切换至 "中华医学电子期刊资源库"

中华结直肠疾病电子杂志 ›› 2020, Vol. 09 ›› Issue (06) : 563 -569. doi: 10.3877/cma.j.issn.2095-3224.2020.06.005

所属专题: 文献

论著

老年直肠黏液腺癌患者预后模型的构建
刘恒昌1, 李春香2, 魏然1, 刘正1, 陈海鹏1, 关旭1, 赵志勋1, 邹霜梅3, 王锡山1,(), 姜争1,()   
  1. 1. 100021 北京,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
    2. 100021 北京,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胸外科
    3. 100021 北京,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病理科
  • 收稿日期:2020-07-02 出版日期:2020-12-25
  • 通信作者: 王锡山, 姜争
  • 基金资助:
    中国科学技术部国家重点研究开发计划(No. 2018YFC1315000/2018YFC1315005); 中国医学科学院医学与健康科技创新工程项目资助(No. 2019-I2M-2-002/2017-I2M-1-006/2018-I2M-AI-008); 中国医学科学院中央级公益性科研院所基本科研业务费课题(No. 2018PT32011/2/3); 中国癌症基金会北京希望马拉松专项基金(No. LC2017A07)

A model for predicting the prognosis of elderly patients with rectal mucinous adenocarcinoma

Hengchang Liu1, Chunxiang Li2, Ran Wei1, Zheng Liu1, Haipeng Chen1, Xu Guan1, Zhixun Zhao1, Shuangmei Zou3, Xishan Wang1,(), Zheng Jiang1,()   

  1. 1. 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
    2. Department of Thoracic 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
    3. Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer / Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
  • Received:2020-07-02 Published:2020-12-25
  • Corresponding author: Xishan Wang, Zheng Jiang
  • About author:
    Corresponding authors: Jiang Zheng, Email:
    Wang Xishan, Email:
引用本文:

刘恒昌, 李春香, 魏然, 刘正, 陈海鹏, 关旭, 赵志勋, 邹霜梅, 王锡山, 姜争. 老年直肠黏液腺癌患者预后模型的构建[J/OL]. 中华结直肠疾病电子杂志, 2020, 09(06): 563-569.

Hengchang Liu, Chunxiang Li, Ran Wei, Zheng Liu, Haipeng Chen, Xu Guan, Zhixun Zhao, Shuangmei Zou, Xishan Wang, Zheng Jiang. A model for predicting the prognosis of elderly patients with rectal mucinous adenocarcinoma[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2020, 09(06): 563-569.

目的

探讨影响老年直肠黏液腺癌(RMAC)患者预后的独立危险因素,并构建可以预测总生存(OS)和肿瘤特异性生存(CSS)的列线图。

方法

从美国国家癌症研究所的监测、流行病学和结果数据库(SEER)中收集2010~2016年确诊并登记的、年龄在60岁及以上的RMAC患者共1 657例的临床病理资料,应用R软件按照7:3随机分为训练队列和验证队列。应用单因素及多因素COX回归模型分析影响预后的独立危险因素,并以此构建预测3年和5年总生存以及肿瘤特异性生存的列线图。用C指数评价列线图的预测效能。应用校正曲线在训练队列和验证队列中检查其预测精准度。

结果

性别、年龄、婚姻状态、肿瘤组织学分级、TNM分期、放疗、辅助化疗、阳性淋巴结数量和肿瘤大小是影响老年RMAC患者OS的独立预后因素;而婚姻状态、种族、肿瘤组织学分级、TNM分期、辅助化疗、阳性淋巴结和肿瘤大小是影响老年RMAC患者CSS的独立预后因素。所构建的列线图模型,对OS和CSS预测的精准度分别为0.735和0.780。新辅助放疗联合辅助化疗可以提高患者的OS(χ2=7.682,P=0.006)和CSS(χ2=6.476,P=0.011)。

结论

本研究发现了影响老年RMAC患者预后的独立危险因素,构建了评价预后的列线图模型。并发现新辅助放疗联合术后辅助化疗可能会改善这部分患者的预后。

Objective

We wanted to explore the independent risk factors for the prognosis of elderly patients with rectal mucinous adenocarcinoma (RMAC), and to construct a nomogram that can predict the overall survival (OS) and cancer specific survival (CSS).

Methods

The clinicopathological data of 1 657 patients with RMAC aged 60 and over who were diagnosed and registered in 2010~2016 were collected from the Surveillance, Epidemiology and End Re sults database (SEER) of the National Cancer Research Institute of the United States. These patients were randomly divided into training queue and verification queue according to the proportion of 7:3 by R software. Univariate and multivariate Cox regression analysis were used to analyze the independent risk factors affecting the prognosis, and then nomograms were constructed to predict the OS and CSS. C-index was used to evaluate the prediction efficiency of these nomograms. The prediction accuracy was checked in training queue and verification queue by using correction curve.

Results

Sex, age, marital status, histological grade, TNM stage, radiotherapy, adjuvant chemotherapy, number of positive lymph nodes and tumor size were independent prognostic factors for OS in elderly RMAC patients. Marriage status, race, histological grade, TNM stage, adjuvant chemotherapy, positive lymph nodes and tumor size are independent prognostic factors of CSS in elderly RMAC patients. The C-index of the nomogram were 0.735 for OS and 0.780 for CSS. Neoadjuvant radiotherapy combined with adjuvant chemotherapy can improve OS (χ2=7.682, P=0.006) and CSS (χ2=6.476, P=0.011).

Conclusions

We've found some independent risk factors affecting the prognosis of elderly RMAC patients, and a nomogram model was constructed to evaluate the prognosis. It was found that neoadjuvant radiotherapy combined with postoperative adjuvant chemotherapy may improve the prognosis of these patients.

表1 619例老年RMAC患者人口学基线资料[例,(%)]
表2 619例老年RMAC患者肿瘤临床特征基线资料[例,(%)]
临床病理特征 训练队列(n=436) 验证队列(n=183) χ2 P
T分期     9.919 0.019
  T1 29(6.71) 15(8.20)    
  T2 53(12.27) 23(12.57)    
  T3 260(59.63) 125(68.31)    
  T4 94(21.56) 20(10.93)    
N分期     0.569 0.752
  N0 208(47.71) 91(49.73)    
  N1 143(32.80) 61(33.33)    
  N2 85(19.50) 31(16.94)    
TNM分期     0.245 0.970
  Ⅰ期 65(14.91) 27(14.75)    
  Ⅱ期 130(29.82) 58(31.69)    
  Ⅲ期 190(43.58) 78(42.62)    
  Ⅳ期 51(11.70) 20(10.93)    
放疗     1.547 0.461
  未行放疗 210(48.17) 83(45.36)    
  行新辅助放疗 175(40.14) 72(39.34)    
  行辅助放疗 51(11.70) 28(15.30)    
辅助化疗     0.323 0.570
  未行辅助化疗 163(37.39) 64(34.97)    
  行辅助化疗 273(62.61) 119(65.03)    
肿瘤分化程度     0.011 0.915
  高/中分化 339(77.75) 143(78.14)    
  低分化/未分化 97(22.25) 40(21.86)    
阳性淋巴结数目(个)     1.554 0.670
  0 187(42.89) 86(46.99)    
  1~3 92(21.10) 40(21.86)    
  4~9 56(12.84) 22(12.02)    
  ≥10 101(23.17) 35(19.13)    
肿瘤大小(mm)     3.215 0.360
  ≤20 55(12.61) 27(14.75)    
  21~40 131(30.05) 60(32.79)    
  41~60 130(29.82) 58(31.69)    
  >60 120(27.52) 38(20.77)    
表3 影响老年RMAC患者OS和CSS的COX多因素分析
临床病理特征 影响OS多因素分析 影响CSS多因素分析
HR(95%CI P HR(95%CI P
性别        
  1(参考值)   1(参考值)  
  0.708(0.546~0.918) 0.009 0.735(0.513~1.052) 0.093
年龄(岁)        
  60~69 1(参考值)   1(参考值)  
  70~79 1.619(1.206~2.175) 0.001 1.420(0.969~2.081) 0.072
  ≥80 2.298(1.687~3.130) <0.001 1.431(0.915~2.239) 1.117
婚姻状态        
  单身、离异或丧偶 1(参考值)   1(参考值)  
  已婚 0.658(0.505~0.857) 0.002 0.626(0.437~0.898) 0.011
  不详 0.894(0.493~1.620) 0.712 1.500(0.693~3.248) 0.304
种族        
  白种人 1(参考值)   1(参考值)  
  黑种人 1.487(0.963~2.297) 0.074 1.993(1.165~3.409) 0.012
  亚太地区及其他 1.298(0.850~1.980) 0.227 0.878(0.441~1.749) 0.711
TNM分期        
  Ⅰ期 1(参考值)   1(参考值)  
  Ⅱ期 2.241(1.129~4.450) 0.021 2.355(0.816~6.795) 0.113
  Ⅲ期 1.588(0.696~3.621) 0.272 2.479(0.810~7.583) 0.112
  Ⅳ期 4.911(2.351~10.258) <0.001 11.106(3.966~31.104) <0.001
T分期        
  T1 1(参考值)   1(参考值)  
  T2 0.772(0.440~1.356) 0.368 0.707(0.327~1.527) 0.377
  T3 1.017(0.552~1.876) 0.956 0.997(0.441~2.253) 0.994
  T4 0.790(0.261~2.394) 0.677 1.361(0.390~4.749) 0.629
N分期        
  N0 1(参考值)   1(参考值)  
  N1 1.336(0.619~2.885) 0.460 1.342(0.544~3.315) 0.523
  N2 1.849(0.843~4.055) 0.125 2.153(0.850~5.450) 0.106
放疗        
  未行放疗 1(参考值)   1(参考值)  
  行新辅助放疗 0.691(0.479~0.997) 0.048 1.430(0.857~2.386) 0.171
  行辅助放疗 0.858(0.566~1.301) 0.471 1.228(0.678~2.223) 0.498
辅助化疗        
  未行辅助化疗 1(参考值)   1(参考值)  
  行辅助化疗 0.704(0.497~0.998) 0.049 0.531(0.322~0.877) 0.013
肿瘤分化程度        
  高/中分化 1(参考值)   1(参考值)  
  低分化/未分化 1.564(1.194~2.048) 0.001 1.742(1.206~2.518) 0.003
阳性淋巴结数目(个)        
  0 1(参考值)   1(参考值)  
  1~3 0.946(0.576~1.552) 0.825 0.928(0.487~1.769) 0.820
  4~9 1.349(0.772~2.358) 0.293 1.244(0.616~2.512) 0.543
  ≥10 1.972(1.381~2.815) <0.001 2.359(1.406~3.958) 0.001
肿瘤大小(mm)        
  ≤20 1(参考值)   1(参考值)  
  21~40 1.712(1.049~2.792) 0.031 1.305(0.642~2.654) 0.462
  41~60 1.679(1.025~2.749) 0.040 1.819(0.924~3.583) 0.084
  >60 2.140(1.300~3.521) 0.003 2.277(1.163~4.460) 0.016
图1 老年RMAC患者的3年和5年列线图预后模型。1A:OS预测模型;1B:CSS预测模型
图2 列线图校准曲线。训练队列3年(2A)和5年(2B)OS预测校准曲线;训练队列3年(2C)和5年(2D)CSS预测校准曲线;训练队列3年(2E)和5年(2F)OS预测校准曲线;训练队列3年(2G)和5年(2H)CSS预测校准曲线
图3 不同辅助治疗方式对预后的影响。仅行辅助化疗对OS(3A)和CSS(3D)的影响;新辅助放疗联合辅助化疗对OS(3B)和CSS(3E)的影响;术后辅助放疗联合辅助化疗对OS(3C)和CSS(3F)的影响
[1]
中华人民共和国卫生和计划生育委员会医政医管局,中华医学会肿瘤学分会.中国结直肠癌诊疗规范(2017版) [J]. 中华胃肠外科杂志, 2018, 21(1): 92-106.
[2]
Sung H, Siegel RL, Rosenberg PS, et al. Emerging cancer trends among young adults in the USA: analysis of a population-based cancer registry [J]. Lancet Public Health, 2019, 4(3): e137-e147.
[3]
Hosseini S, Zohourinia S, Zar-Bandamiri M, et al. Clinical and pathological characteristics of mucinous colorectal adenocarcinoma: a comparative study [J]. Ann Colorectal Res, 2016, 4: e34404.
[4]
Debunne H, Ceelen W. Mucinous differentiation in colorectal cancer: molecular, histological and clinical aspects [J]. Acta Chir Belg, 2013, 113(6): 385-390.
[5]
路彦娟,崔会娟,李娜, 等. 结直肠黏液腺癌与非黏液腺癌临床病理分析 [J]. 中国现代医学杂志, 2016, 26(15): 123-126.
[6]
Kim TG, Park W, Choi DH, et al. Clinical significance of mucinous rectal adenocarcinoma following preoperative chemoradiotherapy and curative surgery [J]. Tumori, 2016, 102(1): 114-121.
[7]
Sengul N, Wexner SD, Woodhouse S, et al. Effects of radiotherapy on different histopathological types of rectal carcinoma [J]. Colorectal Dis, 2006, 8(4): 283-288.
[8]
孙艳武,池畔,林惠铭, 等. 新辅助放化疗联合手术治疗直肠黏液腺癌的疗效分析 [J]. 中华消化外科杂志, 2017, 16(1): 77-82.
[9]
McCawley N, Clancy C, O'Neill BDP, et al. Mucinous rectal adenocarcinoma is associated with a poor response to neoadjuvant chemoradiotherapy: a systematic review and meta-analysis [J]. Dis Colon Rectum, 2016, 59(12): 1200-1208.
[10]
林延明,潘宏达,彭亦凡. 直肠黏液腺癌临床病理学特征及预后分析 [J]. 中华普通外科杂志, 2016, 31(9): 747-749.
[11]
Chand M, Yu S, Swift RI, et al. Mucinous carcinoma of the rectum: a distinct clinicopathological entity [J]. Tech Coloproctol, 2014, 18(4): 335-344.
[12]
Kattan MW, Leung DH, Brennan MF. Postoperative nomogram for 12-year sarcoma-specific death [J]. J Clin Oncol, 2002, 20(3): 791-796.
[13]
Song K, Shi X, Wang H, et al. Can a nomogram help to predict the overall and cancer-specific survival of patients with chondrosarcoma? [J]. Clin Orhtop Relat Res, 2018, 476(5): 987-996.
[14]
Guo LW, Jiang LM, Gong Y, et al. Development and validation of nomograms for predicting overall and breast cancer-specific survival among patients with triple-negative breast cancer [J]. Cancer Manag Res, 2018, 10: 5881-5894.
[15]
王满香,陈琼荣. 结直肠黏液腺癌病理学异质性及与预后的关系[J/CD]. 中华结直肠疾病电子杂志, 2016, 5(5): 428-433.
[16]
Hosseini S, Nguyen N, Mohammadianpanah M, et al. Predictive significance of mucinous histology on pathologic complete response rate following capecitabine-based neoadjuvant chemoradiation in rectal cancer: a comparative study [J]. J Gastrointest Cancer, 2019, 50(4): 716-722.
[17]
McCawley N, Clancy C, O'Neill BD, et al. Mucinous rectal adenocarcinoma is associated with a poor response to neoadjuvant chemoradiotherapy: a systematic review and meta-analysis [J]. Dis Colon Rectum, 2016, 59(12): 1200-1208.
[18]
Madbouly KM, Mashhour AN, Omar W. Is it safe to omit neoadjuvant chemo-radiation in mucinous rectal carcinoma? [J]. Int J Surg, 2015, 23(Pt A): 120-127.
[19]
张悦仪,王枭杰,池畔, 等. 放疗联合手术治疗局部进展期直肠黏液腺癌的疗效分析:一项基于SEER数据库的回顾性研究 [J]. 中华胃肠外科杂志, 2019, 22(1): 85-93.
[20]
范滨,张艳桥. 结直肠黏液腺癌与非黏液腺癌化疗疗效差异及其机制 [J]. 现代肿瘤医学, 2019, 27(15): 2768-2771.
[21]
李海超,袁维堂. 神经浸润对结直肠黏液腺癌预后的评估价值 [J]. 河南医学研究, 2019, 28(13): 2326-2329.
[22]
Emile SH, Magdy A, Elnahas W, et al. Predictors for local recurrence and distant metastasis of mucinous colorectal adenocarcinoma [J]. Surgery, 2018, S0039-6060(17): 30879-30886.
[1] 汪洪斌, 张红霞, 何文, 杜丽娟, 程令刚, 张雨康, 张萌. 低级别阑尾黏液性肿瘤与阑尾黏液腺癌超声及超声造影特征分析[J/OL]. 中华医学超声杂志(电子版), 2024, 21(09): 865-871.
[2] 许杰, 李亚俊, 韩军伟. 两种入路下腹腔镜根治性全胃切除术治疗超重胃癌的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 19-22.
[3] 赵丽霞, 王春霞, 陈一锋, 胡东平, 张维胜, 王涛, 张洪来. 内脏型肥胖对腹腔镜直肠癌根治术后早期并发症的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 35-39.
[4] 吴晖, 佴永军, 施雪松, 魏晓为. 两种解剖入路下行直肠癌侧方淋巴结清扫的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 40-43.
[5] 周世振, 朱兴亚, 袁庆港, 刘理想, 王凯, 缪骥, 丁超, 汪灏, 管文贤. 吲哚菁绿荧光成像技术在腹腔镜直肠癌侧方淋巴结清扫中的应用效果分析[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 44-47.
[6] 高杰红, 黎平平, 齐婧, 代引海. ETFA和CD34在乳腺癌中的表达及与临床病理参数和预后的关系研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 64-67.
[7] 徐逸男. 不同术式治疗梗阻性左半结直肠癌的疗效观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 72-75.
[8] 李代勤, 刘佩杰. 动态增强磁共振评估中晚期低位直肠癌同步放化疗后疗效及预后的价值[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 100-103.
[9] 屈勤芳, 束方莲. 盆腔器官脱垂患者盆底重建手术后压力性尿失禁发生的影响因素及列线图预测模型构建[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(06): 606-612.
[10] 关小玲, 周文营, 陈洪平. PTAAR在乙肝相关慢加急性肝衰竭患者短期预后中的预测价值[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 841-845.
[11] 张润锦, 阳盼, 林燕斯, 刘尊龙, 刘建平, 金小岩. EB病毒相关胆管癌伴多发转移一例及国内文献复习[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 865-869.
[12] 陈晓鹏, 王佳妮, 练庆海, 杨九妹. 肝细胞癌VOPP1表达及其与预后的关系[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 876-882.
[13] 王景明, 王磊, 许小多, 邢文强, 张兆岩, 黄伟敏. 腰椎椎旁肌的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(09): 846-852.
[14] 韦巧玲, 黄妍, 赵昌, 宋庆峰, 陈祖毅, 黄莹, 蒙嫦, 黄靖. 肝癌微波消融术后中重度疼痛风险预测列线图模型构建及验证[J/OL]. 中华临床医师杂志(电子版), 2024, 18(08): 715-721.
[15] 颜世锐, 熊辉. 感染性心内膜炎合并急性肾损伤患者的危险因素探索及死亡风险预测[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 618-624.
阅读次数
全文


摘要