO回归分析发现有7个变量与患者术后早期肝内复发相关,危险因素为术中输血(系数0.012)、肝转移瘤数量(系数0.149)、肝转移瘤最大直径(系数0.173)、原发肿瘤为右半结肠(系数0.366)、KRAS基因突变型(系数0.765)、未行新辅助化疗(系数0.174),保护因素为原发肿瘤T4分期(系数-0.095)。多因素COX分析结果显示,右半结肠癌(HR=1.828,95%CI:1.232-2.712,P=0.003)、肝转移瘤数量(HR=1.203,95%CI:1.030-1.406,P=0.020)、KRAS基因突变(HR=2.761,95%CI:1.878-4.058,P<0.001)、未行新辅助化疗(HR=1.709,95%CI:1.122-2.603,P=0.013)是CCLM肝转移瘤切除术后早期复发的独立危险因素。建立预测CCLM患者术后1年肝内早期复发的列线图模型,其C-index为0.703(95%CI:0.678-0.727),ROC曲线下面积(area under curve,AUC)为0.764,校准曲线显示与对角线较接近,临床决策曲线显示模型曲线离“None线”和“All线”均最远。结论右半结肠癌、肝转移瘤数量、KRAS基因突变、未行新辅助化疗是CCLM患者肝转移瘤切除术后肝内早期复发的独立危险因素。展开更多
2000年国际癌症研究机构(LARC)为了规范治疗重新规定了胃肠道肿瘤的定义和诊断标准,引用了“上皮内瘤变”这一概念,强调上皮内瘤变属于癌前病变,应区别于恶性肿瘤的治疗方法。概念的细化给病理医师诊断上带来了困惑,而且在临床实践中对...2000年国际癌症研究机构(LARC)为了规范治疗重新规定了胃肠道肿瘤的定义和诊断标准,引用了“上皮内瘤变”这一概念,强调上皮内瘤变属于癌前病变,应区别于恶性肿瘤的治疗方法。概念的细化给病理医师诊断上带来了困惑,而且在临床实践中对于治疗方式的选择提出了更高的要求。对于结直肠高级别上皮内瘤变,内镜下介入治疗为主,同时需根据切除术后病理标本结果决定是否追加外科手术及术后随访时间。建议采用多学科综合治疗协作组模式进行综合评估,个体化分析,为病人提供最佳的诊疗方式。In 2000, the International Agency for Research on Cancer (IARC) redefined the definitions and diagnostic criteria for gastrointestinal tumors to standardize treatment. The concept of “intraepithelial neoplasia” was introduced, emphasizing that intraepithelial neoplasia is a precancerous lesion and should be distinguished from malignant tumors in terms of treatment methods. The refinement of this concept has caused some confusion among pathologists in diagnosis and has also posed higher demands on the selection of treatment methods in clinical practice. For colorectal high-grade intraepithelial neoplasia, endoscopic intervention is primarily recommended. However, the decision on whether to perform additional surgical procedures and the postoperative follow-up period should be based on the pathological results of the resected specimens. It is recommended to adopt a multidisciplinary treatment collaboration model for comprehensive evaluation and individualized analysis to provide the best diagnostic and therapeutic approaches for patients.展开更多
目的:在肿瘤幸存者中,良好预后与心血管疾病死亡风险增加相关。本研究的目的是探讨不同肿瘤分期的结直肠肿瘤患者的累积死亡率和心血管疾病死亡风险。方法:我们从Surveillance, Epidemiology, and End Results (SEER)数据库中检索1975~2...目的:在肿瘤幸存者中,良好预后与心血管疾病死亡风险增加相关。本研究的目的是探讨不同肿瘤分期的结直肠肿瘤患者的累积死亡率和心血管疾病死亡风险。方法:我们从Surveillance, Epidemiology, and End Results (SEER)数据库中检索1975~2014年、年龄超过15岁的结直肠肿瘤幸存者。心血管疾病的累积死亡率通过竞争风险模型进行估计。我们计算了结直肠肿瘤死亡患者中心血管疾病死亡的比例。将心血管疾病的标准化死亡率(Standardized mortality ratio, SMR)与美国普通人群进行比较。结果:共纳入353,273例患者,其中早期患者147,465例(41.7%),中期患者141,541例(40.1%),晚期患者64,267例(18.2%)。心血管疾病是所有患者的第二位死亡原因,是早期患者的第一位死亡原因。早期患者确诊后八年心血管疾病累积死亡率高于结直肠肿瘤(12.17%比11.76%,P Objective: Favorable prognoses are associated with an increased risk of death from cardiovascular disease (CVD) among cancer survivors. The objective of this study is to explore cumulative mortality and risk of death from cardiovascular disease in patients with colorectal cancer by tumor stages. Methods: We retrieved colorectal cancer survivors aged 15 years or older between 1975 and 2014 from the Surveillance, Epidemiology, and End Results (SEER) database. Cumulative mortality from cardiovascular disease was estimated by competitive risk models. We calculated the proportions of death from cardiovascular disease among dead patients with colorectal cancer. Standardized mortality ratios (SMRs) for cardiovascular disease were estimated compared to the general US population. Results: A total of 353,273 patients were included, with 147,465 (41.7%) in the early stage, 141,541 (40.1%) in the middle stage, and 64,267 (18.2%) in the late stage. Cardiovascular disease was the second leading cause of death in all patients and the first leading cause of death in patients with localized disease. The cumulative mortality from cardiovascular disease was higher than that from colorectal cancer eight years after diagnosis in patients with localized disease (12.17% vs. 11.76%, P < 0.001). Among patients with different tumor stages, the proportion of deaths due to cardiovascular diseases gradually exceeds those due to colorectal cancer (overall: 30.57% vs 29.73% at the seventh year;early stage: 30.91% vs 29.90% at the fifth year;middle stage: 34.14% vs 23.73% at the ninth year;advanced stage: 28.83% vs 17.12% at the twelfth year). Compared with the general U.S. population, the standardized mortality ratio (SMR) for cardiovascular mortality among colorectal cancer patients is higher within one year after diagnosis (early stage: SMR is 1.12, and 95%CI is 1.07~1.17;middle stage: SMR is 1.13, and 95%CI is 1.08~1.18;advanced stage: SMR is 1.84, and 95%CI is 1.72~1.96), with younger patients at higher risk of death from cardiovascular diseases (early stage: SMR is 1.23, and 95%CI is 0.90~1.64;middle stage: SMR is 1.38, and 95%CI is 1.02~1.83;advanced stage: SMR is 4.19, and 95%CI is 2.87~5.91). Conclusions: Although cardiovascular disease possessed the highest cumulative mortality in colorectal cancer patients with localized disease, the risks of death from cardiovascular disease were greater than that from colorectal cancer among all tumor stages with time after diagnosis.展开更多
文摘背景与目的探讨结直肠癌肝转移瘤(colorectal cancer liver metastases,CCLM)切除术后肝内早期复发的影响因素,建立列线图模型预测复发风险。方法回顾性分析2015年1月至2021年2月,行手术或(和)射频消融治疗肝转移瘤的258例结直肠癌伴肝转移患者的临床和病理资料,采用单因素Cox回归、LASSO回归及多因素Cox回归分析导致早期肝内复发的危险临床病理因素,并构建累计事件发生概率线图,建立列线图模型预测患者早期肝内复发风险,并采用一致性指数(index of concordance,C-index)、受试者工作特征曲线(receiver operating characteristic,ROC)、校准曲线及决策分析曲线(decision curve analysis,DCA)全方位评估模型的预测效能。结果单因素Cox分析显示,肝转移瘤数量[风险比(hazard ratio,HR)=1.305,95%置信区间(confidence interval,CI):1.165-1.461,P<0.001]、肝转移瘤最大直径(HR=1.664,95%CI:1.154-2.397,P=0.006)、原发肿瘤N1分期(HR=1.531,95%CI:0.974-2.406,P=0.065)、原发肿瘤有远处转移(HR=1.429,95%CI:0.965-2.115,P=0.075)、原发肿瘤位置为右半结肠(HR=1.759,95%CI:1.213-2.551,P=0.003)、CRS评分大于3分(HR=1.616,95%CI:1.126-2.319,P=0.009)、KRAS基因突变(HR=2.845,95%CI:1.97-4.108,P<0.001)、未行新辅助化疗(HR=1.415,95%CI:0.966-2.073,P=0.074)是肝内早期复发的危险因素,而原发肿瘤T4分期(HR=0.426,95%CI:0.169-1.071,P=0.070)、未行靶向治疗(HR=0.713,95%CI:0.497-1.023,P=0.066)是复发的预防因素,上述变量继续用LASSO回归分析发现有7个变量与患者术后早期肝内复发相关,危险因素为术中输血(系数0.012)、肝转移瘤数量(系数0.149)、肝转移瘤最大直径(系数0.173)、原发肿瘤为右半结肠(系数0.366)、KRAS基因突变型(系数0.765)、未行新辅助化疗(系数0.174),保护因素为原发肿瘤T4分期(系数-0.095)。多因素COX分析结果显示,右半结肠癌(HR=1.828,95%CI:1.232-2.712,P=0.003)、肝转移瘤数量(HR=1.203,95%CI:1.030-1.406,P=0.020)、KRAS基因突变(HR=2.761,95%CI:1.878-4.058,P<0.001)、未行新辅助化疗(HR=1.709,95%CI:1.122-2.603,P=0.013)是CCLM肝转移瘤切除术后早期复发的独立危险因素。建立预测CCLM患者术后1年肝内早期复发的列线图模型,其C-index为0.703(95%CI:0.678-0.727),ROC曲线下面积(area under curve,AUC)为0.764,校准曲线显示与对角线较接近,临床决策曲线显示模型曲线离“None线”和“All线”均最远。结论右半结肠癌、肝转移瘤数量、KRAS基因突变、未行新辅助化疗是CCLM患者肝转移瘤切除术后肝内早期复发的独立危险因素。
文摘2000年国际癌症研究机构(LARC)为了规范治疗重新规定了胃肠道肿瘤的定义和诊断标准,引用了“上皮内瘤变”这一概念,强调上皮内瘤变属于癌前病变,应区别于恶性肿瘤的治疗方法。概念的细化给病理医师诊断上带来了困惑,而且在临床实践中对于治疗方式的选择提出了更高的要求。对于结直肠高级别上皮内瘤变,内镜下介入治疗为主,同时需根据切除术后病理标本结果决定是否追加外科手术及术后随访时间。建议采用多学科综合治疗协作组模式进行综合评估,个体化分析,为病人提供最佳的诊疗方式。In 2000, the International Agency for Research on Cancer (IARC) redefined the definitions and diagnostic criteria for gastrointestinal tumors to standardize treatment. The concept of “intraepithelial neoplasia” was introduced, emphasizing that intraepithelial neoplasia is a precancerous lesion and should be distinguished from malignant tumors in terms of treatment methods. The refinement of this concept has caused some confusion among pathologists in diagnosis and has also posed higher demands on the selection of treatment methods in clinical practice. For colorectal high-grade intraepithelial neoplasia, endoscopic intervention is primarily recommended. However, the decision on whether to perform additional surgical procedures and the postoperative follow-up period should be based on the pathological results of the resected specimens. It is recommended to adopt a multidisciplinary treatment collaboration model for comprehensive evaluation and individualized analysis to provide the best diagnostic and therapeutic approaches for patients.
文摘目的:在肿瘤幸存者中,良好预后与心血管疾病死亡风险增加相关。本研究的目的是探讨不同肿瘤分期的结直肠肿瘤患者的累积死亡率和心血管疾病死亡风险。方法:我们从Surveillance, Epidemiology, and End Results (SEER)数据库中检索1975~2014年、年龄超过15岁的结直肠肿瘤幸存者。心血管疾病的累积死亡率通过竞争风险模型进行估计。我们计算了结直肠肿瘤死亡患者中心血管疾病死亡的比例。将心血管疾病的标准化死亡率(Standardized mortality ratio, SMR)与美国普通人群进行比较。结果:共纳入353,273例患者,其中早期患者147,465例(41.7%),中期患者141,541例(40.1%),晚期患者64,267例(18.2%)。心血管疾病是所有患者的第二位死亡原因,是早期患者的第一位死亡原因。早期患者确诊后八年心血管疾病累积死亡率高于结直肠肿瘤(12.17%比11.76%,P Objective: Favorable prognoses are associated with an increased risk of death from cardiovascular disease (CVD) among cancer survivors. The objective of this study is to explore cumulative mortality and risk of death from cardiovascular disease in patients with colorectal cancer by tumor stages. Methods: We retrieved colorectal cancer survivors aged 15 years or older between 1975 and 2014 from the Surveillance, Epidemiology, and End Results (SEER) database. Cumulative mortality from cardiovascular disease was estimated by competitive risk models. We calculated the proportions of death from cardiovascular disease among dead patients with colorectal cancer. Standardized mortality ratios (SMRs) for cardiovascular disease were estimated compared to the general US population. Results: A total of 353,273 patients were included, with 147,465 (41.7%) in the early stage, 141,541 (40.1%) in the middle stage, and 64,267 (18.2%) in the late stage. Cardiovascular disease was the second leading cause of death in all patients and the first leading cause of death in patients with localized disease. The cumulative mortality from cardiovascular disease was higher than that from colorectal cancer eight years after diagnosis in patients with localized disease (12.17% vs. 11.76%, P < 0.001). Among patients with different tumor stages, the proportion of deaths due to cardiovascular diseases gradually exceeds those due to colorectal cancer (overall: 30.57% vs 29.73% at the seventh year;early stage: 30.91% vs 29.90% at the fifth year;middle stage: 34.14% vs 23.73% at the ninth year;advanced stage: 28.83% vs 17.12% at the twelfth year). Compared with the general U.S. population, the standardized mortality ratio (SMR) for cardiovascular mortality among colorectal cancer patients is higher within one year after diagnosis (early stage: SMR is 1.12, and 95%CI is 1.07~1.17;middle stage: SMR is 1.13, and 95%CI is 1.08~1.18;advanced stage: SMR is 1.84, and 95%CI is 1.72~1.96), with younger patients at higher risk of death from cardiovascular diseases (early stage: SMR is 1.23, and 95%CI is 0.90~1.64;middle stage: SMR is 1.38, and 95%CI is 1.02~1.83;advanced stage: SMR is 4.19, and 95%CI is 2.87~5.91). Conclusions: Although cardiovascular disease possessed the highest cumulative mortality in colorectal cancer patients with localized disease, the risks of death from cardiovascular disease were greater than that from colorectal cancer among all tumor stages with time after diagnosis.
