Development and validation of a prognostic prediction model for patients with stage Ⅰ to Ⅲ colon cancer incorporating high-risk pathological features / 中华外科杂志
Chinese Journal of Surgery
; (12): 753-759, 2023.
Article
em Zh
| WPRIM
| ID: wpr-985819
Biblioteca responsável:
WPRO
ABSTRACT
Objective:
To examine a predictive model that incorporating high risk pathological factors for the prognosis of stage Ⅰ to Ⅲ colon cancer.Methods:
This study retrospectively collected clinicopathological information and survival outcomes of stage Ⅰ~Ⅲ colon cancer patients who underwent curative surgery in 7 tertiary hospitals in China from January 1, 2016 to December 31, 2017. A total of 1 650 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 (T3HR=1.995,95%CI1.062 to 3.750,P=0.032;T4HR=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 among groups (P<0.01).Conclusions:
The number of lymph nodes examined was an independent prognostic factor for disease-free survival after curative surgery in patients with stage Ⅰ to Ⅲ colon cancer. Incorporating the number of lymph nodes examined as a multi-categorical variable into the T and N staging system could improve prognostic predictive validity.
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Índice:
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Assunto principal:
Prognóstico
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Estudos Retrospectivos
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Fatores de Risco
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Neoplasias do Colo
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Nomogramas
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Linfonodos
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Estadiamento de Neoplasias
Limite:
Female
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Humans
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Male
Idioma:
Zh
Revista:
Chinese Journal of Surgery
Ano de publicação:
2023
Tipo de documento:
Article