Department of Hematology-Oncology, Fujian Children's Hospital, Fuzhou, China; College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.
Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China.
Sci Rep. 2022 Oct 7;12(1):16909. doi: 10.1038/s41598-022-21331-z.
Sigmoid colon cancer often has an unsatisfactory prognosis. This study explored the effect of tumor deposits (TDs) on survival, and whether their presence/absence influence individualized treatment. Data of postoperative patients with sigmoid colon cancer were extracted from the Surveillance, Epidemiology, and End Results database. Overall survival (OS) was calculated using the Kaplan-Meier method and prognostic factors were identified using Cox regression analysis and random forest (RF). The nomogram's discrimination performance was evaluated using a concordance index (C-index), integrated discrimination improvement (IDI), calibration curves, and decision-curve analysis. The N1c group showed a worse prognosis than the N0 group. For N1c patients, a combination of surgery and chemotherapy prolonged survival, compared to surgery alone; however, the chemotherapy-surgery combination did not affect the OS of patients younger than 70 years, in stage T1-2, and/or of black race. Multivariable analysis and RF presented Age, T stage, and N stage were the most important predictors for OS. The novel nomogram had superiority to the TNM staging system with improved C-index and IDI, as well as good consistency and higher clinical benefit. TDs are associated with poor survival from sigmoid colon cancer, and considering TDs can inform the formulation of individual treatment regimens. The nomogram shows satisfactory prediction ability for OS.
乙状结肠癌的预后通常较差。本研究探讨了肿瘤沉积物（TDs）对生存的影响，以及它们的存在/缺失是否影响个体化治疗。从 Surveillance, Epidemiology, and End Results 数据库中提取了乙状结肠癌术后患者的数据。使用 Kaplan-Meier 方法计算总生存率（OS），并使用 Cox 回归分析和随机森林（RF）确定预后因素。通过一致性指数（C-index）、综合判别改善（IDI）、校准曲线和决策曲线分析评估列线图的判别性能。N1c 组的预后比 N0 组差。对于 N1c 患者，与单独手术相比，手术联合化疗可延长生存时间；然而，对于年龄小于 70 岁、T1-2 期和/或黑人的患者，化疗联合手术并不能影响 OS。多变量分析和 RF 表明，年龄、T 分期和 N 分期是 OS 的最重要预测因素。新的列线图与 TNM 分期系统相比具有优越性，C-index 和 IDI 得到改善，一致性好，临床获益更高。TDs 与乙状结肠癌的不良生存相关，考虑 TDs 可以为制定个体化治疗方案提供信息。该列线图对 OS 的预测能力令人满意。
