非转移性结直肠癌患者术后预后影响因素分析及列线图预测模型的构建  

Analysis of related factors of prognosis after surgical treatment of patients with non-metastatic colorectal cancer and construction of a normagram prediction model

作　　者：刘书霞 张磊 石远凯 韩晓红 Liu Shuxia;Zhang Lei;Shi Yuankai;Han Xiaohong(Department of Clinical Laboratory,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100021,China;Department of Medical Oncology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs,Beijing 100021,China;Clinical Pharmacology Research Center,Peking Union Medical College Hospital,State Key Laboratory of Complex Severe and Rare Diseases,NMPA Key Laboratory for Clinical Research and Evaluation of Drug,Beijing Key Laboratory of Clinical PK&PD Investigation for Innovative Drugs,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100032,China)

机构地区：[1]国家癌症中心国家肿瘤临床医学研究中心中国医学科学院北京协和医学院肿瘤医院检验科,北京100021 [2]国家癌症中心国家肿瘤临床医学研究中心中国医学科学院北京协和医学院肿瘤医院内科,抗肿瘤分子靶向药物临床研究北京市重点实验室,北京100021 [3]中国医学科学院北京协和医院临床药理研究中心,疑难重症及罕见病国家重点实验室,国家药监局药物临床研究与评价重点实验室,创新药物临床PK/PD北京市重点实验室,北京100032

出　　处：《中华肿瘤杂志》2022年第2期167-172,共6页Chinese Journal of Oncology

基　　金：国家重大新药创制科技重大专项(2019ZX09201-002)。

摘　　要：目的探讨非转移性结直肠癌(non-mCRC)手术治疗后的预后影响因素, 并构建预后预测模型。方法纳入2014年7月1日至2016年12月31日中国医学科学院肿瘤医院收治的结直肠癌患者846例, 其中转移性结直肠癌(mCRC)组314例, non-mCRC组532例。回顾性收集患者的临床资料、术前血液常规和结直肠癌常见肿瘤标志物检查结果。通过随访获得non-mCRC组患者的无病生存时间(DFS)数据。采用单因素和多因素Cox比例风险模型回归分析明确non-mCRC术后DFS的独立影响因素, 将这些独立影响因素纳入构建列线图预测模型。采用C指数、受试者工作特征曲线(ROC)及校准曲线评价该模型的性能。结果 mCRC组的血小板/淋巴细胞比值(PLR)、中性粒细胞/淋巴细胞比值(NLR)、癌胚抗原(CEA)、糖类抗原19-9(CA19-9)和糖类抗原242(CA242)均高于non-mCRC组, 淋巴细胞/单核细胞比值(LMR)低于non-mCRC组(均P<0.05)。ROC曲线分析显示, 上述6项指标诊断结直肠癌转移的曲下面积(AUC)从高到低依次为CEA(AUC=0.775)、CA19-9(AUC=0.716)、CA242(AUC=0.712)、NLR(AUC=0.607)、LMR(AUC=0.591)和PLR(AUC=0.556)。多因素Cox回归分析显示, 年龄、神经侵犯、pN分期和CA242是non-mCRC患者术后DFS的独立影响因素(均P<0.05), 据此构建预测non-mCRC患者术后3年DFS的列线图预测模型。内部验证结果显示, 该模型预测non-mCRC患者术后3年DFS的C指数为0.710, ROC曲线的AUC为0.733, 优于美国癌症联合委员会第7版TNM分期系统(C指数为0.696, AUC为0.701), 具有较好的区分度。校准曲线显示, 该模型的预测结果与实际观测结果具有较好的一致性。结论年龄、神经侵犯、pN分期和CA242是non-mCRC患者术后DFS的独立影响因素。基于这4个指标建立的non-mCRC患者术后DFS列线图预测模型具有较好的预测性能, 可为结直肠癌患者的预后评估提供参考。Objective To investigate the postoperative prognostic factors of non-metastatic colorectal cancer(non-mCRC),and construct a prognostic prediction model.Methods A total of 846 patients with colorectal cancer who were admitted to the Cancer Hospital,Chinese Academy of Medical Sciences from July 1,2014 to December 31,2016 were included in the study.There were 314 patients in the metastatic colorectal cancer(mCRC)group and 532 patients in the non-mCRC group.The data of clinical characteristics,preoperative blood routine and common serum tumor markers for CRC tests were collected retrospectively.The disease-free survival time(DFS)data of patients in non-mCRC group were obtained by follow-up.Univariate and multivariate Cox regression analyses were used to clarify the independent risk factors of DFS,and then these factors were included to construct a nomogram prediction model.The concordance index(C index),receiver operating characteristic curve(ROC)and calibration curve were used to evaluate the performance of the model.Results Platelet/lymphocyte ratio(PLR),neutrophil/lymphocyte ratio(NLR),carcinoembryonic antigen(CEA),carbohydrate antigen 19-9(CA19-9)and carbohydrate antigen 242(CA242)in the mCRC group were higher than those of the non-mCRC group,while the lymphocyte/monocyte ratio(LMR)was lower than that of the non-mCRC group(P<0.05).ROC analysis showed that the area under curve(AUC)of CEA,CA19-9,CA242,NLR,LMR and PLR for the diagnosis of mCRC were 0.775,0.716,0.712,0.607,0.591 and 0.556,respectively.Multivariate Cox regression analysis demonstrated that age,perineural invasion,pN stage and preoperative CA242 level were independent risk factors for DFS of non-mCRC patients(P<0.05).Based on this,a nomogram prediction model predicting 3 years of DFS for non-mCRC patients was constructed,its C index and AUC for non-CRC prognostic prediction were 0.710 and 0.733,respectively,higher than 0.696 and 0.701 of AJCC 7th edition TNM staging system.The calibration curve of nomogram showed that the predicted DFS rate was consist

关 键 词：结直肠肿瘤 肿瘤标志物 无病生存时间 列线图 

分 类 号：R735.34[医药卫生—肿瘤]