Su Hongbo, Wang Shanshan, Xie Shuping, Huang Liying, Pan Yunlong, Lyu Jun
Department of General Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, 510632, Guangdong, China.
Section of Occupational Medicine, Department of Special Medicine, Shanxi Medical University, Taiyuan, 030001, Shanxi, China.
J Cancer Res Clin Oncol. 2023 Sep;149(12):10435-10452. doi: 10.1007/s00432-023-04913-w. Epub 2023 Jun 6.
PURPOSE: Tumors in parts of the colon other than the transverse colon have been well studied, but little is known about adenocarcinoma of the transverse colon (ATC).The aim of this study was to construct nomograms using competing-risk model for accurately predicting the probability of cancer-specific and non-cancer-specific death in patients with ATC. METHODS: Data on eligible patients recorded during 2000-2019 in the Surveillance, Epidemiology, and End Results database were extracted and screened. Factors that influencing prognosis were screened for death from ATC (DATC) and death from other causes (DOC) using competing-risk analysis, including univariate and multivariate analyses based on Gray's test and the Fine-Gray model, respectively. Independent prognostic factors were identified and nomograms were constructed. For comparison, we also constructed a Cox model and an AJCC stage-only competing-risk model (AJCC model) for patients with DATC. Performance evaluations of the nomograms and comparison between the models were performed using calibration plots, Harrell's concordance index (C-index), receiver operating characteristic (ROC) curves, and the areas under the ROC curve (AUCs). The nomograms and models were validated using a validation cohort. The net reclassification index, integrated discrimination improvement, decision curves, and risk stratification were not assessed because no accepted methods were suited for competing-risk model. RESULTS: This study included 21,469 patients with ATC, and 17 and 9 independent influencing factors were identified for the construction of DATC nomograms (DATCN) and DOC nomograms (DOCN), respectively. In both the training and validation cohorts, the calibration curves indicated good agreement between the nomogram-based predictions and the actual observations in the two nomograms, respectively. The C-index of the DATCN was higher than 80% (80.3-83.3%) at 1, 3 and 5 years in both the training and validation cohorts, significantly outperforming the AJCC (76.7-78%) and Cox (75.4-79.5%) model. The C-index of the DOCN was also higher than 69% (69.0-73.6%). In terms of ROC curves at each time point, those of the DATCN were very close to the upper-left corner of the coordinate axis in both the training and validation cohorts, and their AUCs were larger than 84% (84.2-85.4%).The AUCs of the AJCC (78.4-81.1%) and Cox (79.4-81.5%) models were significantly lower (p < 0.05), and the curves were closer to the diagonal. The ROC curves of the DOCN was similar to those of the DATCN, and the AUCs were 68.5-74%. The DATCN and DOCN therefore had good consistency, accuracy, and stability, respectively. CONCLUSION: This study was the first to construct competing-risk nomograms for ATC. These nomograms have proved useful for accurately assessing patient prognoses and allowing more-individualized follow-up strategies, thereby reducing the mortality.
目的:除横结肠外,结肠其他部位的肿瘤已得到充分研究,但关于横结肠癌(ATC)的腺癌却知之甚少。本研究的目的是使用竞争风险模型构建列线图,以准确预测ATC患者癌症特异性死亡和非癌症特异性死亡的概率。 方法:提取并筛选2000 - 2019年监测、流行病学和最终结果数据库中符合条件患者的数据。使用竞争风险分析筛选影响预后的因素,分别基于Gray检验和Fine - Gray模型进行单因素和多因素分析,以确定ATC死亡(DATC)和其他原因死亡(DOC)的因素。确定独立预后因素并构建列线图。为作比较,我们还为DATC患者构建了Cox模型和仅基于美国癌症联合委员会(AJCC)分期的竞争风险模型(AJCC模型)。使用校准图、Harrell一致性指数(C指数)、受试者工作特征(ROC)曲线和ROC曲线下面积(AUC)对列线图进行性能评估并比较各模型。使用验证队列对列线图和模型进行验证。由于没有适用于竞争风险模型的公认方法,因此未评估净重新分类指数、综合判别改善、决策曲线和风险分层。 结果:本研究纳入21469例ATC患者,分别确定了17个和9个独立影响因素用于构建DATC列线图(DATCN)和DOC列线图(DOCN)。在训练队列和验证队列中,校准曲线均表明两个列线图基于列线图的预测与实际观察结果之间具有良好的一致性。DATCN在训练队列和验证队列中的1年、3年和5年C指数均高于80%(80.3 - 83.3%),显著优于AJCC模型(76.7 - 78%)和Cox模型(75.4 - 79.5%)。DOCN的C指数也高于69%(69.0 - 73.6%)。在各时间点的ROC曲线方面,DATCN在训练队列和验证队列中的曲线均非常接近坐标轴的左上角,其AUC大于84%(84.2 - 85.4%)。AJCC模型(78.4 - 81.1%)和Cox模型(79.4 - 81.5%)的AUC显著更低(p < 0.05),曲线更接近对角线。DOCN的ROC曲线与DATCN相似,AUC为68.5 - 74%。因此,DATCN和DOCN分别具有良好的一致性、准确性和稳定性。 结论:本研究首次为ATC构建了竞争风险列线图。这些列线图已被证明有助于准确评估患者预后并制定更个性化的随访策略,从而降低死亡率。
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