Yang Zifeng, Li Yong, Qin Xiusen, Lv Zejian, Wang Huaiming, Wu Deqing, Yuan Zixu, Wang Hui
Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Supported by National Key Clinical Discipline, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Front Oncol. 2021 Jul 1;11:615321. doi: 10.3389/fonc.2021.615321. eCollection 2021.
Synchronous peritoneal metastasis (S-PM) is considered a poor prognostic factor for colorectal cancer (CRC) and there is no nomogram to predict the survival of these patients. In this study, we aimed to use a multicenter data to identify the factors associated with S-PM of CRC to construct a nomogram for predicting the overall survival (OS) of these patients.
CRC patients with S-PM from two medical centers were enrolled between September 2007 and June 2017. Multivariate analysis was used to identify independent factors associated with OS for the nomogram to predict the 1-, 2-, and 3-year OS rates in the development group. The concordance index (C-index), calibration plot, relative operating characteristic (ROC) curve with area under the curve (AUC) were calculated to evaluate the performance of the nomogram in both the development and an external validation group.
277 CRC patients with S-PM in the development group and 68 patients in the validation group were eligible for this study. In multivariate analysis of development group, age, carbohydrate antigen 19-9 (CA19-9), carbohydrate antigen 125 (CA125), cytoreductive surgery (CRS), hyperthermic intraperitoneal chemotherapy (HIPEC), and chemotherapy were independent variables for OS, based on which the nomogram was built. The C-index of the nomogram in the development and validation group was 0.701 (95% Cl, 0.666-0.736) and 0.716 (95% Cl, 0.622-0.810); demonstrating good discriminative ability. The calibration plots showed satisfactory consistency between actual observation and nomogram-predicted OS probabilities in the development and external validation group. The nomogram showed good predictive accuracy for 1-, 2-, and 3-year OS rates in both groups with AUC >0.70. An online dynamic webserver was also developed for increasing the ease of the nomogram.
We developed and validated a predictive nomogram with good discriminative and high accuracy to predict the OS in CRC patients with S-PM.
同步性腹膜转移（S-PM）被认为是结直肠癌（CRC）的一个不良预后因素，目前尚无用于预测这些患者生存情况的列线图。在本研究中，我们旨在利用多中心数据确定与CRC的S-PM相关的因素，以构建一个预测这些患者总生存期（OS）的列线图。
纳入2007年9月至2017年6月期间来自两个医疗中心的患有S-PM的CRC患者。采用多因素分析确定与用于预测开发组1年、2年和3年OS率的列线图相关的OS独立因素。计算一致性指数（C指数）、校准图、具有曲线下面积（AUC）的相对操作特征（ROC）曲线，以评估列线图在开发组和外部验证组中的性能。
开发组中有277例患有S-PM的CRC患者，验证组中有68例患者符合本研究条件。在开发组的多因素分析中，年龄、糖类抗原19-9（CA19-9）、糖类抗原125（CA125）、细胞减灭术（CRS）、腹腔热灌注化疗（HIPEC）和化疗是OS的独立变量，并据此构建了列线图。开发组和验证组中列线图的C指数分别为0.701（95%CI，0.666-0.736）和0.716（95%CI，0.622-0.810），表明具有良好的辨别能力。校准图显示在开发组和外部验证组中实际观察结果与列线图预测的OS概率之间具有令人满意的一致性。列线图在两组中对1年、2年和3年OS率均显示出良好的预测准确性，AUC>0.70。还开发了一个在线动态网络服务器，以提高列线图的易用性。
我们开发并验证了一个具有良好辨别能力和高准确性的预测列线图，用于预测患有S-PM的CRC患者的OS。
