Department of General Surgery, Qingdao Municipal Hospital, Qingdao Clinical Medical College, Nanjing Medical University, Qingdao, China.
Department of Gastroenterology, Qingdao Municipal Hospital, Qingdao, China.
J Invest Surg. 2022 Jul;35(7):1502-1509. doi: 10.1080/08941939.2022.2069306. Epub 2022 May 4.
To investigate the prognostic value of tumor deposits (TDs) counts in stage III colorectal cancer (CRC) patients and develop a prognostic nomogram.
Data on stage III CRC patients from 2010 to 2015 were collected from the Surveillance, Epidemiology, and End Results () database. The Kaplan-Meier analysis was used to assess differences in survival outcomes among patients. The Cox regression analysis was performed to establish the independent prognostic factors for cancer-specific survival and to establish a nomogram. The nomograms' performance was evaluated by calibration plots and concordance index (C-index). Decision curve analysis (DCA) was used to assess the clinical utility of the prediction model.
A total of 23,345 CRC patients were included in this study, and 3,578 (15.3%) had TDs. Cox multivariate regression analyses revealed that age, race, histological tumor grade, the administered chemotherapy, pathological type, T-stage, CEA, N-stage, peripheral nerve invasion, and TDs were independent prognostic factors. Patients with many TDs (=0/1-4, HR: 1.325,/≥5 HR: 2.223) had poorer cancer-specific survival. The prognostic value of the number of TDs was comparable to that of lymph node metastasis. The C-indices of the nomogram were superior to TNM staging in training (0.730 vs 0.646) and validation (0.714 vs 0.636) groups. DCA revealed that the nomogram had a higher clinical net benefit compared to TNM staging.
TDs count is an adverse prognostic factor for stage III CRC patients. Furthermore, the TDs-based nomogram can accurately predict the prognostic outcomes for stage III CRC.
探讨肿瘤沉积（TDs）计数对 III 期结直肠癌（CRC）患者的预后价值，并构建一个预后列线图。
从 Surveillance，Epidemiology，and End Results（SEER）数据库中收集 2010 年至 2015 年 III 期 CRC 患者的数据。采用 Kaplan-Meier 分析评估患者生存结局的差异。采用 Cox 回归分析确定癌症特异性生存的独立预后因素，并构建列线图。通过校准图和一致性指数（C-index）评估列线图的性能。决策曲线分析（DCA）用于评估预测模型的临床实用性。
本研究共纳入 23345 例 CRC 患者，其中 3578 例（15.3%）有 TDs。Cox 多因素回归分析显示，年龄、种族、组织学肿瘤分级、化疗方案、病理类型、T 分期、CEA、N 分期、周围神经侵犯和 TDs 是独立的预后因素。TDs 较多的患者（=0/1-4，HR：1.325，≥5 HR：2.223）癌症特异性生存较差。TDs 数量的预后价值与淋巴结转移相当。列线图的 C-index 在训练组（0.730 比 0.646）和验证组（0.714 比 0.636）均优于 TNM 分期。DCA 显示，与 TNM 分期相比，该列线图具有更高的临床净获益。
TDs 计数是 III 期 CRC 患者的不良预后因素。此外，基于 TDs 的列线图可准确预测 III 期 CRC 的预后结局。
