Zheng Jixiang, Wang Ting, Wang Huaiming, Yan Botao, Lai Jianbo, Qiu Kemao, Zhou Xinyi, Tan Jie, Wang Shijie, Ji Hongli, Feng Mingyuan, Jiang Wei, Wang Hui, Yan Jun
Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, People's Republic of China.
Department of General Surgery, Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Cancer, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China.
Ann Surg Oncol. 2025 Feb;32(2):771-782. doi: 10.1245/s10434-024-16519-8. Epub 2024 Nov 29.
Approximately 25% of patients with stage III colorectal cancer experience liver metastasis after radical resection; however, there is currently a lack of methods to predict liver metastasis. This study aims to develop and validate a pathomics nomogram to predict liver metastasis in patients with stage III colorectal cancer.
A total of 318 enrolled patients were divided into three cohorts: a training cohort (n = 139), a validation cohort (n = 69), and an external cohort (n = 110). A competitive risk nomogram was established by the pathomics signature and clinicopathological characteristics and assessed by calibration, discrimination, and clinical usefulness.
A significant correlation between the pathomics signature and liver metastasis in stage III colorectal cancer was found. Multivariate Fine-Gray analysis indicated that preoperative carcinoembryonic antigen level, postoperative chemotherapy, and pathomics signature were independent predictors of liver metastasis. A competitive risk nomogram was developed to predict liver metastasis in patients with stage III colorectal cancer. The predicting nomogram shows good discrimination and calibration, with C-indexes of 0.811 (95% confidence interval [CI] 0.651-0.971), 0.759 (95% CI 0.531-0.987), and 0.845 (95% CI 0.641-0.999), with area under the receiver operating characteristic (AUROC) curves at 5 years of 0.833 (95% CI 0.742-0.925), 0.760 (95% CI 0.652-0.893), and 0.812 (95% CI 0.692-0.931) in the training, validation, and external cohorts, respectively. Compared with the clinicopathological nomogram, the nomogram combined with the pathomics signature had better performance (AUROC 0.823 [95% CI 0.764-0.881] vs. 0.678 [95% CI 0.606-0.751]; p < 0.001).
The pathomics signature is a predictive indicator for liver metastasis in patients with stage III colorectal cancer, and the integrated nomogram can be used to predict liver metastasis better than the clinicopathological nomogram alone.
约25%的III期结直肠癌患者在根治性切除术后会发生肝转移；然而，目前缺乏预测肝转移的方法。本研究旨在开发并验证一种病理组学列线图，以预测III期结直肠癌患者的肝转移情况。
共318例入组患者被分为三个队列：训练队列（n = 139）、验证队列（n = 69）和外部队列（n = 110）。通过病理组学特征和临床病理特征建立竞争风险列线图，并通过校准、区分度和临床实用性进行评估。
发现III期结直肠癌的病理组学特征与肝转移之间存在显著相关性。多变量Fine-Gray分析表明，术前癌胚抗原水平、术后化疗和病理组学特征是肝转移的独立预测因素。开发了一种竞争风险列线图来预测III期结直肠癌患者的肝转移情况。该预测列线图显示出良好的区分度和校准度，训练队列、验证队列和外部队列的C指数分别为0.811（95%置信区间[CI] 0.651 - 0.971）、0.759（95% CI 0.531 - 0.987）和0.845（95% CI 0.641 - 0.999），5年时受试者操作特征（AUROC）曲线下面积分别为0.833（95% CI 0.742 - 0.925）、0.760（95% CI 0.652 - 0.893）和0.812（95% CI 0.692 - 0.931）。与临床病理列线图相比，结合病理组学特征的列线图表现更好（AUROC 0.823 [95% CI 0.764 - 0.881] 对 0.678 [95% CI 0.606 - 0.751]；p < 0.001）。
病理组学特征是III期结直肠癌患者肝转移的预测指标，综合列线图比单独的临床病理列线图能更好地预测肝转移情况。
