Fan Jin, Liu Yanlong, Cai Xin, Wang Jingwen, Guo Rui, Ji Yuan, Li Chao, Xu Ye, Li Xinxiang, Zhang Chundong, Zhang Rui, Zhu Ji, Cai Sanjun
Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
Department of Oncology, Shanghai Medical College of Fudan University, Shanghai, China.
Front Oncol. 2020 Dec 1;10:566784. doi: 10.3389/fonc.2020.566784. eCollection 2020.
The prognostic stratification of colon cancer using only the tumor-node-metastasis (TNM) stage has some limitations. We sought to increase the accuracy of stratifying patients with stage III colon cancer by constructing a prognostic model combining carcinoembryonic antigen (CEA) with TNM.
We retrospectively analyzed the data generated from stage III colon cancer patients who had early postoperative CEA measurement from 21 to 100 days after surgery from 2006 to 2017. CEA value was processed using restricted cubic splines (RCS) method. The prognostic model was developed using cox proportional hazards regression.
The time later than 20 days after surgery was optimal for measuring CEA, which was determined by comparing the prognostic value for preoperative and postoperative CEA (N = 2,049), and by evaluating the relationship between the hazard ratio (HR) and postoperative CEA measuring time. Postoperative CEA, T stage and N stage were selected into the final model, and the mean integrated-AUC (iAUC) was 0.78 with 1,000 × bootstrap resampling, which was higher than the model using only T and N stages (TN model; mean iAUC, 0.66). The net reclassification improvement (NRI) was 15% when compared with TN model. Patients could be divided into high and low risk groups by the model, and 3-year disease-free survival (DFS) were 53.7% and 87.0%, respectively (HR, 4.30; 95% CI, 2.65 to 6.96; P < 0.001). Similar results were found in the validation set.
Stage III colon cancer could be stratified more accurately using the new prognostic model combining postoperative CEA with T and N stage.
仅使用肿瘤-淋巴结-转移（TNM）分期对结肠癌进行预后分层存在一定局限性。我们试图通过构建一个将癌胚抗原（CEA）与TNM相结合的预后模型来提高III期结肠癌患者分层的准确性。
我们回顾性分析了2006年至2017年术后21至100天进行早期术后CEA测量的III期结肠癌患者的数据。CEA值采用限制性立方样条（RCS）方法处理。使用Cox比例风险回归建立预后模型。
通过比较术前和术后CEA的预后价值（N = 2049）以及评估风险比（HR）与术后CEA测量时间之间的关系，确定术后20天以后的时间是测量CEA的最佳时间。术后CEA、T分期和N分期被纳入最终模型，通过1000次自抽样重采样，平均综合AUC（iAUC）为0.78，高于仅使用T和N分期的模型（TN模型；平均iAUC为0.66）。与TN模型相比，净重新分类改善（NRI）为15%。该模型可将患者分为高风险组和低风险组，3年无病生存率（DFS）分别为53.7%和87.0%（HR，4.30；95%CI，2.65至6.96；P < 0.001）。在验证集中也发现了类似结果。
使用将术后CEA与T和N分期相结合的新预后模型可以更准确地对III期结肠癌进行分层。
