Lucocq James, Trinder Tom, Homyer Kate, Baig Hassan, Patil Pradeep, Muthukumarasamy Girivasan
Department of Colorectal Surgery, Ninewells Hospital, Dundee, United Kingdom.
Department of General Surgery, Ayr Hospital, Ayr, United Kingdom.
Int J Surg. 2025 Apr 1;111(4):2886-2893. doi: 10.1097/JS9.0000000000002300.
Disease prognostication can be achieved through the derivation of biologically and clinically integrated prediction models. The present study reports 1-, 3-, and 5-year disease-free survival (DFS) in patients undergoing right hemicolectomy for curative intent and both derives and validates a pre- and post-operative prediction tool for DFS for prognostication and risk stratification purposes.
Consecutive patients undergoing right-sided curative-intent resection for colorectal cancer (2010-2020) in a tertiary care unit were followed-up prospectively for recurrence and survival outcomes. Survival analyses were used to derive pre- and post-operative models predicting 1-, 3-, and 5-year DFS. Calibration was reported and internal validation was performed using bootstrapping.
A total of 822 patients underwent resection and 528 had ≥5-year follow-up. The 1-, 3-, and 5-year DFS rates were 85.6%, 72.5% and 57.6%, respectively. Variables associated with death/recurrence included: increasing age (HR > 1.95, P = 0.037), male gender (HR 1.62, P < 0.001), ASA ≥3 (HR 1.79, P < 0.001), low albumin (HR 1.54, P < 0.001), T4 stage (HR 2.35, P = 0.023), R1 status (HR 1.63, P = 0.024), ≥4 positive lymph nodes (HR > 1.74, P < 0.001) and Clavien-Dindo ≥3 (HR 2.83, P < 0.001). The pre- and post-operative models contained 9 and 13 demographic, clinical, biochemical, operative and pathological variables, respectively (C-index 0.75 and 0.79, respectively). Excluding demographic, clinical and operative variables significantly reduced the C-index of the pre- (0.62) and post-operative models (0.70).
The presented prediction tools for DFS will help clinicians stratify risk, offer appropriate adjuvant treatment and predict long-term DFS following curative-intent right-sided colon cancer resection.
疾病预后可通过推导生物和临床综合预测模型来实现。本研究报告了接受根治性右半结肠切除术患者的1年、3年和5年无病生存率（DFS），并推导和验证了用于DFS预后和风险分层的术前及术后预测工具。
对一家三级医疗单位中连续接受右侧根治性结直肠癌切除术（2010 - 2020年）的患者进行前瞻性随访，观察复发和生存结局。采用生存分析推导预测1年、3年和5年DFS的术前及术后模型。报告校准情况并使用自举法进行内部验证。
共有822例患者接受了切除术，528例有≥5年的随访。1年、3年和5年DFS率分别为85.6%、72.5%和57.6%。与死亡/复发相关的变量包括：年龄增加（HR > 1.95，P = 0.037）、男性（HR 1.62，P < 0.001）、美国麻醉医师协会（ASA）分级≥3（HR 1.79，P < 0.001）、低白蛋白（HR 1.54，P < 0.001）、T4期（HR 2.35，P = 0.023）、R1状态（HR 1.63，P = 0.024）、≥4个阳性淋巴结（HR > 1.74，P < 0.001）和Clavien - Dindo分级≥3（HR 2.83，P < 0.001）。术前和术后模型分别包含9个和13个人口统计学、临床、生化、手术和病理变量（C指数分别为0.75和0.79）。排除人口统计学、临床和手术变量显著降低了术前模型（0.62）和术后模型（0.70）的C指数。
所呈现的DFS预测工具将有助于临床医生对风险进行分层，提供适当的辅助治疗，并预测根治性右侧结肠癌切除术后的长期DFS。
