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[结直肠间质瘤的临床病理特征及预后]

[Clinicopathological features and prognosis of colorectal stromal tumor].

作者信息

Wang W P, Wang J F, Hu J, Wang J F, Liu J, Kong D L, Li J

机构信息

Department of Colorectal Oncology, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China.

Department of Internal Medicine, Tianjin University Hospital, Tianjin 300072, China.

出版信息

Beijing Da Xue Xue Bao Yi Xue Ban. 2020 Apr 18;52(2):353-361. doi: 10.19723/j.issn.1671-167X.2020.02.025.

Abstract

OBJECTIVE

The incidence of colorectal stromal tumor is low among digestive tract tumors, therefore the literatures about clinicopathological features and prognosis of colorectal stromal tumor are few at home and abroad. In this study, we performed survival analyses for colorectal stromal tumor. The nomogram made by prognostic factors provided basis for evaluation of prognosis.

METHODS

The clinico-pathological and prognostic data of colorectal stromal tumor between January 1992 and December 2015 were collected from the surveillance, epidemiology, and end results (SEER) database. The survival analyses were made by SPSS 24.0 software. The nomogram and calibration curve were made by RMS package in R 3.5.2 software.

RESULTS

In the study, 546 patients with colorectal stromal tumor were included. The median age of onset was 64 years. The regional lymph node metastasis (LNM) rate was 9.4%. The multivariate Cox regression analyses of the 546 cases showed that the older age of onset (>64 years), single or divorce, colon tumor (compared with rectal tumor), non-surgery, high histological grade, LNM and distant metastasis were associated with worse cancer specific survival (CSS) and overall survival (OS), P < 0.05 for all. The treatment district was independent prognostic factor of OS (P = 0.027). The C-index of independent prognostic factors predicting CSS and OS probability were 0.76 (95%CI: 0.72-0.80) and 0.75 (95%CI: 0.72-0.78), respectively. Multivariate analyses were further carried out in the 174 patients with definite histological grade and tumor location, which revealed that the age of onset, histological grade, surgery or not were independent prognostic factors of CSS and OS (P < 0.05 for all). Tumor location was associated with CSS (P = 0.041) but not OS (P = 0.057) among the 174 cases. Four independent prognostic factors influencing the 174 patients' prognosis were used to make nomogram for predicting survival probability of 546 cases. The C-index of four prognostic factors predicting probability of CSS and OS of the 546 cases were separately 0.71 (95%CI: 0.66-0.75) and 0.73 (95%CI: 0.70-0.77). The nomogram had more accuracy for predicting OS probability of colorectal stromal tumors.

CONCLUSION

The prognosis of colorectal stromal tumor was affected by multiple clinicopathological factors. The nomogram provided the basis for predicting the survival probability of patients with colorectal stromal tumor.

摘要

目的

结直肠间质瘤在消化道肿瘤中的发病率较低,因此国内外关于结直肠间质瘤临床病理特征及预后的文献较少。本研究对结直肠间质瘤进行生存分析。由预后因素构建的列线图为预后评估提供了依据。

方法

收集1992年1月至2015年12月期间来自监测、流行病学和最终结果(SEER)数据库的结直肠间质瘤临床病理及预后数据。采用SPSS 24.0软件进行生存分析。使用R 3.5.2软件中的RMS包制作列线图和校准曲线。

结果

本研究纳入546例结直肠间质瘤患者。发病年龄中位数为64岁。区域淋巴结转移(LNM)率为9.4%。对这546例患者进行多因素Cox回归分析显示,发病年龄较大(>64岁)、单身或离异、结肠肿瘤(与直肠肿瘤相比)、未手术、组织学分级高、LNM和远处转移与较差的癌症特异性生存(CSS)和总生存(OS)相关,所有P均<0.05。治疗地区是OS的独立预后因素(P = 0.027)。预测CSS和OS概率的独立预后因素的C指数分别为0.76(95%CI:0.72 - 0.80)和0.75(95%CI:0.72 - 0.78)。对174例组织学分级和肿瘤位置明确的患者进一步进行多因素分析,结果显示发病年龄、组织学分级、是否手术是CSS和OS的独立预后因素(所有P<0.05)。在这174例病例中,肿瘤位置与CSS相关(P = 0.041),但与OS无关(P = 0.057)。使用影响这174例患者预后的4个独立预后因素制作列线图,以预测546例患者的生存概率。预测546例患者CSS和OS概率的4个预后因素的C指数分别为0.71(95%CI:0.66 - 0.75)和0.73(95%CI:0.70 - 0.77)。该列线图在预测结直肠间质瘤OS概率方面具有更高的准确性。

结论

结直肠间质瘤的预后受多种临床病理因素影响。该列线图为预测结直肠间质瘤患者的生存概率提供了依据。

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[Clinicopathological features and prognosis of colorectal stromal tumor].[结直肠间质瘤的临床病理特征及预后]
Beijing Da Xue Xue Bao Yi Xue Ban. 2020 Apr 18;52(2):353-361. doi: 10.19723/j.issn.1671-167X.2020.02.025.

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