Yao Jinjie, Chen Qichen, Deng Yiqiao, Zhao Jianjun, Bi Xinyu, Li Zhiyu, Huang Zhen, Zhang Yefan, Zhou Jianguo, Zhao Hong, Cai Jianqiang
Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Ann Palliat Med. 2021 Apr;10(4):4220-4231. doi: 10.21037/apm-20-2303. Epub 2021 Mar 23.
It is necessary to identify valuable predictors of primary lymph node metastasis and prognosis for patients with synchronous colorectal cancer liver metastases (CRLM) with simultaneous resection of colorectal cancer (CRC) and liver metastases. This study constructed nomograms especially incorporating preoperative testing markers to predict primary lymph node metastases and prognosis in CRLM patients.
By the highest Youden index (sensitivity + 1-specificity), the optimal cut-off values of testing markers for postoperative major complications and lymph node metastasis were identified. Multivariate regression analysis was used to reveal independent predictors for primary lymph node metastasis, postoperative major complications and progression-free survival (PFS). Nomograms based on independent predictors were constructed, and the discrimination and calibration were evaluated.
A nomogram predicting primary lymph node metastasis was based on four risky independent predictors: American Society of Anesthesiologists (ASA) score 3-4, preoperative albumin (ALB) <41.15 g/L, poor differentiation and multiple liver metastases. The performance of the model was acceptable in predicting lymph node metastasis, with an area under the receiver operating characteristic curve (AUROC) of 0.655 (95% CI: 0.591-0.739). Calibration curves and the Hosmer-Lemeshow test revealed desirable model calibration (chi-square: 13.26, P=0.815). In the multivariate analysis, preoperative lactate dehydrogenase (LDH) ≥202.5 U/L [odds ratio (OR) =2.084, 95% confidence interval (CI): 1.039-4.181, P=0.039] and operation time ≥350.5 min (OR =2.848, 95% CI: 1.418-5.723, P=0.003) were independently associated with the presence of postoperative major complications. A nomogram predicting PFS was constructed based on poor differentiation, positive lymph node metastasis, bilobar liver distribution and R0 resection with good discrimination (C-index: 0.656±0.021) and calibration.
This study established predictive nomograms specifically incorporating preoperative ALB and LDH levels for the prediction of primary lymph node metastasis and prognosis in synchronous CRLM patients with simultaneous resection, which have favourable discrimination and calibration to make individualized predictions.
对于同时性结直肠癌肝转移（CRLM）且需同时切除结直肠癌（CRC）和肝转移灶的患者，有必要确定原发性淋巴结转移和预后的有价值预测指标。本研究构建了特别纳入术前检测指标的列线图，以预测CRLM患者的原发性淋巴结转移和预后。
通过最高约登指数（敏感性 + 1 - 特异性），确定术后主要并发症和淋巴结转移检测指标的最佳临界值。采用多因素回归分析揭示原发性淋巴结转移、术后主要并发症和无进展生存期（PFS）的独立预测因素。基于独立预测因素构建列线图，并评估其区分度和校准度。
预测原发性淋巴结转移的列线图基于四个风险独立预测因素：美国麻醉医师协会（ASA）评分3 - 4、术前白蛋白（ALB）<41.15 g/L、低分化和多发肝转移。该模型在预测淋巴结转移方面表现可接受，受试者工作特征曲线下面积（AUROC）为0.655（95% CI：0.591 - 0.739）。校准曲线和Hosmer - Lemeshow检验显示模型校准良好（卡方值：13.26，P = 0.815）。在多因素分析中，术前乳酸脱氢酶（LDH）≥202.5 U/L [比值比（OR） = 2.084，95%置信区间（CI）：1.039 - 4.181，P = 0.039]和手术时间≥350.5分钟（OR = 2.848，95% CI：1.418 - 5.723，P = 0.003）与术后主要并发症的发生独立相关。基于低分化、阳性淋巴结转移、双叶肝分布和R0切除构建了预测PFS的列线图，其具有良好的区分度（C指数：0.656±0.021）和校准度。
本研究建立了特别纳入术前ALB和LDH水平的预测列线图，用于预测同时性CRLM患者同时切除时的原发性淋巴结转移和预后，具有良好的区分度和校准度，可进行个体化预测。
