Lv Baohua, Li Donghai, Li Jizheng, Shang Kai, Wu Ke, Jin Erhu, Li Xiujuan
Department of Radiology, the Affiliated Taian City Central Hospital of Qingdao University, Tai'an, 271099, China.
Department of Orthopedic, the Affiliated Taian City Central Hospital of Qingdao University, Tai'an, 271099, China.
Sci Rep. 2024 Dec 28;14(1):31469. doi: 10.1038/s41598-024-83166-0.
This study aimed to investigate the correlation between baseline MRI features and baseline carcinoembryonic antigen (CEA) expression status in rectal cancer patients. A training cohort of 168 rectal cancer patients from Center 1 and an external validation cohort of 75 rectal cancer patients from Center 2 were collected. A nomogram was constructed based on the training cohort and validated using the external validation cohort to predict high baseline CEA expression in rectal cancer patients. The nomogram's discriminative ability and clinical utility were tested using the receiver operating characteristic (ROC) curve, and decision curve analysis (DCA). The baseline CEA high-expression group had significantly higher MRI-detected metastatic lymph node (mLN), MRI-detected extramural vascular invasion (mEMVI), infiltrating tumor border configuration (iTBC), peritoneal invasion, annular infiltration, maximum extramural depth (MED), and tumor length than the normal CEA group (P < 0.05). Among them, MED [odds ratio (OR):1.19 (1.03-1.38), P = 0.016] and annular infiltration [OR:2.36 (1.06-5.25), P = 0.036] were independently predicting factors for high baseline CEA expression. The trained and validated model for predicting high baseline CEA expression in the training and external validation cohorts had the area under the curves (AUC) of 0.787 (95% CI 0.716-0.859) and 0.799 (95% CI 0.698-0.899), respectively. The calibration curves of both cohorts demonstrated good agreement between predicted and observed outcomes. Decision curve analysis indicated the clinical value of the nomogram. We developed a visual nomogram to predict high baseline CEA expression for patients with rectal cancer, enabling clinicians to conduct a personalized risk assessment and therapy.
本研究旨在探讨直肠癌患者基线MRI特征与基线癌胚抗原（CEA）表达状态之间的相关性。收集了来自中心1的168例直肠癌患者的训练队列和来自中心2的75例直肠癌患者的外部验证队列。基于训练队列构建了列线图，并使用外部验证队列进行验证，以预测直肠癌患者的高基线CEA表达。使用受试者操作特征（ROC）曲线和决策曲线分析（DCA）测试列线图的判别能力和临床实用性。基线CEA高表达组的MRI检测到的转移淋巴结（mLN）、MRI检测到的壁外血管侵犯（mEMVI）、浸润性肿瘤边界形态（iTBC）、腹膜侵犯、环形浸润、最大壁外深度（MED）和肿瘤长度均显著高于正常CEA组（P < 0.05）。其中，MED [比值比（OR）：1.19（1.03 - 1.38），P = 0.016]和环形浸润[OR：2.36（1.06 - 5.25），P = 0.036]是高基线CEA表达的独立预测因素。在训练队列和外部验证队列中，用于预测高基线CEA表达的经过训练和验证的模型的曲线下面积（AUC）分别为0.787（95%CI 0.716 - 0.859）和0.799（95%CI 0.698 - 0.899）。两个队列的校准曲线显示预测结果与观察结果之间具有良好的一致性。决策曲线分析表明了列线图的临床价值。我们开发了一种可视化列线图来预测直肠癌患者的高基线CEA表达，使临床医生能够进行个性化的风险评估和治疗。
