临床计算器预测微卫星不稳定的 I-III 期结肠癌患者手术后无复发的情况。
Clinical Calculator for Predicting Freedom From Recurrence After Resection of Stage I-III Colon Cancer in Patients With Microsatellite Instability.
机构信息
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
出版信息
JCO Clin Cancer Inform. 2024 Aug;8:e2300233. doi: 10.1200/CCI.23.00233.
PURPOSE
Outcome for patients with nonmetastatic, microsatellite instability (MSI) colon cancer is favorable: however, high-risk cohorts exist. This study was aimed at developing and validating a nomogram model to predict freedom from recurrence (FFR) for patients with resected MSI colon cancer.
PATIENTS AND METHODS
Data from patients who underwent curative resection of stage I, II, or III MSI colon cancer in 2014-2021 (model training cohort, 384 patients, 33 events; median follow-up, 38.8 months) were retrospectively collected from institutional databases. Variables associated with recurrence in multivariable analysis were selected for inclusion in the clinical calculator. The calculator's predictive accuracy was measured with the concordance index and validated using data from patients who underwent treatment for MSI colon cancer in 2007-2013 (validation cohort, 164 patients, eight events; median follow-up, 84.8 months).
RESULTS
T category and number of positive lymph nodes were significantly associated with recurrence in multivariable analysis and were selected for inclusion in the clinical calculator. The calculator's concordance index for FFR in the model training cohort was 0.812 (95% CI, 0.742 to 0.873), compared with 0.759 (95% CI, 0.683 to 0.840) for the staging schema of the eighth edition of the American Joint Committee on Cancer Staging Manual. The concordance index for the validation cohort was 0.744 (95% CI, 0.666 to 0.822), confirming robust predictive accuracy.
CONCLUSION
Although in general patients with nonmetastatic MSI colon cancer had favorable outcome, patients with advanced T category and multiple metastatic lymph nodes had higher risk of recurrence. The clinical calculator identified patients with MSI colon cancer at high risk for recurrence, and this could inform surveillance strategies. In addition, the model could be used in trial design to identify patients suitable for novel adjuvant therapy.
目的
非转移性、微卫星不稳定（MSI）结直肠癌患者的预后良好：然而，存在高危亚群。本研究旨在开发和验证一种列线图模型，以预测接受根治性切除的 MSI 结直肠癌患者的无复发生存率（FFR）。
方法
回顾性收集了 2014 年至 2021 年期间接受 I 期、II 期或 III 期 MSI 结直肠癌根治性切除术的患者数据（模型训练队列，384 例患者，33 例事件；中位随访 38.8 个月），来自机构数据库。多变量分析中与复发相关的变量被选择纳入临床计算器。通过计算一致性指数来衡量计算器的预测准确性，并使用 2007 年至 2013 年期间接受 MSI 结直肠癌治疗的患者的数据进行验证（验证队列，164 例患者，8 例事件；中位随访 84.8 个月）。
结果
多变量分析中 T 分期和阳性淋巴结数量与复发显著相关，并被选择纳入临床计算器。在模型训练队列中，FFR 的计算器一致性指数为 0.812（95%CI，0.742 至 0.873），而第八版美国癌症联合委员会癌症分期手册的分期方案为 0.759（95%CI，0.683 至 0.840）。验证队列的一致性指数为 0.744（95%CI，0.666 至 0.822），证实了其稳健的预测准确性。
结论
尽管非转移性 MSI 结直肠癌患者的总体预后良好，但 T 分期较高和多个转移性淋巴结的患者复发风险较高。临床计算器确定了 MSI 结直肠癌患者的高复发风险，这可以为监测策略提供信息。此外，该模型可用于试验设计，以确定适合新型辅助治疗的患者。
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