Qin Xiusen, Zhao Mingpeng, Deng Weihao, Huang Yan, Cheng Zhiqiang, Chung Jacqueline Pui Wah, Chen Xufei, Yang Keli, Chan David Yiu Leung, 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 the National Key Clinical Discipline, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Front Oncol. 2022 Mar 11;12:826830. doi: 10.3389/fonc.2022.826830. eCollection 2022.
The prognostic value of desmoplastic reaction (DR) has not been investigated in colorectal cancer (CRC) patients with synchronous peritoneal metastasis (SPM). The present study aimed to identify whether DR can predict overall survival (OS) and develop a novel prognostic nomogram.
CRC patients with SPM were enrolled from a single center between July 2007 and July 2019. DR patterns in primary tumors were classified as mature, intermediate, or immature according to the existence and absence of keloid-like collagen or myxoid stroma. Cox regression analysis was used to identify independent factors associated with OS and a nomogram was developed subsequently.
One hundred ninety-eight and 99 patients were randomly allocated into the training and validation groups. The median OS in the training group was 36, 25, and 12 months in mature, intermediate, and immature DR categories, respectively. Age, T stage, extraperitoneal metastasis, differentiation, cytoreductive surgery (CRS), hyperthermic intraperitoneal chemotherapy (HIPEC), and DR categorization were independent variables for OS, based on which the nomogram was developed. The C-index of the nomogram in the training and validation groups was 0.773 (95% CI 0.734-0.812) and 0.767 (95% CI 0.708-0.826). The calibration plots showed satisfactory agreement between the actual outcome and nomogram-predicted OS probabilities in the training and validation cohorts.
DR classification in the primary tumor is a potential prognostic index for CRC patients with SPM. The novel prognostic nomogram combined with DR classification has good discrimination and accuracy in predicting the OS for CRC patients with SPM.
尚未对伴有同步腹膜转移（SPM）的结直肠癌（CRC）患者中促纤维组织增生反应（DR）的预后价值进行研究。本研究旨在确定DR是否可预测总生存期（OS）并开发一种新的预后列线图。
2007年7月至2019年7月期间从单一中心纳入伴有SPM的CRC患者。根据瘢痕疙瘩样胶原或黏液样基质的有无，将原发性肿瘤中的DR模式分为成熟型、中间型或未成熟型。采用Cox回归分析确定与OS相关的独立因素，随后开发列线图。
198例和99例患者被随机分配到训练组和验证组。训练组中，成熟型、中间型和未成熟型DR类别的中位OS分别为36个月、25个月和12个月。年龄、T分期腹膜外转移、分化程度、细胞减灭术（CRS）、腹腔内热灌注化疗（HIPEC）和DR分类是OS的独立变量，并据此开发了列线图。训练组和验证组列线图的C指数分别为0.773（95%CI 0.734-0.812）和0.767（95%CI 0.708-0.826）。校准图显示训练队列和验证队列中实际结果与列线图预测的OS概率之间具有良好的一致性。
原发性肿瘤中的DR分类是伴有SPM的CRC患者潜在的预后指标。结合DR分类的新型预后列线图在预测伴有SPM的CRC患者的OS方面具有良好的辨别力和准确性。
