Table_2_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：越来越多的研究证据表明，肿瘤沉积（TD）与结直肠癌（CRC）患者的局部复发、远处转移（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：本研究从监测、流行病学与最终结果（Surveillance, Epidemiology, and End Results, SEER）数据库中提取了2010至2017年的CRC-NDM患者数据。采用logistic回归模型明确TD发生的危险因素；针对TD阳性CRC-NDM患者，采用Fine-Gray竞争风险模型分析其预后影响因素。基于多因素logistic回归模型构建预测TD发生的列线图（nomogram），采用一致性指数（C-index）、受试者工作特征（ROC）曲线下面积（AUC）及校准曲线对该预测列线图进行效能评估。同时，基于多因素竞争风险回归构建预后列线图，并通过C-index、校准曲线及决策曲线分析（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为0.785，AUC分别为0.787与0.782。竞争风险分析结果显示，化疗的亚分布风险比（SHR）为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CRC-NDM患者的预后预测列线图，其C-index为0.727。低、中、高风险亚组的结直肠癌特异性死亡5年生存率分别为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CRC-NDM患者的预测列线图。此外，本研究还构建了预后列线图，可协助临床医师识别术后TD阳性CRC-NDM患者中的不良预后人群。针对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可获得更优的临床获益。