基于不良病理学特征的Ⅰ~Ⅲ期结肠癌预后预测模型的建立与验证  

Development and validation of a prognostic prediction model for patients with stageⅠtoⅢcolon cancer incorporating high-risk pathological features

作　　者：李珂璇 吴清彬 赵富强 张峻岭[4] 罗双灵[5] 胡时栋[6] 吴斌 李鹤立 林国乐 邱辉忠 陆君阳 徐徕 王征[7] 杜晓辉[6] 康亮[5] 汪欣[4] 王自强 刘骞 肖毅[1] Li Kexuan;Wu Qingbin;Zhao Fuqiang;Zhang Junling;Luo Shuangling;Hu Shidong;Wu Bin;Li Heli;Lin Guole;Qiu Huizhong;Lu Junyang;Xu Lai;Wang Zheng;Du Xiaohui;Kang Liang;Wang Xin;Wang Ziqiang;Liu Qian;Xiao Yi(Department of General Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China;Colorectal Cancer Center,West China Hospital,Sichuan University,Chengdu 610041,China;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 100021,China;Department of Gastrointestinal Surgery,Peking University First Hospital,Beijing 100034,China;Department of Colorectal Surgery,the Sixth Affiliated Hospital of Sun Yat-Sen University,Guangdong Institute of Gastroenterology,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases,Guangzhou 510655,China;Department of General Surgery,the First Medical Center,Chinese People′s Liberation Army General Hospital,Beijing 100853,China;Department of Gastrointestinal Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China)

机构地区：[1]中国医学科学院、北京协和医学院、北京协和医院基本外科,北京100730 [2]四川大学华西临床医学院/华西医院结直肠肿瘤中心,成都610041 [3]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、肿瘤医院结直肠外科,北京100021 [4]北京大学第一医院胃肠外科,北京100034 [5]中山大学附属第六医院结直肠外科、广东省胃肠病学研究所、广东省结直肠盆底疾病研究重点实验室,广州510655 [6]解放军总医院第一医学中心普通外科,北京100853 [7]华中科技大学同济医学院附属协和医院胃肠外科,武汉430022

出　　处：《中华外科杂志》2023年第9期753-759,共7页Chinese Journal of Surgery

基　　金：国家自然科学基金(62172437);中央高水平医院临床科研业务费(2022-PUMCH-B-005)。

摘　　要：目的探讨基于术后不良病理学特征建立Ⅰ~Ⅲ期结肠癌预后预测模型的效力。方法回顾性收集2016年1月1日至2017年12月31日就诊于国内7家三甲医院的Ⅰ~Ⅲ期结肠癌患者的病理学及预后信息,共纳入1650例患者,男性963例,女性687例,年龄[M(IQR)]62(18)岁(范围:14~100岁)。中位随访时间51个月。采用Cox比例风险回归模型筛选不良病理学特征、制作列线图和评分模型,选用Bootstrap重抽样法进行模型的内部验证,使用一致性指数评价模型的区分度,利用校准曲线评估模型的校准度,使用Kaplan-Meier法绘制风险分组后的生存曲线,使用Cox单因素回归比较亚组间生存率的差异。结果无病生存的独立预后因素包括年龄(HR=1.020,95%CI:1.008~1.033,P=0.001)、T分期(T3:HR=1.995,95%CI:1.062~3.750,P=0.032;T4:HR=4.196,95%CI:2.188~8.045,P<0.01)、N分期(N1:HR=1.834,95%CI:1.307~2.574,P<0.01;N2:HR=3.970,95%CI:2.724~5.787,P<0.01)和淋巴结获取数目(≥36枚:HR=0.438,95%CI:0.242~0.790,P=0.006)。基于年龄、T分期、N分期、淋巴结分类二分类变量(<12枚和≥12枚)的评分模型(模型1)的一致性指数为0.723,基于年龄、T分期、N分期、淋巴结分类多分类变量(<12枚、12~<24枚、24~<36枚、≥36枚)的评分模型(模型2)的一致性指数为0.726。建立基于淋巴结多分类变量的评分系统,将风险评分≤1划分为低危组(n=711),2~4划分为中危组(n=626),≥5划分为高危组(n=313),3年无病生存率分别为96.3%、89.0%、71.4%,差异有统计学意义(P<0.01)。结论淋巴结获取数量是Ⅰ~Ⅲ期结肠癌患者术后无病生存的独立预后因素,将其作为多分类变量与T、N分期联合具有良好的预后预测效力。Objective To examine a predictive model that incorporating high risk pathological factors for the prognosis of stageⅠtoⅢcolon cancer.Methods This study retrospectively collected clinicopathological information and survival outcomes of stageⅠ~Ⅲcolon cancer patients who underwent curative surgery in 7 tertiary hospitals in China from January 1,2016 to December 31,2017.A total of 1650 patients were enrolled,aged(M(IQR))62(18)years(range:14 to 100).There were 963 males and 687 females.The median follow-up period was 51 months.The Cox proportional hazardous regression model was utilized to select high-risk pathological factors,establish the nomogram and scoring system.The Bootstrap resampling method was utilized for internal validation of the model,the concordance index(C-index)was used to assess discrimination and calibration curves were presented to assess model calibration.The Kaplan-Meier method was used to plot survival curves after risk grouping,and Cox regression was used to compare disease-free survival between subgroups.Results Age(HR=1.020,95%CI:1.008 to 1.033,P=0.001),T stage(T3:HR=1.995,95%CI:1.062 to 3.750,P=0.032;T4:HR=4.196,95%CI:2.188 to 8.045,P<0.01),N stage(N1:HR=1.834,95%CI:1.307 to 2.574,P<0.01;N2:HR=3.970,95%CI:2.724 to 5.787,P<0.01)and number of lymph nodes examined(≥36:HR=0.438,95%CI:0.242 to 0.790,P=0.006)were independently associated with disease-free survival.The C-index of the scoring model(model 1)based on age,T stage,N stage,and dichotomous variables of the lymph nodes examined(<12 and≥12)was 0.723,and the C-index of the scoring model(model 2)based on age,T stage,N stage,and multi-categorical variables of the lymph nodes examined(<12,12 to<24,24 to<36,and≥36)was 0.726.A scoring system was established based on age,T stage,N stage,and multi-categorical variables of lymph nodes examined,the 3-year DFS of the low-risk(≤1),middle-risk(2 to 4)and high-risk(≥5)group were 96.3%(n=711),89.0%(n=626)and 71.4%(n=313),respectively.Statistically significant difference was observed amon

关 键 词：结肠肿瘤 结肠切除术 预测模型 淋巴结获取 

分 类 号：R735.35[医药卫生—肿瘤]