Department of Abdominal Oncology, West China Hospital of Medicine, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China.
Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education), The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.
Clin Exp Metastasis. 2021 Feb;38(1):89-95. doi: 10.1007/s10585-020-10069-5. Epub 2021 Jan 9.
Prognostic factors of synchronous bone metastatic colorectal cancer (CRC) are still undetermined. We aimed to investigate survival outcome and prognostic factors of patients with synchronous bone metastatic CRC. Information of patients with synchronous bone metastatic CRC were obtained from the Surveillance, Epidemiology, and End Results (SEER) and West China Hospital (WCH) databases. Cases from SEER database composed construction cohort, while cases from WCH database were used as validation cohort. A novel nomogram was constructed to predict individual survival probability based on Cox regression model. The performance of the nomogram was internally and externally validated using calibration curves and concordance index (C-index). Three hundred and eighty-one patients from SEER database were eligible. The median disease specific OS was 9.0 months (95% confidence interval [CI]: 7.3-10.7 months). Multivariate Cox analysis identified seven independent prognostic factors including histological type, differentiation grade, T stage of primary tumor, CEA level, systemic chemotherapy, combined with liver metastasis and combined with lung metastasis. A novel nomogram was established based on these variables. In the internal validation, the C-index (0.72, 95% CI 0.69-0.75) and calibration curve indicated well performance of this nomogram at predicting survival outcome in bone metastatic CRC. In the external validation, the C-index was 0.57 (95% CI 0.46-0.68). The prognosis of synchronous bone metastatic CRC is very poor. Histological type, differentiation grade, T stage of primary tumor, CEA level, systemic chemotherapy, combined with liver metastasis and combined with lung metastasis are independent prognostic factors. Further study is warranted to confirm the practicality of the prognostic nomogram.
同步骨转移结直肠癌（CRC）的预后因素仍未确定。我们旨在探讨同步骨转移 CRC 患者的生存结局和预后因素。从监测、流行病学和最终结果（SEER）和华西医院（WCH）数据库中获取同步骨转移 CRC 患者的信息。SEER 数据库中的病例构成构建队列，而 WCH 数据库中的病例用于验证队列。基于 Cox 回归模型构建了一种新的列线图来预测个体生存概率。通过校准曲线和一致性指数（C 指数）对内和外部验证列线图的性能。从 SEER 数据库中筛选出 381 名符合条件的患者。疾病特异性总生存期的中位数为 9.0 个月（95%置信区间 [CI]：7.3-10.7 个月）。多变量 Cox 分析确定了 7 个独立的预后因素，包括组织学类型、分化程度、原发肿瘤的 T 分期、CEA 水平、全身化疗、合并肝转移和合并肺转移。基于这些变量建立了一个新的列线图。在内部验证中，C 指数（0.72，95%CI 0.69-0.75）和校准曲线表明该列线图在预测骨转移 CRC 生存结局方面具有良好的性能。在外部验证中，C 指数为 0.57（95%CI 0.46-0.68）。同步骨转移 CRC 的预后非常差。组织学类型、分化程度、原发肿瘤的 T 分期、CEA 水平、全身化疗、合并肝转移和合并肺转移是独立的预后因素。需要进一步的研究来证实该预后列线图的实用性。
