Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, Australia; NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, Australia.
Pathology. 2022 Feb;54(1):79-86. doi: 10.1016/j.pathol.2021.04.012. Epub 2021 Jul 22.
Several prognostic nomograms designed to predict survival after curative resection for colorectal cancer (CRC) have been proposed. Recently, routine pathological assessment has evolved with subtle changes to the AJCC staging system, and routine screening for mismatch repair deficiency (MMRd). Therefore we sought to develop and validate a new prognostic nomogram. All cause survival data from 4517 consecutive patients with primary CRC were used as independent training and validation cohorts to develop a final model including only: age, sex, tumour stage, nodal status, number of lymph nodes resected, apical node status, distant metastases, thin-walled vascular invasion, and MMR status. Patients were stratified into four risk groups to assess model discrimination and calibration. To assess discrimination, the area-under-the-curve (AUC) of a receiver-operator-curve (ROC), concordance-index (C-index), and D-index were calculated. The model was compared to the Memorial Sloan Kettering Cancer Center (MSKCC) CRC nomogram and the AJCC TNM staging. Based on the 5-year ROC analysis, the AUC for our model was 0.81 (0.79 and 0.74 for MSKCC and AJCC, respectively). Moreover, our model demonstrated a concordance index of 0.77 (95% CI 0.70-0.82) compared to 0.75 (95% CI 0.68-0.81) for MSKCC and 0.73 (95% CI 0.65-0.79) for AJCC. In conclusion, our new prognostic nomogram incorporates a larger number of clinically relevant prognostic markers, including MMR status, and therefore demonstrates improved predictive capability. As these factors are routinely assessed, it is hoped that this model will inform prognostication and difficult management decisions, such as patient selection for adjuvant therapy.
已经提出了几种旨在预测结直肠癌（CRC）根治性切除术后生存的预后列线图。最近，AJCC 分期系统的常规病理评估发生了细微变化，并且常规筛查错配修复缺陷（MMRd）。因此，我们试图开发和验证一种新的预后列线图。使用来自 4517 例原发性 CRC 连续患者的全因生存数据作为独立的训练和验证队列，开发最终模型，该模型仅包括：年龄、性别、肿瘤分期、淋巴结状态、切除的淋巴结数量、顶端淋巴结状态、远处转移、薄壁血管侵犯和 MMR 状态。将患者分层为四个风险组以评估模型的区分度和校准度。为了评估区分度，计算了接收者操作特征曲线（ROC）的曲线下面积（AUC）、一致性指数（C 指数）和 D 指数。将该模型与 Memorial Sloan Kettering Cancer Center（MSKCC）CRC 列线图和 AJCC TNM 分期进行比较。基于 5 年 ROC 分析，我们的模型 AUC 为 0.81（MSKCC 和 AJCC 分别为 0.79 和 0.74）。此外，与 MSKCC（95%CI 0.75）和 AJCC（95%CI 0.73）相比，我们的模型显示出 0.77（95%CI 0.70-0.82）的一致性指数。我们的新预后列线图纳入了更多的临床相关预后标志物，包括 MMR 状态，因此显示出更好的预测能力。由于这些因素是常规评估的，希望该模型能够提供预后和困难的管理决策，例如辅助治疗患者的选择。
