Guan Xu, Ma Chen-Xi, Quan Ji-Chuan, Zhao Zhi-Xun, Chen Hai-Peng, Sun Peng, Wang Song, Lu Zhao, Ma Xiao-Long, Liu Zheng, Jiang Zheng, Wang Xi-Shan
Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Bejing, China.
Department of Colorectal Surgery, the Second Affiliated Hospital of Harbin Medical University, Harbin, China.
J Cancer. 2020 May 11;11(15):4366-4372. doi: 10.7150/jca.40921. eCollection 2020.
The prognosis of synchronous bone metastasis (BM) in colorectal cancer (CRC) is poor and rarely concerned. A clinical tool to evaluate the prognosis and clinical outcomes for BM would be attractive in current clinical practice. A total of 342 CRC patients with synchronous BM were identified from Surveillance, Epidemiology, and End Results (SEER) database. The cancer specific survival (CSS) was estimated with the Kaplan-Meier method. Prognostic factors were identified from multivariate Cox model, and the final clinical nomogram was developed to predict the CSS. The concordance index (C-index) was used to assess the discriminative ability. Calibration curves were provided to internally validate the performance of the nomogram. The nomogram finally consisted of 6 prognostic factors including age, tumor grade, AJCC N stage, carcinoembryonic antigen (CEA) levels, primary tumor resection and chemotherapy, which translated the effects of prognostic factors into certain scores to predict the 1-, 2- and 3-year CSS for the synchronous BM in CRC patients. The nomogram presented a good accuracy for predicting the CSS with the C-index of 0.742. The calibration of the nomogram predictions was also accurate. This nomogram was accurate enough to predict the CSS of CRC patients with synchronous BM using readily available clinicopathologic factors and could provide individualized clinical decisions for both physicians and patients.
结直肠癌（CRC）同步骨转移（BM）的预后较差且很少受到关注。在当前临床实践中，一种评估BM预后和临床结局的临床工具将很有吸引力。从监测、流行病学和最终结果（SEER）数据库中识别出总共342例患有同步BM的CRC患者。采用Kaplan-Meier方法估计癌症特异性生存率（CSS）。从多变量Cox模型中确定预后因素，并开发最终的临床列线图以预测CSS。一致性指数（C-index）用于评估判别能力。提供校准曲线以内部验证列线图的性能。该列线图最终由6个预后因素组成，包括年龄、肿瘤分级、美国癌症联合委员会（AJCC）N分期、癌胚抗原（CEA）水平、原发肿瘤切除和化疗，这些因素将预后因素的影响转化为特定分数，以预测CRC患者同步BM的1年、2年和3年CSS。该列线图在预测CSS方面具有良好的准确性，C-index为0.742。列线图预测的校准也很准确。该列线图能够利用现成的临床病理因素准确预测CRC同步BM患者的CSS，并可为医生和患者提供个性化的临床决策。
