Kanemitsu Y, Kato T, Hirai T, Yasui K
Department of Gastroenterological Surgery, The Aichi Cancer Centre, Nagoya, Japan.
Br J Surg. 2004 Jan;91(1):112-20. doi: 10.1002/bjs.4370.
The aim of this study was identify readily available factors most helpful in predicting survival and to develop a prognostic nomogram for patients with pulmonary metastases from colorectal cancer who are candidates for thoracotomy.
Pretreatment data on 313 patients with metastases who underwent thoracotomy were analysed. Fourteen preoperative clinical and pathological variables were used to develop a probability model, in which their association with 3-year survival was tested. A nomogram to predict median, 1- and 3-year survival was constructed and validated internally using the concordance index (c-index). The nomogram was then validated with an external data set.
Five variables were identified as independent predictors of 3-year survival: prethoracotomy carcinoembryonic antigen level, number of pulmonary tumours, presence of hilar or mediastinal tumour-infiltrated lymph nodes, histology of the primary tumour and presence of extrathoracic disease. The nomogram was well calibrated for predicting 3-year overall survival. The internal validated c-index of the nomogram was 0.72. Applied to another data set, the external validated c-index was 0.66.
This model has moderate predictive ability to discriminate between patients who are likely to survive after thoracotomy for pulmonary metastases from colorectal cancer.
本研究的目的是确定最有助于预测生存的现成因素，并为拟行开胸手术的结直肠癌肺转移患者制定一个预后列线图。
分析了313例行开胸手术的转移患者的术前数据。使用14个术前临床和病理变量建立概率模型，并测试它们与3年生存率的相关性。构建了一个预测中位生存期、1年和3年生存率的列线图，并使用一致性指数（c指数）进行内部验证。然后用外部数据集对该列线图进行验证。
五个变量被确定为3年生存率的独立预测因素：开胸术前癌胚抗原水平、肺肿瘤数量、肺门或纵隔有肿瘤浸润淋巴结、原发肿瘤组织学类型和胸外疾病的存在。该列线图在预测3年总生存率方面校准良好。列线图的内部验证c指数为0.72。应用于另一个数据集时，外部验证c指数为0.66。
该模型具有中等预测能力，可区分结直肠癌肺转移开胸手术后可能存活的患者。
