The First Affiliated Hospital, Cancer Research Institute, Hengyang Medical School, University of South China, Hengyang, Hunan, People's Republic of China.
The First Affiliated Hospital, Department of Ultrasound Medicine, Hengyang Medical School, University of South China Hengyang, Hunan, People's Republic of China.
Int J Colorectal Dis. 2022 Oct;37(10):2173-2184. doi: 10.1007/s00384-022-04251-2. Epub 2022 Sep 23.
Mucinous histology is generally considered as a risk factor of prognosis in stage II colon cancer, but there is no appropriate model for prognostic evaluation and treatment decision in patients with stage II colon mucinous adenocarcinoma (C-MAC) Thus, it is urgent to develop a comprehensive, individualized evaluation tool to reflect the heterogeneity of stage II C-MAC.
Patients with stage II C-MAC who underwent surgical treatment in the Surveillance, Epidemiology, and End Results Program were enrolled and randomly divided into training cohort (70%) and internal validation cohort (30%). Prognostic predictors which were determined by univariate and multivariate analysis in the training cohort were included in the nomogram. The calibration curves, decision curve analysis, X-tile analysis, and Kaplan-Meier curve of the nomogram were validated in the internal validation cohort.
Three thousand seven hundred sixty-two patients of stage II C-MAC were enrolled. The age, pathological T (pT) stage, tumor number, serum carcinoembryonic antigen (CEA), and perineural invasion (PNI) were independent predictors of overall survival (OS), which were used to establish a nomogram. Calibration curves of the nomogram indicated good consistency between nomogram prediction and actual survival for 1-, 3- and 5-year OS. Besides, patients with stage II C-MAC could be divided into high-, middle-, and low-risk subgroups by the nomogram. Further subgroup analysis indicated that patients in the high-risk group could have a survival benefit from chemotherapy after surgical treatment.
We established the first nomogram to accurately predict the survival of stage II C-MAC patients who underwent surgical treatment. In addition, the nomogram identified low-, middle-, and high-risk subgroups of patients and found chemotherapy might improve survival in the high-risk subgroup of stage II C-MAC patients.
黏液组织学通常被认为是 II 期结肠癌预后的一个危险因素，但对于 II 期结肠黏液腺癌（C-MAC）患者，尚无合适的预后评估和治疗决策模型。因此，迫切需要开发一种全面的、个体化的评估工具来反映 II 期 C-MAC 的异质性。
纳入在监测、流行病学和最终结果计划中接受手术治疗的 II 期 C-MAC 患者，并将其随机分为训练队列（70%）和内部验证队列（30%）。在训练队列中通过单因素和多因素分析确定的预后预测因子被纳入列线图。在内部验证队列中验证了列线图的校准曲线、决策曲线分析、X 分割分析和 Kaplan-Meier 曲线。
共纳入 3762 例 II 期 C-MAC 患者。年龄、病理 T（pT）分期、肿瘤数目、血清癌胚抗原（CEA）和神经周围侵犯（PNI）是总生存（OS）的独立预测因素，这些因素被用于建立列线图。列线图的校准曲线表明，列线图预测与实际生存 1、3 和 5 年 OS 的一致性较好。此外，可根据列线图将 II 期 C-MAC 患者分为高、中、低风险亚组。进一步的亚组分析表明，手术治疗后，高风险组患者接受化疗可能会获益。
我们建立了首个能够准确预测接受手术治疗的 II 期 C-MAC 患者生存的列线图。此外，该列线图确定了患者的低、中、高风险亚组，并发现化疗可能改善 II 期 C-MAC 患者中高风险亚组的生存。
