Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
Int J Surg. 2018 Jun;54(Pt A):149-155. doi: 10.1016/j.ijsu.2018.04.051. Epub 2018 May 3.
The objective of this study was to summarize the clinicopathological and molecular features of synchronous colorectal peritoneal metastases (CPM). We then combined clinical and pathological variables associated with synchronous CPM into a nomogram and confirmed its utilities using decision curve analysis.
Synchronous metastatic colorectal cancer (mCRC) patients who received primary tumor resection and underwent KRAS, NRAS, and BRAF gene mutation detection at our center from January 2014 to September 2015 were included in this retrospective study. An analysis was performed to investigate the clinicopathological and molecular features for independent risk factors of synchronous CPM and to subsequently develop a nomogram for synchronous CPM based on multivariate logistic regression. Model performance was quantified in terms of calibration and discrimination. We studied the utility of the nomogram using decision curve analysis.
In total, 226 patients were diagnosed with synchronous mCRC, of whom 50 patients (22.1%) presented with CPM. After uni- and multivariate analysis, a nomogram was built based on tumor site, histological type, age, and T4 status. The model had good discrimination with an area under the curve (AUC) at 0.777 (95% CI 0.703-0.850) and adequate calibration. By decision curve analysis, the model was shown to be relevant between thresholds of 0.10 and 0.66.
Synchronous CPM is more likely to happen to patients with age ≤60, right-sided primary lesions, signet ring cell cancer or T4 stage. This is the first nomogram to predict synchronous CPM. To ensure generalizability, this model needs to be externally validated.
本研究旨在总结同时性结直肠腹膜转移（CPM）的临床病理和分子特征。然后，我们将与同时性 CPM 相关的临床和病理变量结合起来，纳入一个列线图，并使用决策曲线分析来确认其效用。
本回顾性研究纳入了 2014 年 1 月至 2015 年 9 月在我中心接受原发肿瘤切除术并接受 KRAS、NRAS 和 BRAF 基因突变检测的同时转移性结直肠癌（mCRC）患者。对这些患者的临床病理和分子特征进行分析，以确定同步 CPM 的独立危险因素，并基于多变量逻辑回归建立同步 CPM 的列线图。通过校准和鉴别力来评估模型性能。我们使用决策曲线分析研究了该列线图的实用性。
共诊断出 226 例同时性 mCRC 患者，其中 50 例（22.1%）患者存在 CPM。在单因素和多因素分析后，根据肿瘤部位、组织学类型、年龄和 T4 状态建立了一个列线图。该模型具有良好的鉴别力，曲线下面积（AUC）为 0.777（95%CI 0.703-0.850），校准度也足够。通过决策曲线分析，该模型在阈值为 0.10 至 0.66 之间具有相关性。
同时性 CPM 更可能发生在年龄≤60 岁、右侧原发肿瘤、印戒细胞癌或 T4 期的患者中。这是第一个预测同时性 CPM 的列线图。为了确保其可推广性，需要对该模型进行外部验证。
