背景:结直肠肝转移(CRLM)患者的预后预测工具有限,CRLM患者术前新辅助化疗的标准仍存在争议。
方法:本研究纳入2009年1月至2019年12月华西医院(WCH)的532例CRLM患者。从训练队列中确定预后因素,以构建WCH列线图并评估验证队列的准确性。使用接收器工作特征(ROC)曲线分析将预测准确性与其他现有预测工具进行比较。
结果:根据对培训队列的分析,四个独立的预后危险因素,即肿瘤标志物评分,KRAS突变,原发性淋巴结转移,并确定了肿瘤负荷评分,并在此基础上构建了WCH列线图。两个队列的C指数分别为0.674(95%CI:0.634-0.713)和0.655(95%CI:0.586-0.723),分别,这比以前报告的预测分数(CRS,m-CS和游戏得分)。ROC曲线显示AUC预测1-,3-,训练队列中的5年总生存率(OS)为0.758、0.709和0.717,验证队列中的0.860、0.669和0.692,分别。根据5年OS的ROC曲线的最大Youden指数,获得WCH-列线图总分114.5分的截止值。危险分层显示低风险组的预后明显更好,然而,高危人群更有可能从新辅助化疗中获益.
结论:与以前的评分系统相比,WCH列线图显示出更好的预后分层,有效识别可能从新辅助化疗中获益最大的CRLM患者。
BACKGROUND: The prognostic predictive tool for patients with colorectal liver metastasis (CRLM) is limited and the criteria for administering preoperative neoadjuvant chemotherapy in CRLM patients remain controversial.
METHODS: This study enrolled 532 CRLM patients at West China Hospital (WCH) from January 2009 to December 2019. Prognostic factors were identified from the training cohort to construct a WCH-nomogram and evaluating accuracy in the validation cohort. Receiver operating characteristic (ROC) curve analysis was used to compare the prediction accuracy with other existing prediction tools.
RESULTS: From the analysis of the training cohort, four independent prognostic risk factors, namely tumor marker score, KRAS mutation, primary lymph node metastasis, and tumor burden score were identified on which a WCH-nomogram was constructed. The C-index of the two cohorts were 0.674 (95% CI: 0.634-0.713) and 0.655 (95% CI: 0.586-0.723), respectively, which was better than the previously reported predication scores (CRS, m-CS and GAME score). ROC curves showed AUCs for predicting 1-, 3-, and 5-year overall survival (OS) of 0.758, 0.709, and 0.717 in the training cohort, and 0.860, 0.669, and 0.692 in the validation cohort, respectively. A cutoff value of 114.5 points was obtained for the WCH-nomogram total score based on the maximum Youden index of the ROC curve of 5-year OS. Risk stratification showed significantly better prognosis in the low-risk group, however, the high-risk group was more likely to benefit from neoadjuvant chemotherapy.
CONCLUSIONS: The WCH-nomogram demonstrates superior prognostic stratification compared to prior scoring systems, effectively identifying CRLM patients who may benefit the most from neoadjuvant chemotherapy.