Zhu Ya-Juan, Chen Ye, Hu Hao-Yue, Zhou Yu-Wen, Zhu Yue-Ting, Liu Ji-Yan
Department of Biotherapy, Cancer Center, and National Clinical Research Center for Geriatrics, West China Hospital, West China Medical School, Sichuan University, Chengdu, China.
Department of Abdominal Cancer, Cancer Center, West China Hospital, West China Medical School, Sichuan University, Chengdu, China.
Front Oncol. 2020 Oct 2;10:1681. doi: 10.3389/fonc.2020.01681. eCollection 2020.
To develop and validate predictive nomograms of cancer specific survival (CSS) and overall survival (OS) for synchronous colon cancer with liver metastasis (SCLM) patients.
Patients with pathologically diagnosed colon cancer with liver metastasis were retrieved from the SEER database between 2010 and 2015. Only SCLM patients were included. Univariate and multivariate cox regression analyses were conducted to identify the potential predictors of patients' survival outcomes. The selected variables were integrated to create predictive nomograms via R tools. Furthermore, the concordance index Harrell's C statistic (C-index) was calculated to describe the discrimination of nomograms. Calibration (1000 bootstrap resamples) curves were plotted to compare the predictions of nomograms with the observed outcomes. Decision curve analysis (DCA) and clinical impact curves were performed to evaluate the clinical effects of nomograms.
A total of 22,378 SCLM patients were included. The median time of OS and CSS was 13 and 17 months, respectively. The 1-, 2-, and 3-year rate of OS was 50.6, 28.1, and 14.8%, respectively. While the 1-, 2-, and 3-year rate of CSS was 58.7, 36.8, and 22.5%, respectively. SCLM patients with increased age, left primary tumor location, AJCC IVb stage, and no chemotherapy were associated with an obviously reduced OS and CSS. Variables including age, histological grade, T/N/M stage, tumor size, bone/lung metastasis, CEA, surgery of primary site, and chemotherapy were closely related to the prognoses of SCLM patients. Nomograms of OS and CSS were built and displayed online for convenient utilization. The C-index of OS and CSS monograms were 0.74 and 0.73, respectively, indicating relatively good discrimination of the nomograms. The calibration curves suggested a good agreement between the actual observation and the nomogram prediction. DCAs and clinical impact curves reflected favorable potential clinical effects of predictive nomograms.
Chemotherapy, surgery of primary site, and age were important independent risk factors for the CSS and OS of SCLM patients. We built and validated two reliable nomograms of OS and CSS to predict the prognoses of SCLM patients, which can be accessed online at (https://predictive-tool.shinyapps.io/CSS-DynNomapp/; https://predictive-tool.shinyapps.io/OS-DynNomapp/).
开发并验证同步性结肠癌肝转移（SCLM）患者的癌症特异性生存（CSS）和总生存（OS）预测列线图。
从2010年至2015年的SEER数据库中检索出经病理诊断为结肠癌伴肝转移的患者。仅纳入SCLM患者。进行单因素和多因素Cox回归分析以确定患者生存结局的潜在预测因素。通过R工具整合所选变量以创建预测列线图。此外，计算一致性指数Harrell's C统计量（C指数）以描述列线图的辨别能力。绘制校准曲线（1000次自抽样重采样）以比较列线图的预测结果与观察到的结局。进行决策曲线分析（DCA）和临床影响曲线分析以评估列线图的临床效果。
共纳入22378例SCLM患者。OS和CSS的中位时间分别为13个月和17个月。OS的1年、2年和3年生存率分别为50.6%、28.1%和14.8%。而CSS的1年、2年和3年生存率分别为58.7%、36.8%和22.5%。年龄增加、原发肿瘤位于左侧、AJCC IVb期且未接受化疗的SCLM患者的OS和CSS明显降低。包括年龄、组织学分级、T/N/M分期、肿瘤大小、骨/肺转移、癌胚抗原、原发部位手术和化疗等变量与SCLM患者的预后密切相关。构建了OS和CSS列线图并在线展示以便于使用。OS和CSS列线图的C指数分别为0.74和0.73，表明列线图具有较好的辨别能力。校准曲线表明实际观察结果与列线图预测结果之间具有良好的一致性。DCA和临床影响曲线反映了预测列线图具有良好的潜在临床效果。
化疗、原发部位手术和年龄是SCLM患者CSS和OS的重要独立危险因素。我们构建并验证了两个可靠的OS和CSS列线图以预测SCLM患者的预后，可通过（https://predictive-tool.shinyapps.io/CSS-DynNomapp/；https://predictive-tool.shinyapps.io/OS-DynNomapp/）在线访问。
