背景:在结肠癌中,淋巴结阳性(LODDS)的对数几率被认为是优于N分期的分期系统,然而,其在确定III期结肠癌患者辅助化疗最佳持续时间方面的价值尚未得到评估.这项研究旨在评估将LODDS与III期结肠癌患者的临床病理信息相结合的模型的预后价值,并旨在使用该模型对这些患者进行分层。确定可以从不同持续时间的辅助化疗中受益的个体。
方法:共663例连续诊断为III期结肠癌的患者,2007年11月至2020年6月在中山大学肿瘤防治中心和福建医科大学附属龙岩第一医院进行结肠肿瘤切除,参加了这项研究。使用Kaplan-Meier分析生存结果,Cox回归。列线图用于预测患者DFS,与时间相关的接收器工作特性(timeROC)的曲线下面积(AUC)值和用于评估列线图的准确性和可靠性的校准图。
结果:多因素分析显示神经周浸润(HR=1.776,95%CI:1.052-3.003,P=0.032),肿瘤分化差(HR=1.638,95%CI:1.084-2.475,P=0.019),2和1的LODDS分组(HR=1.920,95%CI:1.297-2.842,P=0.001)是训练队列中无病生存(DFS)的独立预测因子。从LODDS构建的列线图,神经周浸润,在训练(3年AUC=0.706,5年AUC=0.678)和验证队列(3年AUC=0.744,5年AUC=0.762)中,肿瘤分化差对3年和5年DFS表现出稳健的预测性能。根据该模型进行的分层显示,高风险组中的患者从完成8个周期的化疗中获得了显着的益处(训练队列,82.97%vs67.17%,P=0.013;验证队列,89.49%vs63.97%,P=0.030)。
结论:预后模型,集成LODDS,病理分化,和神经入侵,对III期结肠癌预后具有很强的预测准确性。此外,通过该模型进行的分层为术后辅助化疗的最佳持续时间提供了有价值的见解.
BACKGROUND: The log odds of positive lymph nodes (LODDS) was considered a superior staging system to N stage in colon cancer, yet its value in determining the optimal duration of adjuvant chemotherapy for stage III colon cancer patients has not been evaluated. This study aims to assess the prognostic value of a model that combines LODDS with clinicopathological information for stage III colon cancer patients and aims to stratify these patients using the model, identifying individuals who could benefit from varying durations of adjuvant chemotherapy.
METHODS: A total of 663 consecutive patients diagnosed with stage III colon cancer, who underwent colon tumor resection between November 2007 and June 2020 at Sun Yat-sen University Cancer Center and Longyan First Affiliated Hospital of Fujian Medical University, were enrolled in this study. Survival outcomes were analyzed using Kaplan-Meier, Cox regression. Nomograms were developed to forecast patient DFS, with the Area Under the Curve (AUC) values of time-dependent Receiver Operating Characteristic (timeROC) and calibration plots utilized to assess the accuracy and reliability of the nomograms.
RESULTS: Multivariate analysis revealed that perineural invasion (HR = 1.776, 95% CI: 1.052-3.003, P = 0.032), poor tumor differentiation (HR = 1.638, 95% CI: 1.084-2.475, P = 0.019), and LODDS groupings of 2 and 1 (HR = 1.920, 95% CI: 1.297-2.842, P = 0.001) were independent predictors of disease-free survival (DFS) in the training cohort. Nomograms constructed from LODDS, perineural invasion, and poor tumor differentiation demonstrated robust predictive performance for 3-year and 5-year DFS in both training (3-year AUC = 0.706, 5-year AUC = 0.678) and validation cohorts (3-year AUC = 0.744, 5-year AUC = 0.762). Stratification according to this model showed that patients in the high-risk group derived significant benefit from completing 8 cycles of chemotherapy (training cohort, 82.97% vs 67.17%, P = 0.013; validation cohort, 89.49% vs 63.97%, P = 0.030).
CONCLUSIONS: The prognostic model, integrating LODDS, pathological differentiation, and neural invasion, demonstrates strong predictive accuracy for stage III colon cancer prognosis. Moreover, stratification via this model offers valuable insights into optimal durations of postoperative adjuvant chemotherapy.