Tan Winson Jianhong, Dorajoo Sreemanee Raaj, Chee Madeline Yen Min, Tan Wah Siew, Foo Fung Joon, Tang Choong Leong, Chew Min Hoe
1 Department of Colorectal Surgery, Singapore General Hospital, Singapore 2 Department of Pharmacy, National University of Singapore, Singapore 3 Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Dis Colon Rectum. 2017 Sep;60(9):895-904. doi: 10.1097/DCR.0000000000000821.
A prognostic scoring model has been devised previously to predict survival following primary tumor resection in patients with metastatic colorectal cancer and unresectable metastases. This has yet to be validated.
The main objectives of this study are to validate the proposed prognostic scoring model and create an interactive online calculator to estimate an individual's survival after primary tumor resection.
Clinical data and survival outcomes of patients were extracted from a prospectively maintained database. Patients were categorized into good, moderate, or poor survivor groups based on the previously proposed scoring algorithm. Discrimination was assessed and recalibration was performed, with the recalibrated model implemented as an interactive Web application to provide individualized survival probability.
This study was conducted at a tertiary referral center.
The study included 324 consecutive patients with metastatic colorectal carcinoma and unresectable metastases who underwent primary tumor resection between January 2008 and December 2013.
The primary outcome measured was overall survival.
Three hundred twenty-four patients were included in the study. Median survival in the good, moderate, and poor prognostic groups was 56.8, 25.7, and 19.9 months (log rank test, p = 0.003). The κ statistic was 0.638 and RD was 0.101. Significant differences in survival were found between the moderate and good prognostic groups (HR, 2.79; 95% CI, 1.51-5.15; p = 0.001) and between poor and good prognostic groups (HR, 4.12; 95% CI, 1.98-8.55; p < 0.001). The model was implemented as an interactive online calculator to provide individualized survival estimation after primary tumor resection (http://bit.ly/Stage4PrognosticScore).
Selection bias and single-center data preclude the generalizability of the proposed model. Information regarding the severity or likelihood of developing symptoms from the primary tumor were also not accounted for in the prognostic scoring model proposed.
The prognostic scoring model provides good prognostic stratification of survival after primary tumor resection and may be a useful tool to predict survival after primary tumor resection. See Video Abstract at http://links.lww.com/DCR/A330.
先前已设计出一种预后评分模型，用于预测转移性结直肠癌且有不可切除转移灶的患者在原发性肿瘤切除后的生存情况。该模型尚未得到验证。
本研究的主要目的是验证所提出的预后评分模型，并创建一个交互式在线计算器，以估计个体在原发性肿瘤切除后的生存情况。
从一个前瞻性维护的数据库中提取患者的临床数据和生存结果。根据先前提出的评分算法，将患者分为良好、中等或不良生存组。评估辨别力并进行重新校准，将重新校准后的模型作为交互式网络应用程序实施，以提供个性化的生存概率。
本研究在一家三级转诊中心进行。
该研究纳入了2008年1月至2013年12月期间连续324例接受原发性肿瘤切除的转移性结直肠癌且有不可切除转移灶的患者。
测量的主要结局是总生存期。
324例患者纳入研究。良好、中等和不良预后组的中位生存期分别为56.8个月、25.7个月和19.9个月（对数秩检验，p = 0.003）。κ统计量为0.638，RD为0.101。在中等和良好预后组之间（HR，2.79；95%CI，1.51 - 5.15；p = 0.001）以及不良和良好预后组之间（HR，4.12；95%CI，1.98 - 8.55；p < 0.001）发现了生存的显著差异。该模型作为交互式在线计算器实施，以提供原发性肿瘤切除后的个性化生存估计（http://bit.ly/Stage4PrognosticScore）。
选择偏倚和单中心数据妨碍了所提出模型的普遍性。所提出的预后评分模型也未考虑原发性肿瘤出现症状的严重程度或可能性的信息。
该预后评分模型对原发性肿瘤切除后的生存情况提供了良好的预后分层，可能是预测原发性肿瘤切除后生存情况的有用工具。见视频摘要：http://links.lww.com/DCR/A330。
