ABSTRACT
Objective:To investigate the construction and application value of a nomogram predictive model for the prognosis of rectal cancer liver metastases based on Surveillance, Epidemio-logy, and End Results (SEER) database.Methods:The retrospective cohort study was conducted. The clinicopathological data of 6 192 patients with rectal cancer liver metastases in the SEER database ( http://seer.cancer.gov/) and 312 patients who were admitted to The Second Affiliated Hospital of Naval Medical University January 2010 to December 2016 were collected. Of 6 192 patients, there were 3 592 males and 2 600 cases. There were 1 076 cases with age lower than 50 years, 2 862 cases with age as 50-69 years, 2 254 cases with age equal to or more than 70 years, respectively. Of 312 pati-ents, there were 177 males and 135 cases. There were 51 cases with age lower than 50 years, 155 cases with age as 50-69 years, 109 cases with age equal to or more than 70 years, respectively. Patients of the SEER database were set as the training set, and patients in The Second Affiliated Hospital of Naval Medical University were set as the validation set. Univariate and multivariate COX proportional hazards regression models were used to analyze risk factors associated with prognosis, and construct and verify the accuracy of nomogram predictive model for the prognosis of rectal cancer liver metas-tasis. The training set were used to construct the nomogram prediction model, and the validation set were used to verify its performance. Observation indicators: (1) prognostic factors analysis in patients with rectal cancer liver metastases; (2) construction and verificative of the predictive model for the prognosis of rectal cancer liver metastasis. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Comparison of ordinal data was analyzed using the rank sum test. The COX regression model was used for univariate and multivariate analyses. Kaplan-Meier method was used to calculate survival rates, and Log-Rank test was used for survival analysis. Results:(1) Prognostic factors analysis in patients with rectal cancer liver metastases. Results of multivariate analysis showed that age >50 years, TNM Ⅱ-Ⅳ stage, stage T3-T4, stage N1-N2, the number of lymph nodes dissected <12, tumor diameter >5.1 cm, positive carcinoembryonic antigen, peripheral nerve infiltration, radiotherapy and adjuvant chemotherapy, poorly differentiated or undifferented tumor were independent prognostic factors of patients ( P<0.05). (2) Construction and verification of the predictive model for the prognosis of rectal cancer liver metastasis. A nomogram predictive model for the prognosis of rectal cancer liver metastasis was constructed based in the multivariate analysis. The C-index of the nomogram predictive model was 0.91, with area under the curve as 0.726, indicating a good discriminant ability. Results of the calibration curve in validation dataset showed that the colorectal cancer survival rate predicted by the nomogram predictive model was consistent with the actual survival rate. Conclusion:The nomogram predictive model can accurately predict the survival probability of patients with rectal cancer liver metastases.
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Objective:To investigate the influencing factors of anastomotic leakage after laparoscopic intersphincter resection (ISR) for extremely low rectal cancer and construction of nomogram prediction model.Methods:The retrospective case-control study was conducted. The clinicopathological data of 812 patients who underwent laparoscopic ISR for extremely low rectal cancer in the Second Affiliated Hospital of Naval Medical University (Shanghai Changzheng Hospital) from February 2012 to February 2022 were collected. There were 459 males and 353 females, aged (51±11)years. Observation indicators: (1) surgical situations; (2) follow-up; (3) influencing factors of postoperative anastomotic leakage; (4) construction and evaluation of nomogram prediction model for postoperative anastomotic leakage. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. The COX proportional hazard model was used for univariate and multivariate analyses. The R software(3.5.1 version) was used to construct nomogram prediction model. The receiver operating characteristic (ROC) curve was drawn and the area under curve (AUC) was used to evaluate the efficacy of the nomogram prediction model. The Bootstrap method was used for internal verification and to calculate the average consistency index (C-index). Results:(1) Surgical situations. All 812 patients underwent laparoscopic ISR for extremely low rectal cancer, including 388 cases undergoing partial ISR, 218 cases undergoing subtotal ISR and 206 cases undergoing complete ISR. All 812 patients underwent ileal protective ostomy, and there were 306 cases with double anastomosis and 203 cases with left colic artery preserved, respectively. The operation time and volume of intraoperative blood loss of 812 patients was (179±33)minutes and (33±13)mL, respectively. (2) Follow-up. All 812 patients were followed up for (13.5±0.9)months. Of the 812 patients, there were 62 cases with postoperative anastomotic leakage and the healing time of these cases was (33±6)days. (3) Influencing factors of postoperative anastomotic leakage. Results of multivariate analysis showed that male, neoadjuvant chemoradiotherapy, failure of reser-ving left colic artery were independent risk factors of anastomotic leakage after laparoscopic ISR for extremely low rectal cancer ( hazard ratio=5.98, 4.00, 16.26, 95% confidence interval as 1.66-24.12, 1.30-12.42, 3.00-90.89, P<0.05). (4) Construction and evaluation of nomogram prediction model for postoperative anastomotic leakage. According to the results of multivariate analysis, male, neoadju-vant chemoradiotherapy and failure of reserving left colic artery were used to construct the nomogram prediction model for anastomotic leakage after laparoscopic ISR for extremely low rectal cancer, and the score of these indexes in the nomogram prediction model was 50, 49, 93, respectively. The total score of these index corresponded to the incidence rate of anastomotic leakage. Results of ROC curve showed that the AUC of nomogram prediction model of anastomotic leakage after laparoscopic ISR for extremely low rectal cancer was 0.87 (95% confidence interval as 0.80-0.93, P<0.05), with sensi-tivity and specificity 0.96 and 0.60, respectively. Results of internal verification showed that the C-index of nomogram prediction model was 0.87. Conclusion:Male, neoadjuvant chemoradiotherapy, failure of reserving left colic artery are independent risk factors of anastomotic leakage after laparo-scopic ISR for extremely low rectal cancer, and the nomogram prediction model based on these indexes can predict the incidence rate of postoperative anastomotic leakage.
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Objective To evaluate the diagnostic value of endoscopic ultrasonography (EUS) in staging of rectal cancer (RC).Methods From January 2015 to January 2017,the clinical data of 204 patients with RC and received EUS and surgery were retrospectively analyzed.Patients were divided into surgery alone group (155 cases) and preoperative neoadjuvant chemoradiation therapy (CRT) plus surgery group (49 cases).The preoperative staging by EUS and postoperative pathological staging of two groups were compared.Kappa test was performed for statistical analysis.Results Compared with postoperative pathologic diagnosis,the accuracy rate of EUS in the evaluation of invasion depth of RC in surgery alone group was 81.9％ (127/155),and the accuracy rates in the diagnosis of Tis,T1,T2,T3 and T4 were 3/4,11/13,82.1％(32/39),91.1％(41/45) and 74.1％(40/54),respectively,with a good consistency (kappa=0.751,P＜0.01).However,the accuracy rate of EUS in the invasion depth of RC in CRT plus surgery group was 34.7％ (17/49),and the accuracy rates in the diagnosis of T2,T3 and T4 were 1/13,2/7 and 14/16,respectively,with a poor consistency (kappa =0.107,P=0.850).Compared with postoperative pathologic diagnosis,the diagnostic accuracy rate of EUS in evaluating regional lymph node metastasis in surgery alone group was 70.3％ (109/155),and the accuracies in the diagnosis of cases with or without regional lymph node metastasis were 40.7％ (24/59) and 88.5％ (85/96),respectively,with a poor consistency (kappa=0.317,P＜0.01).The diagnostic accuracy rate of EUS in evaluating regional lymph node metastasis of preoperative CRT plus surgery group was 51.0％ (25/49),and the accuracies in the diagnosis of cases with or without regional lymph node metastasis were 5/11 and 52.6％ (20/38),respectively,with a poor consistency (kappa =0.014,P =0.911).Conclusions EUS can accurately evaluate the depth of tumor invasion and lymph node metastasis in preoperative staging of RC,which may be helpful for determining clinical treatment strategy.However,for patients received CRT treatment,EUS has a limited value in diagnosing and staging the tumor.