完整结肠系膜切除术时代预测结肠癌生存和复发的列线图
Nomograms predicting survival and recurrence in colonic cancer in the era of complete mesocolic excision.
机构信息
Department of Colorectal Surgery National Cancer Centre Hospital Saitama Japan.
Department of Surgery National Defense Medical College Saitama Japan.
出版信息
BJS Open. 2019 Apr 26;3(4):539-548. doi: 10.1002/bjs5.50167. eCollection 2019 Aug.
BACKGROUND
More extensive lymphadenectomy may improve survival after resection of colonic cancer. Nomograms were created predicting overall survival and recurrence for patients who undergo D2-D3 lymph node dissection, and their validity determined.
METHODS
This was a multicentre study of patients with colonic cancer who underwent resection with D2-D3 lymph node dissection in Japan. Inclusion criteria included R0 resection. A training cohort of patients operated on from 2007 to 2008 was analysed to construct prognostic models predicting survival and recurrence. Discrimination and calibration were performed using an external validation cohort from the Japanese colorectal cancer registry (procedures in 2005-2006).
RESULTS
The training cohort consisted of 2746 patients. Predictors of survival were: age (hazard ratio (HR) 1·04), female sex (HR 0·71), depth of tumour invasion (HR 1·15, 1·22, 2·96 and 3·14 for T2, T3, T4a and T4b respectively T1), lymphatic invasion (HR 1·11, 1·15 and 2·95 for ly1, ly2 and ly3 ly0), preoperative carcinoembryonic antigen (CEA) level (HR 1·21, 1·59 and 1·99 for 5·1-10·0, 10·1-20·0 and 20·1 and over 0-5·0 ng/ml), number of metastatic lymph nodes (HR 1·07), number of lymph nodes examined (HR 0·98) and extent of lymphadenectomy (HR 0·23, 0·13 and 0·11 for D1, D2 and D3 D0). Predictors of recurrence were: female sex (HR 0·82), macroscopic type (HR 3·82, 4·56, 6·66, 7·74 and 3·22 for types I, II, III, IV and V type 0), depth of invasion (HR 1·25, 2·66, 5·32 and 6·43 for T2, T3, T4a and T4b T1), venous invasion (HR 1·43, 3·05 and 4·79 for v1, v2 and v3 v0), preoperative CEA level (HR 1·39, 1·43, 1·56 and 1·85 for 5·1-10·0, 10·1-20·0, 20·1-40·0 and 40·1 or more 0-5 ng/ml), number of metastatic lymph nodes (HR 1·07) and number of lymph nodes examined (HR 0·98). The validation cohort comprised 4446 patients. The internal and external validated Harrell's C-index values for the nomogram predicting survival were 0·75 and 0·74 respectively. Corresponding values for recurrence were 0·78 and 0·75.
CONCLUSION
These nomograms could predict survival and recurrence after curative resection of colonic cancer.
背景
更广泛的淋巴结清扫术可能会提高结肠癌切除术后的生存率。为接受 D2-D3 淋巴结清扫术的患者创建了预测总生存率和复发率的列线图，并确定了其有效性。
方法
这是一项在日本进行的接受 D2-D3 淋巴结清扫术的结肠癌患者的多中心研究。纳入标准包括 RO 切除。对 2007 年至 2008 年接受手术的患者进行训练队列分析，构建预测生存和复发的预后模型。使用来自日本结直肠癌登记处的外部验证队列（2005-2006 年的手术）进行区分度和校准。
结果
训练队列包括 2746 名患者。生存的预测因素包括：年龄（风险比 (HR) 1.04）、女性（HR 0.71）、肿瘤浸润深度（HR 1.15、1.22、2.96 和 3.14 分别为 T2、T3、T4a 和 T4b T1）、淋巴管浸润（HR 1.11、1.15 和 2.95 分别为 ly1、ly2 和 ly3 ly0）、术前癌胚抗原（CEA）水平（HR 1.21、1.59 和 1.99 分别为 5.1-10.0、10.1-20.0 和 20.1 及以上 0-5.0ng/ml）、转移性淋巴结数量（HR 1.07）、检查的淋巴结数量（HR 0.98）和淋巴结清扫范围（HR 0.23、0.13 和 0.11 分别为 D1、D2 和 D3 D0）。复发的预测因素包括：女性（HR 0.82）、大体类型（HR 3.82、4.56、6.66、7.74 和 3.22 分别为 I、II、III、IV 和 V 型 0）、浸润深度（HR 1.25、2.66、5.32 和 6.43 分别为 T2、T3、T4a 和 T4b T1）、静脉侵犯（HR 1.43、3.05 和 4.79 分别为 v1、v2 和 v3 v0）、术前 CEA 水平（HR 1.39、1.43、1.56 和 1.85 分别为 5.1-10.0、10.1-20.0、20.1-40.0 和 40.1 或更高 0-5ng/ml）、转移性淋巴结数量（HR 1.07）和检查的淋巴结数量（HR 0.98）。验证队列包括 4446 名患者。预测生存的列线图的内部和外部验证 Harrell's C 指数值分别为 0.75 和 0.74。相应的复发值分别为 0.78 和 0.75。
结论
这些列线图可以预测结肠癌根治性切除术后的生存和复发。
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