Department of General Surgery, Xiamen Branch, Zhongshan Hospital, Fudan University, Jinhu Road 668, Huli District, Xiamen, 361015, China.
BMC Surg. 2022 Jul 4;22(1):256. doi: 10.1186/s12893-022-01710-z.
BACKGROUND: The purpose of this study was to develop a large population-based nomogram incorporating the log odds of positive nodes (LODDS) for predicting the overall survival (OS) of stage II/III rectal cancer patients treated with neoadjuvant chemoradiotherapy (NCRT) followed by surgical resection. METHODS: The Surveillance, Epidemiology, and End Results database was used to collect information on patients diagnosed with stage II/III rectal cancer between 2010 and 2015 and treated with NCRT followed by surgical resection. The Cox regression analyses were performed to determine the independent prognostic factors. In this study, LODDS was employed instead of American Joint Committee on Cancer (AJCC) 7th N stage to determine lymph node status. Then a nomogram integrating independent prognostic factors was developed to predict the 24-, 36-, and 60-month overall survival. The receiver operating characteristic (ROC) curves and calibration curves were used to validate the nomogram. Furthermore, patients were stratified into three risk groups (high-, middle-, and low-risk) based on the total points obtained from the nomogram. And Kaplan-Meier curves were plotted to compare the OS of the three groups. RESULTS: A total of 3829 patients were included in the study. Race, sex, age, marital status, T stage, tumor grade, tumor size, LODDS, CEA level, and postoperative chemotherapy were identified as independent prognostic factors, based on which the prognostic nomogram was developed. The area under curve values of the nomogram for the 24-, 36-, and 60-month OS in the training cohort were 0.736, 0.720, and 0.688, respectively; and 0.691, 0.696, and 0.694 in the validation cohort, respectively. In both the validation and training cohorts, the calibration curves showed a high degree of consistency between actual and nomogram-predicted survival rates. The Kaplan-Meier curves showed that the three risk groups had significant differences in overall survival (P < 0.001). CONCLUSION: A large population-based nomogram incorporating LODDS was developed to assist in evaluating the prognosis of stage II/III rectal cancer patients treated with NCRT followed by surgical resection. The nomogram showed a satisfactorily discriminative and stable ability to predict the OS for those patients.
背景：本研究旨在开发一个大型基于人群的列线图，纳入对数优势阳性淋巴结（LODDS），用于预测接受新辅助放化疗（NCRT）后行手术切除的 II/III 期直肠癌患者的总生存（OS）。
方法：本研究使用 Surveillance, Epidemiology, and End Results 数据库收集了 2010 年至 2015 年间诊断为 II/III 期直肠癌并接受 NCRT 后行手术切除的患者信息。采用 Cox 回归分析确定独立的预后因素。在本研究中，采用 LODDS 代替美国癌症联合委员会（AJCC）第 7 版 N 分期来确定淋巴结状态。然后开发一个整合独立预后因素的列线图，以预测 24、36 和 60 个月的总生存。采用接收者操作特征（ROC）曲线和校准曲线对列线图进行验证。此外，根据列线图获得的总积分将患者分为高、中、低风险三组，并绘制 Kaplan-Meier 曲线比较三组的 OS。
结果：共纳入 3829 例患者。基于种族、性别、年龄、婚姻状况、T 分期、肿瘤分级、肿瘤大小、LODDS、CEA 水平和术后化疗，确定了独立的预后因素，并在此基础上开发了预后列线图。在训练队列中，该列线图预测 24、36 和 60 个月 OS 的曲线下面积值分别为 0.736、0.720 和 0.688；在验证队列中分别为 0.691、0.696 和 0.694。在验证和训练队列中，校准曲线均显示实际生存率与列线图预测生存率高度一致。Kaplan-Meier 曲线显示，三组在总生存率方面存在显著差异（P<0.001）。
结论：本研究开发了一个大型基于人群的列线图，纳入 LODDS 以帮助评估接受 NCRT 后行手术切除的 II/III 期直肠癌患者的预后。该列线图对预测患者 OS 具有良好的区分度和稳定性。
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