Department of Radiology, PingYang People's Hospital, Wenzhou Medical University, Wenzhou, 325400, China.
Department of Obstetrics, PingYang People's Hospital, Wenzhou Medical University, Wenzhou, 325400, China.
BMC Cancer. 2024 Apr 6;24(1):425. doi: 10.1186/s12885-024-12208-7.
The objective of this study was to investigate the correlation between spleen density and the prognostic outcomes of patients who underwent curative resection for colorectal cancer (CRC).
The clinical data of patients who were diagnosed with CRC and underwent radical resection were retrospectively analyzed. Spleen density was determined using computed tomography. Analysis of spleen density in relation to overall survival (OS) and disease-free survival (DFS) utilizing the Kaplan-Meier method. Univariate and multivariate Cox regression models were used to screen for independent prognostic factors, and a nomogram was constructed to predict OS and DFS. Moreover, internally validated using a bootstrap resamplling method.
Two hundred twelve patients were included, of whom 23 (10.85%) were defined as having a diffuse reduction of spleen density (DROSD) based on diagnostic cutoff values (spleen density≦37.00HU). Kaplan-Meier analysis indicated that patients with DROSD had worse OS and DFS than those non-DROSD (P < 0.05). Multivariate Cox regression analysis revealed that DROSD, carbohydrate antigen 199 (CA199) > 37 U/mL, tumor node metastasis (TNM) stage III-IV, laparoscopy-assisted operation and American Society of Anesthesiology (ASA) score were independent risk factors for 3-year DFS. DROSD, CA199 > 37 U/mL, TNM stage III-IV, hypoalbuminemia, laparoscopy-assisted operation and ASA score were chosen as predictors of for 3-year OS. Nomograms showed satisfactory accuracy in predicting OS and DFS using calibration curves, decision curve analysis and bootstrap resamplling method.
Patients with DROSD who underwent curative resection have worse 3-year DFS and OS. The nomogram demonstrated good performance, particularly in predicting 3-year DFS with a net clinical benefit superior to well-established risk calculator.
本研究旨在探讨脾密度与接受结直肠癌（CRC）根治性切除术患者预后结局之间的相关性。
回顾性分析经病理诊断为 CRC 并接受根治性切除术患者的临床资料。采用 CT 测量脾密度。采用 Kaplan-Meier 法分析脾密度与总生存（OS）和无病生存（DFS）的关系。采用单因素和多因素 Cox 回归模型筛选独立预后因素，并构建预测 OS 和 DFS 的列线图。此外，还采用 bootstrap 重采样方法进行内部验证。
共纳入 212 例患者，其中根据诊断截止值（脾密度≦37.00HU）将 23 例（10.85%）定义为弥漫性脾密度降低（DROSD）。Kaplan-Meier 分析表明，DROSD 患者的 OS 和 DFS 均较非 DROSD 患者差（P<0.05）。多因素 Cox 回归分析显示，DROSD、CA199>37U/mL、TNM 分期 III-IV 期、腹腔镜辅助手术和美国麻醉医师协会（ASA）评分是 3 年 DFS 的独立危险因素。DROSD、CA199>37U/mL、TNM 分期 III-IV 期、低蛋白血症、腹腔镜辅助手术和 ASA 评分是 3 年 OS 的预测因素。校准曲线、决策曲线分析和 bootstrap 重采样方法表明，列线图在预测 OS 和 DFS 方面具有较好的准确性。
接受根治性切除术的 DROSD 患者 3 年 DFS 和 OS 较差。该列线图具有良好的性能，特别是在预测 3 年 DFS 方面，其净临床获益优于成熟的风险计算器。
