Massacesi C, Norman A, Price T, Hill M, Ross P, Cunningham D
The Department of Medicine and GI Unit, The Royal Marsden NHST, London and Sutton, SM2 5PT, Surrey, UK.
Eur J Cancer. 2000 Oct;36(16):2044-52. doi: 10.1016/s0959-8049(00)00286-0.
From our prospectively accrued database of patients with gastrointestinal cancer, 1057 patients with advanced colorectal cancer were identified with the aim of determining predictive factors for survival of greater than 2 years and to use this information to develop a predictive nomogram. Patient's baseline characteristics, type and number of chemotherapy regimens received, and response to chemotherapy were assessed by univariate and multivariate logistic regression comparing those who survived greater than or less than 2 years. A total of 161 (15.2%) patients survived more than 2 years, so-called long survivors (LS). In multivariate analysis, positive predictive factors for LS were: good performance status (PS), normal serum carcinoembryonic antigen (CEA), rectal primary, Dukes' stage A-B, well or moderate differentiation, two or less disease sites, response to chemotherapy and treatment used protracted venous infusion (PVI) 5-fluorouracil (5-FU) in first-line chemotherapy, and the increasing number of chemotherapy treatments received. From these PS, CEA, number of sites and response to first-line chemotherapy were used to develop a nomogram capable of predicting the probability of survival beyond 2 years for an individual patient. This large study confirmed the relevance of known prognostic factors in metastatic colorectal cancer and demonstrated the importance of response to chemotherapy as an independent factor to predict LS. By combining these, we developed a nomogram which provides information which is likely to prove useful in the management of patients with advanced colorectal cancer.
从我们前瞻性收集的胃肠道癌患者数据库中，确定了1057例晚期结直肠癌患者，目的是确定生存超过2年的预测因素，并利用这些信息制定预测列线图。通过单因素和多因素逻辑回归比较生存超过2年和不足2年的患者，评估患者的基线特征、接受的化疗方案类型和数量以及对化疗的反应。共有161例（15.2%）患者生存超过2年，即所谓的长期生存者（LS）。在多因素分析中，LS的阳性预测因素为：良好的体能状态（PS）、血清癌胚抗原（CEA）正常、直肠原发、Dukes分期A - B、高分化或中分化、疾病部位两个或更少、对化疗有反应以及一线化疗中使用了延长静脉输注（PVI）5 - 氟尿嘧啶（5 - FU），以及接受化疗治疗的次数增加。根据这些PS、CEA、部位数量和对一线化疗的反应，制定了一个列线图，能够预测个体患者生存超过2年的概率。这项大型研究证实了已知预后因素在转移性结直肠癌中的相关性，并证明了化疗反应作为预测LS的独立因素的重要性。通过综合这些因素，我们制定了一个列线图，该列线图提供的信息可能对晚期结直肠癌患者的管理有用。
