Bai Rui, Tan Yinuo, Li Dan, Yang Mengyuan, Yu Linzhen, Yuan Ying, Fang Xuefeng
Department of Medical Oncology, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
Ann Transl Med. 2021 Apr;9(8):620. doi: 10.21037/atm-20-4728.
The number of tumor deposits (TDs) in colorectal cancer (CRC) prognosis remains debated. We evaluated whether the number of TDs affects prognosis in stage III CRC patients.
Univariate and multivariate analyses were performed with Cox proportional hazards models. The Kaplan-Meier method was used to estimate survival curves. The best cutoff was determined using X-Tile. Patients were 1:1 randomly divided into the training set or the testing set. Prognostic nomogram was established for stage III CRC patients. Concordance index (C-index) and calibration plot were used to assess Nomogram models.
In total, 18,043 (84.69%) CRC patients without TDs and 3,263 (15.31%) patients with TDs were analyzed. Patients with TDs had significantly worse cancer-specific survival (CSS) rates (P<0.001). The number of TDs is an independent factor for the CSS of stage III CRC patients. CSS nomogram of stage III CRC patients was constructed based on race, age at diagnosis, tumor location, histological grade, pathological type, T, N, TDs, chemotherapy. In training set, C-index for CSS nomogram 0.762 (95% CI: 0.752-0.772). In testing set, the C-index for CSS nomogram 0.759 (95% CI: 0.749-0.768). The quality of calibration plots of nomogram models was high.
The presence of TDs is an independent risk prognostic factor for stage III CRC. The number of TDs had a high proportion of prognostic impact.
结直肠癌（CRC）预后中肿瘤结节（TDs）的数量仍存在争议。我们评估了TDs的数量是否会影响III期CRC患者的预后。
采用Cox比例风险模型进行单因素和多因素分析。使用Kaplan-Meier方法估计生存曲线。使用X-Tile确定最佳截断值。患者按1:1随机分为训练集或测试集。为III期CRC患者建立预后列线图。使用一致性指数（C-index）和校准图评估列线图模型。
总共分析了18043例（84.69%）无TDs的CRC患者和3263例（15.31%）有TDs的患者。有TDs的患者癌症特异性生存率（CSS）显著更差（P<0.001）。TDs的数量是III期CRC患者CSS的独立因素。基于种族、诊断年龄、肿瘤位置、组织学分级、病理类型、T、N、TDs、化疗构建了III期CRC患者的CSS列线图。在训练集中，CSS列线图的C-index为0.762（95%CI：0.752-0.772）。在测试集中，CSS列线图的C-index为0.759（95%CI：0.749-0.768）。列线图模型校准图的质量较高。
TDs的存在是III期CRC的独立风险预后因素。TDs的数量对预后影响比例较高。
