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Abstract：
Medullary Carcinoma of the Colon (MCC) is a rare histological subtype of colon cancer, and there is currently no recognized optimal treatment plan for it, with its prognosis remaining unclear. The aim of this study is to analyze the independent prognostic factors for MCC patients and develop and validate nomograms to predict overall survival (OS). A total of 760 patients newly diagnosed with MCC from 2004 to 2020 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. All patients were randomly allocated to a training group and a validation group in a 7:3 ratio. Univariate and multivariable Cox regression analyses were conducted to identify prognostic factors and construct nomograms. The nomogram prediction model was evaluated and validated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). The study found that elderly women are more susceptible to MCC, and the ascending colon and cecum are the most common sites of involvement. MCC is poorly differentiated, with stages II and III being the most common. Surgery is the primary treatment for MCC. The prognosis for patients with stage IV MCC is poor, with a median survival time of only 10 months. Independent prognostic factors for MCC include age, N stage, M stage, surgery, chemotherapy, and tumor size. Among them, age < 75 years and completion of chemotherapy were protective factors for colon medullary carcinoma, while N2 (HR = 2.18, 95%CI 1.40-3.38), M1 (HR = 3.31, 95%CI 2.01-5.46), no surgery (HR = 27.94, 95%CI 3.69-211.75), and tumor diameter > 7 cm (HR = 1.66, 95%CI 1.20-2.30) were risk factors for colon medullary carcinoma. The results of ROC, AUC, calibration curves, and DCA demonstrate that the nomogram prediction model exhibits good predictive performance. We have updated the demographic characteristics of colon medullary carcinoma and identified age, N staging, M staging, surgery, chemotherapy and tumor size as independent prognostic factors for colon medullary carcinoma. Additionally, we have established nomograms for prognostic prediction. These nomograms can provide personalized predictions and serve as valuable references for clinical decision-making.
摘要：
结肠髓样癌（MCC）是结肠癌的一种罕见的组织学亚型，目前还没有公认的最佳治疗方案，其预后仍不清楚。这项研究的目的是分析MCC患者的独立预后因素，并开发和验证列线图以预测总生存期（OS）。从监测中选择2004年至2020年新诊断为MCC的760例患者，流行病学,和结束结果(SEER)数据库。所有患者以7:3的比例随机分配到训练组和验证组。进行单变量和多变量Cox回归分析以确定预后因素并构建列线图。使用受试者工作特征（ROC）曲线评估和验证了列线图预测模型，校正曲线,和决策曲线分析(DCA)。研究发现，老年女性更容易患MCC，升结肠和盲肠是最常见的受累部位。MCC分化差，第二阶段和第三阶段是最常见的。手术是MCC的主要治疗方法。IV期MCC患者的预后较差，中位生存时间仅为10个月。MCC的独立预后因素包括年龄，N级,M阶段,手术,化疗,和肿瘤大小。其中,年龄<75岁和完成化疗是结肠癌的保护因素，而N2（HR=2.18，95CI1.40-3.38），M1（HR=3.31，95CI2.01-5.46），无手术（HR=27.94，95CI3.69-211.75），肿瘤直径>7cm（HR=1.66，95CI1.20-2.30）是结肠癌的危险因素。ROC的结果，AUC,校正曲线,和DCA表明，列线图预测模型具有良好的预测性能。我们更新了结肠髓样癌的人口统计学特征，并确定了年龄，N分期，M分期，手术,化疗和肿瘤大小是结肠髓样癌的独立预后因素。此外,我们建立了预测预后的列线图.这些列线图可以提供个性化的预测，并为临床决策提供有价值的参考。
