Zhu Sirui, Xing Yuncan, Tu Jiawei, Pei Wei, Bi Jianjun, Zheng Zhaoxu, Feng Qiang
Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Transl Cancer Res. 2025 Apr 30;14(4):2367-2380. doi: 10.21037/tcr-24-1888. Epub 2025 Apr 14.
The incidence of colorectal cancer (CRC) has been rising in recent years, with a concurrent increase in early-stage rectal cancer (ESRC) cases. This study aimed to investigate risk factors and developed nomograms to predict overall survival (OS) and cancer-specific survival (CSS) in ESRC patients in order to improve clinical outcomes across diverse patient subgroups.
Risk factors were investigated in ESRC patients by analyzing data from the Surveillance, Epidemiology, and End Results (SEER) database. We developed and validated nomograms to predict OS and CSS after dividing patients into two risk groups. Then we assessed the potential benefits of various therapies across subgroups after propensity score-matching (PSM).
T stage, tumor grade, age, carcinoembryonic antigen (CEA) levels, tumor size, and surgical options emerged as independent risk factors through univariate and multivariate Cox regression analyses, contributing to the OS nomogram; while for CSS, the identified risk factors were tumor grade, age, elevated CEA levels and surgical options. The Concordance-index of the nomogram surpassed that of the American Joint Committee on Cancer (AJCC) 7 staging system, with values of 0.69 (C-index, 0.64-0.74) in the training set and 0.65 (C-index, 0.62-0.68) in the testing set. The receiver operating characteristic (ROC) analysis revealed area under the curve (AUC) values of 0.70, 0.70, and 0.67 for 1-, 3-, and 5-year OS in the development cohort, with comparable results in the validation cohort. Calibration plots demonstrated strong alignment between predicted and observed outcomes. Decision curve analysis (DCA) confirmed the nomogram's superior clinical utility relative to the AJCC 7 staging system, with similar findings for CSS. Kaplan-Meier curves illustrated significant differences in OS and CSS between low- and high-risk groups. Notably, radiation and chemotherapy conferred no benefit, while low-risk patients, especially younger individuals, may benefit from local resection.
This study presents a comprehensive prognostic analysis of patients with ESRC and developed predictive nomograms for OS and CSS. Subgroup analyses highlight the potential benefits of local resection in younger patients with low risk.
近年来,结直肠癌(CRC)的发病率一直在上升,同时早期直肠癌(ESRC)病例也在增加。本研究旨在调查风险因素,并制定列线图以预测ESRC患者的总生存期(OS)和癌症特异性生存期(CSS),从而改善不同患者亚组的临床结局。
通过分析监测、流行病学和最终结果(SEER)数据库中的数据,对ESRC患者的风险因素进行了调查。在将患者分为两个风险组后,我们开发并验证了用于预测OS和CSS的列线图。然后,在倾向评分匹配(PSM)后,我们评估了各亚组中各种治疗方法的潜在益处。
通过单因素和多因素Cox回归分析,T分期、肿瘤分级、年龄、癌胚抗原(CEA)水平、肿瘤大小和手术选择成为独立的风险因素,这些因素构成了OS列线图;而对于CSS,确定的风险因素是肿瘤分级、年龄、CEA水平升高和手术选择。列线图的一致性指数超过了美国癌症联合委员会(AJCC)第7版分期系统,训练集中的值为0.69(C指数,0.64 - 0.74),测试集中的值为0.65(C指数,0.62 - 0.68)。受试者操作特征(ROC)分析显示,在开发队列中,1年、3年和5年OS的曲线下面积(AUC)值分别为0.70、0.70和0.67,在验证队列中结果相似。校准图显示预测结果与观察结果之间有很强的一致性。决策曲线分析(DCA)证实了列线图相对于AJCC第7版分期系统具有更高的临床实用性,CSS的结果相似。Kaplan - Meier曲线显示低风险组和高风险组在OS和CSS方面存在显著差异。值得注意的是,放疗和化疗没有益处,而低风险患者,尤其是年轻患者,可能从局部切除中获益。
本研究对ESRC患者进行了全面的预后分析,并开发了用于OS和CSS的预测列线图。亚组分析突出了局部切除对低风险年轻患者的潜在益处。