Shahabi Fatemeh, Abdollahi Abbas, Rasouli Mahboobeh
Endoscopic and Minimally Invasive Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.
J Res Med Sci. 2024 Aug 2;29:54. doi: 10.4103/jrms.jrms_95_23. eCollection 2024.
One of the most appropriate methods for analyzing longitudinal data is multistate model. This study has aimed to evaluate the risk factors of transfer to local recurrence (LR), distant metastasis (DM), and death in rectal cancer patients through multistate survival analysis.
This is a retrospective cohort of rectal cancer patients in Mashhad, Iran. Multistate models were applied to show the difference between the significant risk factors affecting death and recurrence in different defined transitions. Risk factors include age, sex, primary surgical technique, tumor location, postoperative tumor stage, circumferential or distal resection involvement, surgery time, and surgical complications.
A total of 280 eligible patients with a median (interquartile range) survival time of 60 (42-76.2) months were investigated. Based on Cox proportional multistate model, the hazard ratio (HR) of DM increases by 3%/1-year increase in age ( = 0.018). The HR of DM and the HR of LR in patients with postoperative disease Stage II/III were 3.06 and 2.53 times higher than patients with cancer Stage 0/I ( < 0.05). When the resection margins of distal or circumferential were involved, the HR of DM was 3.58 times higher than those patients without involvement. In the extended multistate model, time of DM was a significant predictor of death ( = 0.006).
Age and margin involvement in DM path and stage in LR and DM path had a significant effect; however, no effective variable was seen on the death of patients with recurrence. The time of metastasis also had an effect on the path of death.
分析纵向数据最合适的方法之一是多状态模型。本研究旨在通过多状态生存分析评估直肠癌患者发生局部复发（LR）、远处转移（DM）和死亡的危险因素。
这是一项对伊朗马什哈德直肠癌患者的回顾性队列研究。应用多状态模型来显示在不同定义的转变中影响死亡和复发的显著危险因素之间的差异。危险因素包括年龄、性别、初次手术技术、肿瘤位置、术后肿瘤分期、环周或远端切除受累情况、手术时间和手术并发症。
共调查了280例符合条件的患者，中位（四分位间距）生存时间为60（42 - 76.2）个月。基于Cox比例多状态模型，年龄每增加1岁，DM的风险比（HR）增加3%（P = 0.018）。术后疾病分期为II/III期患者的DM的HR和LR的HR分别比癌症分期为0/I期的患者高3.06倍和2.53倍（P < 0.05）。当远端或环周切缘受累时，DM的HR比未受累患者高3.58倍。在扩展多状态模型中，DM时间是死亡的显著预测因素（P = 0.006）。
年龄以及DM路径中的切缘受累情况和LR及DM路径中的分期有显著影响；然而，未发现对复发患者的死亡有影响的有效变量。转移时间也对死亡路径有影响。
