Table_3_Predictive and Prognostic Assessment Models for Tumor Deposit in Colorectal Cancer Patients With No Distant Metastasis.pdf

BackgroundMore and more evidence indicated that tumor deposit (TD) was significantly associated with local recurrence, distant metastasis (DM), and poor prognosis for patients with colorectal cancer (CRC). This study aims to explore the main clinical risk factors for the presence of TD in CRC patients with no DM (CRC-NDM) and the prognostic factors for TD-positive patients after surgery.
MethodsThe data of patients with CRC-NDM between 2010 and 2017 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. A logistic regression model was used to identify risk factors for TD presence. Fine and Gray’s competing-risk model was performed to analyze prognostic factors for TD-positive CRC-NDM patients. A predictive nomogram was constructed using the multivariate logistic regression model. The concordance index (C-index), the area under the receiver operating characteristic (ROC) curve (AUC), and the calibration were used to evaluate the predictive nomogram. Also, a prognostic nomogram was built based on multivariate competing-risk regression. C-index, the calibration, and decision-curve analysis (DCA) were performed to validate the prognostic model.
ResultsThe predictive nomogram to predict the presence of TD had a C-index of 0.785 and AUC of 0.787 and 0.782 in the training and validation sets, respectively. From the competing-risk analysis, chemotherapy (subdistribution hazard ratio (SHR) = 0.542, p < 0.001) can significantly reduce CRC-specific death (CCSD). The prognostic nomogram for the outcome prediction in postoperative CRC-NDM patients with TD had a C-index of 0.727. The 5-year survival of CCSD was 17.16%, 36.20%, and 63.19% in low-, medium-, and high-risk subgroups, respectively (Gray’s test, p < 0.001).
ConclusionsWe constructed an easily predictive nomogram in identifying the high-risk TD-positive CRC-NDM patients. Besides, a prognostic nomogram was built to help clinicians identify poor-outcome individuals in postoperative CRC-NDM patients with TD. For the high-risk or medium-risk subgroup, additional chemotherapy may be more advantageous for the TD-positive patients rather than radiotherapy.

背景 越来越多的证据表明，肿瘤沉积（tumor deposit, TD）与结直肠癌（colorectal cancer, CRC）患者的局部复发、远处转移（distant metastasis, DM）及不良预后显著相关。本研究旨在探讨无远处转移结直肠癌（CRC-NDM）患者发生TD的主要临床危险因素，以及术后TD阳性患者的预后影响因素。
方法 提取2010至2017年无远处转移结直肠癌患者的监测、流行病学与最终结果（Surveillance, Epidemiology, and End Results, SEER）数据库数据。采用逻辑回归模型识别TD发生的危险因素；使用费恩-格雷竞争风险模型分析TD阳性无远处转移结直肠癌患者的预后影响因素。基于多因素逻辑回归模型构建预测列线图，通过一致性指数（C-index）、受试者工作特征（ROC）曲线下面积（AUC）及校准度对该预测列线图进行评估。此外，基于多因素竞争风险回归构建预后列线图，并通过C-index、校准度及决策曲线分析（DCA）对该预后模型进行验证。
结果 用于预测TD发生的预测列线图在训练集与验证集中的C-index分别为0.785、0.787，AUC分别为0.787与0.782。竞争风险分析结果显示，化疗（亚分布风险比SHR=0.542, P<0.001）可显著降低结直肠癌特异性死亡（CCSD）风险。针对术后TD阳性无远处转移结直肠癌患者的预后预测列线图，其C-index为0.727。低、中、高风险亚组的5年结直肠癌特异性死亡率分别为17.16%、36.20%与63.19%（Gray检验，P<0.001）。
结论 本研究构建了一款可简便识别高风险TD阳性无远处转移结直肠癌患者的预测列线图。此外，构建的预后列线图可帮助临床医师识别术后TD阳性无远处转移结直肠癌患者中的不良预后人群。对于高风险或中风险亚组，TD阳性患者接受额外化疗相较于放疗更具优势。