Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China.
Eur Spine J. 2019 Jun;28(6):1491-1501. doi: 10.1007/s00586-019-05879-5. Epub 2019 Jan 18.
To develop a novel nomogram for predicting survival of patients with spine metastasis from colorectal cancer (SMCRC) based on the clinical characteristics and prognostic factors.
Included in this study were 93 SMCRC patients who received treatments in our institute between 2006 and 2017, whose clinical data were analyzed retrospectively by univariate and multivariate analysis to identify independent variables that could predict prognosis. A nomogram for survival prediction was established on the basis of preoperative independent factors, and then subjected to bootstrap re-samples for internal validation. The discrimination was measured by concordance index (C-index). We used ROC analysis with the corresponding AUROC to compare the prediction accuracy of Changzheng Nomogram with three existing prognostic systems (Tomita, Tokuhashi and Bauer).
The high and median degrees of primary tumor differentiation, primary tumor surgery, carcinoembryonic antigen ≤ 5 ng/ml, no visceral metastases and ECOG-PS (0-2) were favorable prognostic factors for CRC metastases in the spine. These five preoperative independent factors were identified and entered into the nomogram with the C-index of 0.786 (0.739-0.833). The calibration curves for probability of 12- and 24-month overall survival (OS) showed good agreement between the predictive risk and the actual risk, and calibration was assessed. Compared with the previous prognostic systems, Changzheng Nomogram reported in this study showed higher accuracy in predicting OS of patients with SMCRC spinal metastases (p < 0.05).
By using this novel predictive model, clinicians could more precisely estimate the survival outcome of individual patients by evaluating clinical characteristics and identify subgroups of patients who are in need of a specific individual treatment strategy. These slides can be retrieved under Electronic Supplementary Material.
基于临床特征和预后因素，建立预测结直肠癌脊柱转移患者（SMCRC）生存的列线图。
本研究纳入 2006 年至 2017 年在我院接受治疗的 93 例 SMCRC 患者，回顾性分析其临床资料，采用单因素和多因素分析确定预测预后的独立变量。基于术前独立因素建立生存预测列线图，并进行 Bootstrap 重采样内部验证。采用一致性指数（C-index）评估判别能力。通过 ROC 分析及其对应的 AUROC 比较长正列线图与三种现有预后系统（Tomita、Tokuhashi 和 Bauer）的预测准确性。
肿瘤原发灶高、中分化程度、原发灶手术、癌胚抗原≤5ng/ml、无内脏转移和 ECOG-PS（0-2）是结直肠癌脊柱转移的有利预后因素。确定了这五个术前独立因素，并将其纳入列线图，C-index 为 0.786（0.739-0.833）。12 个月和 24 个月总生存（OS）概率的校准曲线显示，预测风险与实际风险之间具有良好的一致性，并进行了校准评估。与以往的预后系统相比，本研究报告的长正列线图在预测 SMCRC 脊柱转移患者 OS 方面具有更高的准确性（p<0.05）。
通过使用该新型预测模型，临床医生可以通过评估临床特征更准确地估计个体患者的生存结局，并确定需要特定个体化治疗策略的患者亚组。这些幻灯片可在电子补充材料中检索。
