Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China.
School of Optical and Electronic Information, Huazhong University of Science and Technology, Wuhan 430074, China.
Oxid Med Cell Longev. 2021 Jan 9;2021:6693707. doi: 10.1155/2021/6693707. eCollection 2021.
Oxidative stress plays an important role in the development of colorectal cancer (CRC). This study is aimed at developing and validating a novel scoring system, based on oxidative stress indexes, for prognostic prediction in CRC patients. A retrospective analysis of 1422 CRC patients who underwent surgical resection between January 2013 and December 2017 was performed. These patients were randomly assigned to the training set ( = 1022) or the validation set ( = 400). Cox regression model was used to analyze the laboratory parameters. The CRC-Integrated Oxidative Stress Score (CIOSS) was developed from albumin (ALB), direct bilirubin (DBIL), and blood urea nitrogen (BUN), which were significantly associated with survival in CRC patients. Furthermore, a survival nomogram was generated by combining the CIOSS with other beneficial clinical characteristics. The CIOSS generated was as follows: 0.074 × albumin (g/L), -0.094 × bilirubin (mol/L), and -0.099 × blood urea nitrogen (mmol/L), based on the multivariable Cox regression analysis. Using 50% (0.1025) and 85% (0.481) of CIOSS as cutoff values, three prognostically distinct groups were formed. Patients with high CIOSS experienced worse overall survival (OS) (hazard ratio [HR] = 4.33; 95% confidence interval [CI], 2.80-6.68; < 0.001) and worse disease-free survival (DFS) (HR = 3.02; 95% CI, 1.96-4.64; < 0.001) compared to those with low CIOSS. This predictive nomogram had good calibration and discrimination. ROC analyses showed that the CIOSS possessed excellent performance (AUC = 0.818) in predicting DFS. The AUC of the OS nomogram based on CIOSS, TNM stage, T stage, and chemotherapy was 0.812, while that of the DFS nomogram based on CIOSS, T stage, and TNM stage was 0.855. Decision curve analysis showed that these two prediction models were clinically useful. CIOSS is a CRC-specific prognostic index based on the combination of available oxidative stress indexes. High CIOSS is a powerful indicator of poor prognosis. The CIOSS also showed better predictive performance compared to TNM stage in CRC patients.
氧化应激在结直肠癌（CRC）的发展中起着重要作用。本研究旨在开发和验证一种新的评分系统，该系统基于氧化应激指标，用于预测 CRC 患者的预后。对 2013 年 1 月至 2017 年 12 月期间接受手术切除的 1422 例 CRC 患者进行回顾性分析。这些患者被随机分配到训练集（=1022）或验证集（=400）。使用 Cox 回归模型分析实验室参数。CRC 综合氧化应激评分（CIOSS）由白蛋白（ALB）、直接胆红素（DBIL）和血尿素氮（BUN）组成，这三个指标与 CRC 患者的生存显著相关。此外，通过将 CIOSS 与其他有益的临床特征相结合，生成了生存列线图。基于多变量 Cox 回归分析，CIOSS 计算如下：0.074×白蛋白（g/L），-0.094×胆红素（mol/L），-0.099×血尿素氮（mmol/L）。使用 50%（0.1025）和 85%（0.481）的 CIOSS 作为截断值，将患者分为三个预后明显不同的组。CIOSS 较高的患者总生存（OS）（风险比[HR] = 4.33；95%置信区间[CI]，2.80-6.68；<0.001）和无病生存（DFS）（HR = 3.02；95%CI，1.96-4.64；<0.001）更差。与低 CIOSS 相比，预测列线图具有良好的校准和区分度。ROC 分析表明，CIOSS 在预测 DFS 方面具有优异的性能（AUC = 0.818）。基于 CIOSS、TNM 分期、T 分期和化疗的 OS 列线图的 AUC 为 0.812，而基于 CIOSS、T 分期和 TNM 分期的 DFS 列线图的 AUC 为 0.855。决策曲线分析表明，这两个预测模型具有临床应用价值。CIOSS 是一种基于现有氧化应激指标组合的 CRC 特异性预后指标。高 CIOSS 是预后不良的有力指标。与 CRC 患者的 TNM 分期相比，CIOSS 显示出更好的预测性能。
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