Xue Jun-Shuai, Maimaitiming Nuersimanguli, Zhang Bo-Lun, Xu Bo-Wen, Yin Xin, Huang Zhen, Che Xu, Zhao Hong, Cai Jian-Qiang
Department of Hepatobiliary Surgery, National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
Department of Hepatobiliary Surgery, Shenzhen Center, Cancer Hospital Chinese Academy of Medical Sciences, Shenzhen, 518000, China.
BMC Cancer. 2025 Apr 17;25(1):718. doi: 10.1186/s12885-025-14135-7.
To improve prognosis of patients with synchronous colorectal liver metastasis (CRLM), we constructed a nomogram model to improve outcome through risk stratification and decision support.
The 389 CRLM patients (273 training set and 116 validation set at a ratio of 7: 3) receiving systematic chemotherapy and synchronously resection with/without radiofrequency ablation (RFA) were retrospectively investigated. Overall survival (OS) and recurrence free survival (RFS) were mainly endpoint. A normo-gram model was conduct. The receiver operating characteristic (ROC) curve, decision curve analysis (DCA), C-index and calibration curve were performed to assess stablity and efficacy of model. The prognosis was evaluated based on Kaplan-Meier (KM) curve.
A total of 389 CRLM patients were included. The median OS and RFS times were 70.20 months (95% CIs: 57.73, 82.68) and 11.70 months (95% CIs: 9.75, 13.65), respectively. These patients were divided into training set and validation set at a ratio of 7: 3. In training set, 1, 3, and 5-year survival rate of OS was 97.38%, 71.18%, and 54.56% as well as RFS was 52.57%, 22.65%, and 21.12%, respectively. Cox model showed that hospital day, R0 resection, RFA, only neoadjuvant chemotherapy and CRS score were independent prognostic factors for CRLM patients. The patients were divided into high-risk group and low-risk group based on cut-off value of score calculated by model. The KM curves were statistically different between two groups (P < 0.01). The ROC curve, DCA and calibration curve showed a good prediction efficacy. the C-index of OS and RFS were 0.72 and 0.68, respectively, which were also verified in the validation set (OS, 0.71; RFS, 0.65).
A good prediction model was developed and validated to assess the prognoses of CRLM patients. Systematic chemotherapy and R0 resection could benefit patients' survival and improve prognosis.
为改善同时性结直肠癌肝转移（CRLM）患者的预后，我们构建了一个列线图模型，通过风险分层和决策支持来改善预后。
回顾性研究了389例接受系统化疗并同步进行有/无射频消融（RFA）手术切除的CRLM患者（273例训练集和116例验证集，比例为7:3）。总生存期（OS）和无复发生存期（RFS）为主要终点。构建了一个列线图模型。采用受试者操作特征（ROC）曲线、决策曲线分析（DCA）、C指数和校准曲线来评估模型的稳定性和有效性。基于Kaplan-Meier（KM）曲线评估预后。
共纳入389例CRLM患者。OS和RFS的中位时间分别为70.20个月（95%置信区间：57.73，82.68）和11.70个月（95%置信区间：9.75，13.65）。这些患者按7:3的比例分为训练集和验证集。在训练集中，OS的1、3和5年生存率分别为97.38%、71.18%和54.56%，RFS分别为52.57%、22.65%和21.12%。Cox模型显示，住院天数、R0切除、RFA、仅新辅助化疗和CRS评分是CRLM患者的独立预后因素。根据模型计算的评分临界值将患者分为高危组和低危组。两组之间的KM曲线有统计学差异（P<0.01）。ROC曲线、DCA和校准曲线显示出良好的预测效果。OS和RFS的C指数分别为0.72和0.68，在验证集中也得到了验证（OS，0.71；RFS，0.65）。
开发并验证了一个良好的预测模型，用于评估CRLM患者的预后。系统化疗和R0切除可使患者生存获益并改善预后。
