Chen Rujie, Zhu Jun, Xu Dong, Fan Xiaoyan, Qiao Yihuan, Jiang Xunliang, Hao Jun, Du Yongtao, Chen Xihao, Yuan Guo, Li Jipeng
Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.
Department of General Surgery, The Southern Theater Air Force Hospital, Guangzhou, China.
Front Oncol. 2025 Mar 25;15:1512960. doi: 10.3389/fonc.2025.1512960. eCollection 2025.
Lymph node metastasis is a crucial determinant of prognosis in colorectal cancer (CRC), significantly impacting survival outcomes and treatment decision-making. This study aims to evaluate the prognostic value of tumor infiltration proportion within lymph nodes (TIPLN) in N1 CRC patients and to develop a TIPLN-based nomogram to predict prognosis.
A total of 416 N1 CRC patients who underwent radical resection were enrolled and divided into training and validation cohorts. Whole-slide images of lymph nodes were annotated to assess the TIPLN. Univariable and multivariable Cox regression analyses were conducted to identify independent prognostic factors and to develop a nomogram for predicting patient outcomes. The precision and discrimination of the nomogram were evaluated using the area under the receiver operating characteristic curve (AUC), concordance index (C-index), and calibration curve. Decision curve analysis (DCA) was performed to compare the net benefit of the nomogram at different threshold probabilities. Additionally, net reclassification index (NRI) and integrated discrimination improvement (IDI) were used to evaluate the nomogram's clinical utility.
High TIPLN levels were significantly associated with poorer overall survival (OS). Five variables, including TIPLN, were selected to construct the nomogram. The C-index in OS prediction was 0.739 and 0.753 for the training and validation cohorts, respectively. Additionally, strong precision and discrimination were demonstrated through AUC and calibration curves. The NRI (training cohort: 0.191 for 3-year and 0.436 for 5-year OS prediction; validation cohort: 0.180 for 3-year and 0.439 for 5-year OS prediction) and IDI (training cohort: 0.079 for 3-year and 0.094 for 5-year OS prediction; validation cohort: 0.078 for 3-year and 0.098 for 5-year OS prediction) suggest that the TIPLN-based nomogram significantly outperformed the clinicopathological nomogram. Furthermore, DCA demonstrated the high clinical applicability of the TIPLN-based nomogram for predicting OS.
TIPLN could serve as a prognostic predictor for N1 CRC patients. The TIPLN-based nomogram enhances survival prediction accuracy and facilitates more informed, individualized clinical decision-making.
淋巴结转移是结直肠癌（CRC）预后的关键决定因素，对生存结果和治疗决策有重大影响。本研究旨在评估N1期CRC患者淋巴结内肿瘤浸润比例（TIPLN）的预后价值，并开发基于TIPLN的列线图以预测预后。
共纳入416例行根治性切除术的N1期CRC患者，并分为训练队列和验证队列。对淋巴结的全切片图像进行标注以评估TIPLN。进行单变量和多变量Cox回归分析以确定独立预后因素，并开发用于预测患者结局的列线图。使用受试者操作特征曲线（AUC）下面积、一致性指数（C指数）和校准曲线评估列线图的精度和区分度。进行决策曲线分析（DCA）以比较列线图在不同阈值概率下的净效益。此外，使用净重新分类指数（NRI）和综合判别改善（IDI）评估列线图的临床实用性。
高TIPLN水平与较差的总生存期（OS）显著相关。选择包括TIPLN在内的五个变量构建列线图。训练队列和验证队列中OS预测的C指数分别为0.739和0.753。此外，通过AUC和校准曲线显示出较强的精度和区分度。NRI（训练队列：3年OS预测为0.191，5年OS预测为0.436；验证队列：3年OS预测为0.180，5年OS预测为0.439）和IDI（训练队列：3年OS预测为0.079，5年OS预测为0.094；验证队列：3年OS预测为0.078，5年OS预测为0.098）表明基于TIPLN的列线图明显优于临床病理列线图。此外，DCA证明了基于TIPLN的列线图在预测OS方面具有较高的临床适用性。
TIPLN可作为N1期CRC患者的预后预测指标。基于TIPLN的列线图提高了生存预测准确性，并有助于做出更明智、个性化的临床决策。
