肿瘤大小对3114例Ⅱ期结直肠癌患者预后的影响

Objective To explore the impact of tumor size on the prognosis of stage II colorectal cancer patients and analyze its clinical application value. Methods The clinicopathological data of stage II colorectal cancer patients admitted to the Sixth Affiliated Hospital of Sun Yat-sen University from October 2007 to March 2020 were retrospectively analyzed. According to the high-risk factors reported in the existing guidelines, the patients were divided into two groups: high-risk and low-risk. The Kaplan-Meier method was used to draw the survival curve, and the log-rank test was used to compare the survival differences among patients. The independent risk factors affecting the prognosis of stage II colorectal cancer patients were determined by univariate and multivariate Cox regression analyses. Based on the results of the multivariate analysis, a nomogram prediction model was constructed. Results A total of 3,114 patients were included in the analysis, including 1,149 patients in the high-risk group and 1,965 patients in the low-risk group. Only in the survival analysis of the low-risk group patients, it was found that the 5-year disease-free survival rate of patients with tumors ≤5 cm was lower than that of patients with tumors >5 cm (83.1% vs. 89.8%), and the difference between the two was statistically significant (χ² = 6.004, P = 0.014). Multivariate Cox regression analysis showed that tumors ≤5 cm, age >60 years, CEA >5 ng/mL, CA125 >35 U/mL, and postoperative complications were independent risk factors affecting the prognosis of low-risk group patients. A nomogram prognostic prediction model for low-risk group patients was constructed based on the above five independent prognostic factors. The model was evaluated by the concordance index (0.631), the area under the receiver operating characteristic curve (0.796 for 1 year, 0.760 for 3 years, and 0.654 for 5 years), and the calibration curve (fitted well with the standard curve), showing that the accuracy of the model prediction was good. Conclusion Tumor size is an independent prognostic factor for stage II low-risk colorectal cancer patients, but has no relation to the prognosis of stage II high-risk colorectal cancer patients. The nomogram prediction model constructed in this study can relatively accurately predict the 1-year, 3-year, and 5-year disease-free survival rates of stage II low-risk colorectal cancer patients.

目的 探讨肿瘤大小对Ⅱ期结直肠癌患者预后的影响，并分析其临床应用价值。.方法 回顾性分析2007年10月至2020年3月在中山大学附属第六医院收治的Ⅱ期结直肠癌患者的临.床病理资料。根据现有指南报道的高危因素，将患者分为高危和低危两组。采用Kaplan-Meier法绘制.生存曲线，log-rank检验比较患者生存差异，并通过单、多因素Cox回归分析确定影响Ⅱ期结直肠癌.患者预后的独立危险因素。基于多因素分析结果，构建列线图预测模型。结果 共有3 114例患者被.纳入分析，其中高危组患者1 149例和低危组患者1 965例。仅在低危组患者的生存分析中，发现肿瘤.≤5 cm比肿瘤＞5 cm的患者的5年无病生存率更低（83.1% vs. 89.8%），两者比较差异有统计学意义.（χ²=6.004，P=0.014）。多因素 Cox 回归分析显示，肿瘤≤5 cm、年龄＞60 岁、CEA＞5 ng/mL、.CA125＞35 U/mL及合并术后并发症是影响低危组患者预后的独立危险因素。基于以上五种独立预后.因素构建低危组患者的列线图预后预测模型。通过一致性指数（0.631）、受试者工作特征曲线下面积.（1年为0.796，3年为0.760和5年为0.654）和校准曲线（与标准曲线拟合较好）对模型进行评估，显.示模型预测的准确性较好。结论 肿瘤大小是Ⅱ期低危结直肠癌患者的独立预后因素，而与Ⅱ期高危.结直肠癌患者的预后无关。本研究构建的列线图预测模型可较准确地预测Ⅱ期低危结直肠癌患者的.1年、3年、5年无病生存率。