Li Jian, Tong De Ming, Lv Peng, Xu Peng, Zhang Cheng
Department of General Surgery, General Hospital of Northern Theater Command (Teaching Hospital of China Medical University), Shenyang, China.
Discov Oncol. 2024 Nov 7;15(1):625. doi: 10.1007/s12672-024-01490-3.
Whether patients with early-onset colorectal cancer (EOCRC) receive chemotherapy has been controversial, so our study aimed to screen patients with EOCRC who benefit from chemotherapy.
A total of 2166 EOCRC patients were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Patients were divided into chemotherapy and non-chemotherapy groups, propensity score matching (PSM) was performed to balance the differences between the groups, and the Kaplan-Meier method was used to calculate the cancer-specific survival (CSS) of EOCRC patients. Multifactorial COX regression analysis was used to identify independent prognostic factors for CSS and to construct a nomogram for predicting CSS in EOCRC patients. The overall risk score was calculated based on Nomogram, and EOCRC patients were classified into high-risk and low-risk groups to assess further chemotherapy's therapeutic effect on patients with different risk stratification.
Before PSM, patients in the chemotherapy group had poorer CSS (p < 0.001). After PSM, there was no significant difference in patient CSS between the two groups (p = 0.057). Independent prognostic factors (Race, Grade, Pathology, AJCC.N, AJCC.M, CEA, Marital. Status) were screened according to multifactorial COX regression analyses and included in the Nomogram predicting CSS in EOCRC patients. A risk stratification system for EOCRC patients was further developed, and the results showed that chemotherapy had no significant effect on CSS in the low-risk group of patients, but in the high-risk group, chemotherapy significantly improved CSS in EOCRC patients.
We developed a clinical risk model by combining different risk factors, which can accurately screen those with high-risk EOCRC for benefit from chemotherapy. For low-risk EOCRC patients, our results did not observe a better survival benefit from chemotherapy, and more prospective studies are needed in the future to prove our conclusions.
早发性结直肠癌（EOCRC）患者是否接受化疗一直存在争议，因此我们的研究旨在筛选出能从化疗中获益的EOCRC患者。
从监测、流行病学和最终结果（SEER）数据库中识别出总共2166例EOCRC患者。将患者分为化疗组和非化疗组，进行倾向评分匹配（PSM）以平衡组间差异，采用Kaplan-Meier方法计算EOCRC患者的癌症特异性生存率（CSS）。使用多因素COX回归分析确定CSS的独立预后因素，并构建预测EOCRC患者CSS的列线图。根据列线图计算总体风险评分，将EOCRC患者分为高风险和低风险组，以评估进一步化疗对不同风险分层患者的治疗效果。
在PSM之前，化疗组患者的CSS较差（p < 0.001）。PSM之后，两组患者的CSS无显著差异（p = 0.057）。根据多因素COX回归分析筛选出独立预后因素（种族、分级、病理、AJCC.N、AJCC.M、癌胚抗原、婚姻状况），并纳入预测EOCRC患者CSS的列线图中。进一步建立了EOCRC患者的风险分层系统，结果显示化疗对低风险组患者的CSS无显著影响，但在高风险组中，化疗显著改善了EOCRC患者的CSS。
我们通过结合不同风险因素建立了一个临床风险模型，该模型可以准确筛选出能从化疗中获益的高风险EOCRC患者。对于低风险EOCRC患者，我们的结果未观察到化疗能带来更好的生存获益，未来需要更多前瞻性研究来证实我们的结论。
