Wang Xiaojie, Chi Pan, Lin Huiming, Lu Xingrong, Huang Ying, Xu Zongbin, Huang Shenghui, Sun Yanwu, Ye Daoxiong
Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Fuzhou 350001, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2017 Dec 25;20(12):1387-1392.
To establish a nomogram model to predict the peritoneal metastasis in colon cancer patients without distant metastasis by preoperative imaging examination.
Clinicopathological data of colon cancer patients without distant metastasis by preoperative imaging examination who underwent surgery in our department between January 2000 and December 2014 were retrospectively analyzed. Predictors of peritoneal carcinomatosis were analyzed by univariate and Logistic multivariate analyses. Base on the independent predictors by multivariable analysis results, a nomogram model was formulated with further use of R software. The total score was calculated by the addition of each predictor score, indicating the corresponding risk of peritoneal metastasis. The score was greater in the nomogram, and the risk was higher in peritoneal implantation metastasis. A receiver operating characteristic(ROC) curve was then constructed to evaluate the predictive abilities of the various preoperative factors and nomogram.
A total of 1 417 patients were defined as above and enrolled in the study. The median age was (60.5±13.3) years, 835 cases (58.9%) were male, and 132 cases (9.3%, 132/1417) were diagnosed with synchronous peritoneal carcinomatosis during operation. Univariate analysis showed that peritoneal metastasis was associated with age, incidence of abdominal pain, incidence of mucous bloody stool, CEA level, traversible rate, tumor diameter, ratio of infiltrating type cancer, differentiation, histological type, cT staging and cN staging (all P<0.05). Logistic multivariate analysis revealed that younger age (OR:0.974, 95%CI: 0.958 to 0.990, P=0.001), later clinical T stage (OR: 2.949, 95%CI: 1.588 to 5.476, P=0.001), lesion not traversible(OR: 0.519, 95%CI: 0.314 to 0.858, P=0.011), infiltrative gross type (OR: 1.812, 95%CI: 1.099 to 2.987, P=0.020), larger tumor (OR: 1.044, 95%CI: 0.998 to 1.093, P=0.061), higher preoperative serum CEA level(OR:1.004,95%CI: 1.001 to 1.007, P=0.007) and histopathologic type of mucinous or signet ring cell adenocarcinoma (OR:1.642, 95%CI: 1.009 to 2.673, P=0.046) were independent risk factors. The nomogram model was further established based on above 7 independent risk factors, whose total score was 350 and area under the ROC curve was 0.753(P=0.000).
The nomogram model can be helpful to screen the colon cancer patients with high risk of peritoneal metastasis and to avoid unnecessary laparotomy for colon cancer patients without distant metastasis by preoperative imaging examination.
通过术前影像学检查建立列线图模型，以预测无远处转移的结肠癌患者发生腹膜转移的情况。
回顾性分析2000年1月至2014年12月在我科接受手术的术前影像学检查无远处转移的结肠癌患者的临床病理资料。通过单因素分析和Logistic多因素分析对腹膜癌的预测因素进行分析。基于多变量分析结果中的独立预测因素，进一步使用R软件构建列线图模型。通过将每个预测因素的得分相加计算总分，总分表示腹膜转移的相应风险。列线图得分越高，腹膜种植转移风险越高。然后构建受试者工作特征（ROC）曲线，以评估各种术前因素和列线图的预测能力。
共1417例患者符合上述标准并纳入本研究。中位年龄为（60.5±13.3）岁，男性835例（58.9%），术中诊断为同时性腹膜癌132例（9.3%，132/1417）。单因素分析显示，腹膜转移与年龄、腹痛发生率、黏液血便发生率、癌胚抗原（CEA）水平、可切除率、肿瘤直径、浸润型癌比例、分化程度、组织学类型、cT分期和cN分期有关（均P<0.05）。Logistic多因素分析显示，年龄较小（OR：0.974，95%CI：0.958至0.990，P=0.001）、临床T分期较晚（OR：2.949，95%CI：1.588至5.476，P=0.001）、病变不可切除（OR：0.519，95%CI：0.314至0.858，P=0.011）、大体类型为浸润型（OR：1.812，95%CI：1.099至2.987，P=0.020）、肿瘤较大（OR：1.044，95%CI：0.998至1.093，P=约0.061）、术前血清CEA水平较高（OR：1.004，95%CI：1.001至1.007，P=0.007）以及组织病理学类型为黏液腺癌或印戒细胞腺癌（OR：1.642，95%CI：1.009至2.673，P=0.046）是独立危险因素。基于上述7个独立危险因素进一步建立列线图模型，其总分350分，ROC曲线下面积为0.753（P=0.000）。
列线图模型有助于筛选腹膜转移高危的结肠癌患者，避免对术前影像学检查无远处转移的结肠癌患者进行不必要的剖腹手术。
