Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China.
Int J Colorectal Dis. 2023 Aug 16;38(1):215. doi: 10.1007/s00384-023-04508-4.
Limited attention was paid to adenocarcinoma with mixed subtypes (AM) of the colon and rectum due to its low incidence. This study aims to assess the frequency and survival rates of tumors in the population.
The data were extracted from the Surveillance, Epidemiology, and End Results (SEER) database between 2000 and 2019. The incidence of tumors was evaluated based on patient gender, age, race, and location. Univariate and multivariate Cox analyses were performed to identify risk factors associated with tumor survival. Additionally, a nomogram was constructed using these risk factors to predict cancer-specific survival (CSS) at 1, 2, and 3 years. Receiver operating characteristic (ROC) and calibration curves were applied to examine the model's accuracy.
The overall incidence of colorectal AM reached its highest level in 2016 (2.350 (95% CI: 2.241-2.462)). AM is more frequent in elderly patients and predominantly located in the rectum. By forest plot for multivariable Cox regression analysis, patient age, the number of regional positive lymph nodes and lymph nodes removed, tumor N/M stage, and postoperative chemotherapy were identified as independent risk indicators for CSS. Nomogram was constructed and validated as a feasible prediction model of CSS in patients with colorectal AM.
The presence of colorectal AM in elderly patients, particularly in the rectum, is frequent and often associated with poor prognosis. Our nomograms can offer a relatively accurate prediction of CSS of patients with AM after tumor resection.
由于结肠癌和直肠癌混合亚型（AM）的发病率较低，因此对其关注有限。本研究旨在评估人群中肿瘤的发病率和生存率。
从 2000 年至 2019 年期间从监测、流行病学和最终结果（SEER）数据库中提取数据。根据患者性别、年龄、种族和位置评估肿瘤发病率。采用单因素和多因素 Cox 分析确定与肿瘤生存相关的危险因素。此外，使用这些危险因素构建列线图以预测癌症特异性生存（CSS）在 1、2 和 3 年的情况。应用接收者操作特征（ROC）和校准曲线来检查模型的准确性。
结直肠 AM 的总体发病率在 2016 年达到最高水平（2.350（95%CI：2.241-2.462））。AM 更常见于老年患者，主要位于直肠。通过多变量 Cox 回归分析的森林图，患者年龄、区域阳性淋巴结和切除的淋巴结数量、肿瘤 N/M 分期以及术后化疗被确定为 CSS 的独立危险因素。构建并验证了列线图，作为结直肠 AM 患者 CSS 的可行预测模型。
老年患者中存在结直肠 AM，尤其是直肠，较为常见，且通常预后不良。我们的列线图可以为肿瘤切除后 AM 患者的 CSS 提供相对准确的预测。
