Li Wei, Shen Liming, Yang Qinglin, Zhang Qun, Cao Yinghao, Liu Tao
Department of Digestive Surgical Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
Sci Rep. 2025 Feb 12;15(1):5253. doi: 10.1038/s41598-025-86693-6.
Oxidative stress has been implicated as a pivotal factor in the pathogenesis of numerous malignancies. However, the association between oxidative stress and the prognosis of patients with colorectal cancer liver metastasis (CRCLM) is not well elucidated. We conducted a retrospective analysis of 424 patients with CRCLM who underwent primary resection at the Union Hospital, Tongji Medical College, Wuhan, between July 2013 and September 2018. Patients were randomly divided into a training set (n = 300) and a test set (n = 124) in a 7:3 ratio.To develop the CRCLM-integrated Oxidative Stress Score (CLIOSS) for CRCLM, we utilized individual oxidative stress markers. The overall survival (OS) and disease-free survival (DFS) were estimated using the Kaplan-Meier method, and the log-rank test was employed to assess prognostic factors.To validate the predictive performance of CLIOSS, we constructed Receiver Operating Characteristic (ROC) curves and calculated the Area Under the Curve (AUC) values. Additionally, Decision Curve Analysis (DCA) and calibration plots were used to evaluate the clinical utility and predictive consistency of the model. The CLIOSS prognostic model was constructed based on the following variables and their corresponding β coefficients: 0.042 × total bilirubin (TBIL, µmol/L) + 0.032 × blood urea nitrogen (BUN, mmol/L) - 0.001 × uric acid (UA, µmol/L). Higher CLIOSS were associated with poorer OS (2.934;95% CI 2.167-3.974;P < 0.001) and DFS(2.707; 95% CI 2.000-3.664; P < 0.001. The 3-year OS AUC values were 0.803 in the training set and 0.851 in the testset, while the 3-year DFS AUC values were 0.892 and 0.898, respectively. Decision curve analysis demonstrated that both predictive models have significant clinical utility in practice. CLIOSS is a comprehensive prognostic index derived from oxidative stress markers, designed to predict long-term survival in patients with CRCLM. Our study shows that higher CLIOSS are significantly associated with poorer outcomes, making it an important tool for assessing patient risk.
氧化应激被认为是众多恶性肿瘤发病机制中的关键因素。然而，氧化应激与结直肠癌肝转移（CRCLM）患者预后之间的关联尚未得到充分阐明。我们对2013年7月至2018年9月期间在武汉同济医学院附属协和医院接受初次手术的424例CRCLM患者进行了回顾性分析。患者按7:3的比例随机分为训练集（n = 300）和测试集（n = 124）。为了构建用于CRCLM的综合氧化应激评分（CLIOSS），我们使用了个体氧化应激标志物。采用Kaplan-Meier法估计总生存期（OS）和无病生存期（DFS），并使用对数秩检验评估预后因素。为了验证CLIOSS的预测性能，我们构建了受试者工作特征（ROC）曲线并计算曲线下面积（AUC）值。此外，决策曲线分析（DCA）和校准图用于评估模型的临床实用性和预测一致性。CLIOSS预后模型基于以下变量及其相应的β系数构建：0.042×总胆红素（TBIL，µmol/L）+ 0.032×血尿素氮（BUN，mmol/L） - 0.001×尿酸（UA，µmol/L）。较高的CLIOSS与较差的OS（2.934；95%CI 2.167 - 3.974；P < 0.001）和DFS（2.707；95%CI 2.000 - 3.664；P < 0.001）相关。训练集的3年OS AUC值为0.803，测试集为0.851，而3年DFS AUC值分别为0.892和0.898。决策曲线分析表明，这两种预测模型在实践中均具有显著的临床实用性。CLIOSS是一种从氧化应激标志物得出的综合预后指标，旨在预测CRCLM患者的长期生存。我们的研究表明，较高的CLIOSS与较差的预后显著相关，使其成为评估患者风险的重要工具。
