晚期印戒细胞型结直肠癌中肿瘤沉积的预后和预测价值：SEER数据库分析及多中心验证

Prognostic and predictive value of tumor deposits in advanced signet ring cell colorectal cancer: SEER database analysis and multicenter validation.

作者信息

Li Fuchao, Liu Lei, Feng Qingzhao, Wang Xiaohong, Liu Fang, Yang Li, Miao Lin, Wang Weiming, Ji Guozhong, Yu Chenggong

机构信息

Department of Gastroenterology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, 210008, China.

Department of Geriatrics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210000, China.

出版信息

World J Surg Oncol. 2024 Apr 22;22(1):107. doi: 10.1186/s12957-024-03362-0.

DOI:10.1186/s12957-024-03362-0

PMID:38644507

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11034099/

Abstract

BACKGROUND

Colorectal signet-ring cell carcinoma (SRCC) is a rare cancer with a bleak prognosis. The relationship between its clinicopathological features and survival remains incompletely elucidated. Tumor deposits (TD) have been utilized to guide the N staging in the 8th edition of American Joint Committee on Cancer (AJCC) staging manual, but their prognostic significance remains to be established in colorectal SRCC.

PATIENTS AND METHODS

The subjects of this study were patients with stage III/IV colorectal SRCC who underwent surgical treatment. The research comprised two cohorts: a training cohort and a validation cohort. The training cohort consisted of 631 qualified patients from the SEER database, while the validation cohort included 135 eligible patients from four independent hospitals in China. The study assessed the impact of TD on Cancer-Specific Survival (CSS) and Overall Survival (OS) using Kaplan-Meier survival curves and Cox regression models. Additionally, a prognostic nomogram model was constructed for further evaluation.

RESULTS

In both cohorts, TD-positive patients were typically in the stage IV and exhibited the presence of perineural invasion (PNI) (P < 0.05). Compared to the TD-negative group, the TD-positive group showed significantly poorer CSS (the training cohort: HR, 1.87; 95% CI, 1.52-2.31; the validation cohort: HR, 2.43; 95% CI, 1.55-3.81; all P values < 0.001). This association was significant in stage III but not in stage IV. In the multivariate model, after adjusting for covariates, TD maintained an independent prognostic value (P < 0.05). A nomogram model including TD, N stage, T stage, TNM stage, CEA, and chemotherapy was constructed. Through internal and external validation, the model demonstrated good calibration and accuracy. Further survival curve analysis based on individual scores from the model showed good discrimination.

CONCLUSION

TD positivity is an independent factor of poor prognosis in colorectal SRCC patients, and it is more effective to predict the prognosis of colorectal SRCC by building a model with TD and other clinically related variables.

摘要

背景

结直肠印戒细胞癌（SRCC）是一种罕见的癌症，预后较差。其临床病理特征与生存之间的关系仍未完全阐明。肿瘤结节（TD）已被用于指导美国癌症联合委员会（AJCC）第8版分期手册中的N分期，但其在结直肠SRCC中的预后意义仍有待确定。

患者与方法

本研究的对象为接受手术治疗的III/IV期结直肠SRCC患者。研究包括两个队列：一个训练队列和一个验证队列。训练队列由来自监测、流行病学和最终结果（SEER）数据库的631例合格患者组成，而验证队列包括来自中国四家独立医院的135例符合条件的患者。本研究使用Kaplan-Meier生存曲线和Cox回归模型评估TD对癌症特异性生存（CSS）和总生存（OS）的影响。此外，构建了一个预后列线图模型进行进一步评估。

结果

在两个队列中，TD阳性患者通常处于IV期，且存在神经周围侵犯（PNI）（P<0.05）。与TD阴性组相比，TD阳性组的CSS明显更差（训练队列：风险比[HR]，1.87；95%置信区间[CI]，1.52-2.31；验证队列：HR，2.43；95%CI，1.55-3.81；所有P值<0.001）。这种关联在III期显著，但在IV期不显著。在多变量模型中，调整协变量后，TD保持独立的预后价值（P<0.05）。构建了一个包括TD、N分期、T分期、TNM分期、癌胚抗原（CEA）和化疗的列线图模型。通过内部和外部验证，该模型显示出良好的校准和准确性。基于模型个体评分的进一步生存曲线分析显示出良好的区分度。