中国晚期结直肠癌患者骨转移风险及预后列线图的开发与验证
Development and validation of risk and prognostic nomograms for bone metastases in Chinese advanced colorectal cancer patients.
作者信息
Wang Nan, Liu Fangqi, Xi Wenqi, Jiang Jinling, Xu Yun, Guan Bingjie, Wu Junwei, Zhou Chenfei, Shi Min, Zhu Zhenggang, Xu Ye, Liu Jing, Zhang Jun
机构信息
Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.
出版信息
Ann Transl Med. 2021 May;9(10):875. doi: 10.21037/atm-21-2550.
BACKGROUND
Bone metastases (BM) from colorectal cancer (CRC) are often accompanied by extraosseous metastases, resulting in a dismal prognosis. The present study aimed to determine the risk factors for BM in metastatic CRC (mCRC) and the prognostic factors for CRC patients with BM.
METHODS
The study was based on a training cohort of 214 mCRC patients (of which, 101 patients had BM) from our center, and a validation cohort of 511 mCRC patients (of which, 173 patients had BM) from another institute. Risk and prognostic nomograms for BM were developed using univariate and multivariate analyses. The goodness of fit, discrimination, and calibration performance of the nomograms were assessed by R, concordance statistics (C-statistics), and the calibration curve. The results were internally validated using bootstrap resampling in the training cohort, and externally validated in the validation cohort.
RESULTS
The novel BM risk nomogram comprised seven variables [degree of tumor differentiation, N-stage, serum alkaline phosphatase (ALP), lactate dehydrogenase (LDH), carcinoembryonic antigen (CEA), liver metastasis, and lung metastasis]. It showed good performance, with an R of 0.447 and a C-statistic of 0.846 [95% confidence interval (CI), 0.793 to 0.898] in the training cohort, and an R of 0.325 and a C-statistic of 0.792 (95% CI, 0.750 to 0.834) in the validation cohort. The optimal cutoff value to identify individuals at low or high risk was 56% probability, with a sensitivity of 71.3% and a specificity of 89.4%. The prognostic nomogram included five factors (tumor differentiation, number of extra-BM organs, number of BM lesions, ALP, and LDH), and had an R of 0.284 and a C-statistic of 0.723 (95% CI, 0.657 to 0.789) in the training set. This nomogram was externally validated in the validation cohort, with an R of 0.182 and a C-statistic of 0.682 (95% CI, 0.638 to 0.726).
CONCLUSIONS
The developed and validated risk and prognostic nomograms showed good performance for predicting the occurrence of BM in mCRC as well as the prognosis of CRC patients with BM. The risk nomogram can be used as a cost-effective preliminary screening tool prior to bone scanning.
背景
结直肠癌（CRC）骨转移（BM）常伴有骨外转移，导致预后不良。本研究旨在确定转移性结直肠癌（mCRC）中BM的危险因素以及BM的CRC患者的预后因素。
方法
本研究基于来自我们中心的214例mCRC患者（其中101例有BM）的训练队列，以及来自另一家机构的511例mCRC患者（其中173例有BM）的验证队列。使用单因素和多因素分析制定BM的风险和预后列线图。通过R、一致性统计量（C统计量）和校准曲线评估列线图的拟合优度、区分度和校准性能。结果在训练队列中使用自助重抽样进行内部验证，并在验证队列中进行外部验证。
结果
新的BM风险列线图包含七个变量[肿瘤分化程度、N分期、血清碱性磷酸酶（ALP）、乳酸脱氢酶（LDH）、癌胚抗原（CEA）、肝转移和肺转移]。它表现出良好的性能，在训练队列中R为0.447，C统计量为0.846[95%置信区间（CI），0.793至0.898]，在验证队列中R为0.325，C统计量为0.792（95%CI，0.750至0.834）。识别低风险或高风险个体的最佳截断值为概率56%，敏感性为71.3%，特异性为89.4%。预后列线图包括五个因素（肿瘤分化、BM外器官数量、BM病灶数量、ALP和LDH），在训练集中R为0.284，C统计量为0.723（95%CI，0.657至0.789）。该列线图在验证队列中进行了外部验证，R为0.182，C统计量为0.682（95%CI，0.638至0.726）。
结论
所开发并验证的风险和预后列线图在预测mCRC中BM的发生以及BM的CRC患者的预后方面表现良好。风险列线图可作为骨扫描前具有成本效益的初步筛查工具。
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