Li Yuqiang, Liu Wenxue, Zhao Lilan, Güngör Cenap, Xu Yang, Song Xiangping, Wang Dan, Zhou Zhongyi, Zhou Yuan, Li Chenglong, Pei Qian, Tan Fengbo, Pei Haiping
Department of Gastrointestinal Surgery, Xiangya Hospital, Central South University, Changsha, China.
Department of General Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
J Cancer. 2020 Aug 27;11(21):6213-6225. doi: 10.7150/jca.46155. eCollection 2020.
Colorectal cancer (CRC) ranks as the third most frequent cancer type and the second leading cause of cancer-related death worldwide. The liver is the most common metastatic site of CRC with 20%-34% of patients suffering synchronous liver metastasis. Patients with colorectal liver-limited metastasis account for one-third of deaths from colorectal cancer. Moreover, some evidence indicated that CRC patients with synchronous liver disease encounter a worse prognosis and more disseminated disease state comparing with metastatic liver disease that develops metachronously. Data in this retrospective analysis were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Nomograms were constructed with basis from a multivariate Cox regression analysis. The prognostic nomograms were validated by C-index, time-dependent receiver operating characteristic (ROC) curve, decision curve analysis (DCA) and calibration curves. A total of 9,958 CRC patients with synchronous liver-limited metastasis were extracted from the SEER database during 2010-2016. Both overall survival (OS) and cancer-specific survival (CSS) were significantly correlated with age, marital status, race, tumor location, pathological grade, histologic type, T stage, N stage, surgery for primary tumor, surgery for liver metastasis, chemotherapy and CEA. All of the significant variables were used to create the nomograms predicting OS and CSS. C-index values, time-dependent ROC curves, DCA curves and calibration curves, proved the superiority of the nomograms. Our research investigated a national cohort of almost 10,000 patients to create and verify nomograms based on pathological, therapeutic and demographic features to predict OS and CSS for synchronous colorectal liver-limited metastasis (SCLLM). The nomograms may act as an excellent tool to integrate clinical characteristics to guide the therapeutic choice for SCLLM patients.
结直肠癌（CRC）是全球第三大常见癌症类型，也是癌症相关死亡的第二大主要原因。肝脏是CRC最常见的转移部位，20%-34%的患者发生同步肝转移。结直肠肝局限性转移患者占结直肠癌死亡人数的三分之一。此外，一些证据表明，与异时性发生的转移性肝病相比，患有同步性肝病的CRC患者预后更差，疾病扩散程度更高。本回顾性分析的数据来自监测、流行病学和最终结果（SEER）数据库。根据多变量Cox回归分析构建列线图。通过C指数、时间依赖性受试者操作特征（ROC）曲线、决策曲线分析（DCA）和校准曲线对预后列线图进行验证。2010年至2016年期间，从SEER数据库中提取了9958例同步肝局限性转移的CRC患者。总生存期（OS）和癌症特异性生存期（CSS）均与年龄、婚姻状况、种族、肿瘤位置、病理分级、组织学类型、T分期、N分期、原发肿瘤手术、肝转移手术、化疗和癌胚抗原（CEA）显著相关。所有显著变量均用于创建预测OS和CSS的列线图。C指数值、时间依赖性ROC曲线、DCA曲线和校准曲线证明了列线图的优越性。我们的研究调查了近10000名患者的全国队列，以创建和验证基于病理、治疗和人口统计学特征的列线图，以预测同步结直肠肝局限性转移（SCLLM）的OS和CSS。这些列线图可能是整合临床特征以指导SCLLM患者治疗选择的优秀工具。
