基于阴性淋巴结/肿瘤分期对数概率的列线图可预测结直肠癌患者的预后：一项基于SEER数据库的回顾性研究及在中国的外部验证
Nomogram based on the log odds of negative lymph node/T stage can predict the prognosis of patients with colorectal cancer: a retrospective study based on SEER database and external validation in China.
作者信息
Cai Boyong, Zheng Mengli, Li Yimin, Chen Zhicao, Zhong Canxin, Chen Xiaochun, Chen Guiquan
机构信息
Department of Gastroenterology, The Tenth Affiliated Hospital, Southern Medical University (Dongguan People's Hospital), Dongguan, China.
Department of Gastroenterology, The Tenth Affiliated Hospital, Southern Medical University (Dongguan People's Hospital), Dongguan, China
出版信息
BMJ Open. 2024 Dec 20;14(12):e083942. doi: 10.1136/bmjopen-2024-083942.
OBJECTIVES
This study investigated the prognostic role of log odds of negative lymph node/T stage (LONT) and established a nomogram based on LONT to predict the prognosis in colorectal cancer (CRC) patients.
DESIGN
A retrospective cohort study.
SETTING AND PARTICIPANTS
We enrolled 80 518 CRC patients from the Surveillance, Epidemiology and End Results database between 2010 and 2015. The dataset was split into a training cohort (56 364 patients) and a validation cohort (24 154 patients) at a ratio of 7:3. Furthermore, 500 CRC patients who underwent surgery in the Tenth Affiliated Hospital of Southern Medical University between 1 January 2017 and 20 December 2018, were recruited as the external validation set.
OUTCOME MEASURES
1-, 3- and 5-year cancer-specific survival (CSS).
METHODS
The univariate and multivariate Cox regression analyses were carried out to identify the significant independent prognostic factors of CSS. A nomogram was established based on LONT to predict the prognosis. The performance of the nomogram was comprehensively assessed via the time-dependent receiver operating characteristic curve, concordance index (C-index), calibration curve and decision curve analysis (DCA) comprehensively. Moreover, Kaplan-Meier curves were performed to assess the CSS of the three risk subgroups.
RESULT
LONT was a significant independent prognostic factor for CSS (LONT1 vs LONT2, HR=0.670, 95% CI 0.642 to 0.698, p<0.001; LONT1 vs LONT3, HR=0.443, 95% CI 0.420 to 0.467, p<0.001). LONT, age, sex, race, subsite, differentiation, histology, tumour size, T stage, N stage, M stage and chemotherapy were included in the nomogram. The 1-, 3- and 5-year survival area under the curve were 0.856, 0.862 and 0.852, respectively. The C-index of the model was 0.809 (95% CI 0.825 to 0.839) in the model. The calibration curve and DCA verified the favourable predictive performance and clinical application of the nomogram.
CONCLUSION
CRC patients with a high LONT had a low incidence of CSS. The nomogram based on LONT could effectively predict the CSS of CRC.
目的
本研究调查了阴性淋巴结/ T分期对数比值（LONT）的预后作用，并基于LONT建立了列线图以预测结直肠癌（CRC）患者的预后。
设计
一项回顾性队列研究。
设置与参与者
我们从2010年至2015年的监测、流行病学和最终结果数据库中纳入了80518例CRC患者。数据集按7:3的比例分为训练队列（56364例患者）和验证队列（24154例患者）。此外，招募了2017年1月1日至2018年12月20日在南方医科大学第十附属医院接受手术的500例CRC患者作为外部验证集。
观察指标
1年、3年和5年癌症特异性生存率（CSS）。
方法
进行单因素和多因素Cox回归分析以确定CSS的显著独立预后因素。基于LONT建立列线图以预测预后。通过时间依赖性受试者工作特征曲线、一致性指数（C指数）、校准曲线和决策曲线分析（DCA）对列线图的性能进行综合评估。此外，绘制Kaplan-Meier曲线以评估三个风险亚组的CSS。
结果
LONT是CSS的显著独立预后因素（LONT1与LONT2，HR = 0.670，95%CI 0.642至0.698，p < 0.001；LONT1与LONT3，HR = 0.443，95%CI 0.420至0.467，p < 0.001）。列线图纳入了LONT、年龄、性别、种族、亚部位、分化程度、组织学类型、肿瘤大小、T分期、N分期、M分期和化疗。曲线下1年、3年和5年生存率分别为0.856、0.862和0.852。模型的C指数为0.809（95%CI 0.825至0.839）。校准曲线和DCA验证了列线图良好的预测性能和临床应用价值。
结论
LONT高的CRC患者CSS发生率低。基于LONT的列线图可有效预测CRC的CSS。
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