Department of Gastrointestinal Surgery, The Fourth Affiliated Hospital, China Medical University.
Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Int J Surg. 2023 Nov 1;109(11):3407-3416. doi: 10.1097/JS9.0000000000000623.
The tumor area may be a potential prognostic indicator. The present study aimed to determine and validate the prognostic value of tumor area in curable colon cancer.
This retrospective study included a training and validation cohorts of patients who underwent radical surgery for colon cancer. Independent prognostic factors for overall survival (OS) and disease-free survival (DFS) were identified using Cox proportional hazards regression models. The prognostic discrimination was evaluated using the integrated area under the receiver operating characteristic curves (iAUCs) for prognostic factors and models. The prognostic discrimination between tumor area and other individual factors was compared, along with the prognostic discrimination between the tumor-node-metastasis (TNM) staging system and other prognostic models. Two-sample Wilcoxon tests were carried out to identify significant differences between the two iAUCs. A two-sided P <0.05 was considered statistically significant.
A total of 3051 colon cancer patients were included in the training cohort and 872 patients in the validation cohort. Tumor area, age, differentiation, T stage, and N stage were independent prognostic factors for both OS and DFS in the training cohort. Tumor area had a better OS and DFS prognostic discrimination characteristics than T stage, maximal tumor diameter, differentiation, tumor location, and number of retrieved lymph nodes. The novel prognostic model of T stage + N stage + tumor area (iAUC for OS, 0.714, P <0.001; iAUC for DFS, 0.694, P <0.001) showed a better prognostic discrimination than the TNM staging system (T stage + N stage; iAUC for OS, 0.664; iAUC for DFS, 0.658). Similar results were observed in an independent validation cohort.
Tumor area was identified as an independent prognostic factor for both OS and DFS in curable colon cancer patients, and in cases with an adequate number of retrieved lymph nodes. The novel prognostic model of combining T stage, N stage, and tumor area may be an alternative to the current TNM staging system.
肿瘤面积可能是一个潜在的预后指标。本研究旨在确定并验证可治愈结肠癌中肿瘤面积的预后价值。
本回顾性研究纳入了接受根治性手术治疗结肠癌的患者的训练和验证队列。使用 Cox 比例风险回归模型确定总生存（OS）和无病生存（DFS）的独立预后因素。使用预测因素和模型的综合受试者工作特征曲线下面积（iAUC）评估预后区分度。比较了肿瘤面积与其他单个因素之间的预后区分度，以及肿瘤-淋巴结-转移（TNM）分期系统与其他预后模型之间的预后区分度。进行了两样本 Wilcoxon 检验以确定两个 iAUC 之间的显著差异。双侧 P<0.05 被认为具有统计学意义。
共有 3051 例结肠癌患者纳入训练队列，872 例患者纳入验证队列。在训练队列中，肿瘤面积、年龄、分化程度、T 分期和 N 分期是 OS 和 DFS 的独立预后因素。肿瘤面积在 OS 和 DFS 方面具有比 T 分期、最大肿瘤直径、分化程度、肿瘤位置和检出的淋巴结数量更好的预后区分度特征。新的 T 分期+N 分期+肿瘤面积预后模型（OS 的 iAUC，0.714，P<0.001；DFS 的 iAUC，0.694，P<0.001）显示出比 TNM 分期系统（T 分期+N 分期；OS 的 iAUC，0.664；DFS 的 iAUC，0.658）更好的预后区分度。在独立验证队列中也观察到了类似的结果。
肿瘤面积被确定为可治愈结肠癌患者 OS 和 DFS 的独立预后因素，并且在检出足够数量的淋巴结的情况下。结合 T 分期、N 分期和肿瘤面积的新预后模型可能是当前 TNM 分期系统的替代方案。
