背景:许多生物标志物对肿瘤患者的总生存期(OS)和无病生存期(DFS)具有预测价值。然而,间接胆红素(IBIL)在接受新辅助放化疗(nCRT)治疗的局部晚期直肠癌(LARC)患者中的作用尚未得到研究.
目的:探讨nCRT前IBIL(pre-IBIL)对接受nCRT治疗的LARC患者OS和DFS的预测价值。
方法:纳入324例接受nCRT全直肠系膜切除术(TME)的LARC患者。收集术前临床特点及术后病理特点。进行Cox回归分析,并开发了基于Cox的列线图来预测OS和DFS。我们还通过校准图和接收器工作特征(ROC)曲线评估了列线图的预测性能。
结果:在324名患者中,前IBIL中位数为6.2μmol/L(四分位数间距:4.6μmol/L-8.4μmol/L)。在Cox多元回归分析中,我们发现在IBIL之前,吸烟史,肿瘤消退分级(TRG),血管浸润,nCRT前糖类抗原19-9(pre-CA19-9)是OS的预测因子。此外,pre-IBIL,体重指数(BMI),nCRT与手术间隔,TRG,血管侵犯是DFS的预测因子。预测列线图用于预测5年OS和5年DFS,ROC曲线下面积值分别为0.7518和0.7355。校准图和ROC曲线显示了内部验证的良好统计性能。
结论:这项研究表明,在接受nCRT和TME治疗的LARC患者中,前IBIL是OS和DFS的独立预后因素。包含IBIL之前的列线图,BMI,吸烟史,nCRT与手术间隔,TRG,血管浸润,和pre-CA19-9可能有助于预测OS和DFS。
BACKGROUND: Many biomarkers have predictive value for overall survival (OS) and disease-free survival (DFS) in tumor patients. However, the role of indirect bilirubin (IBIL) in local advanced rectal cancer (LARC) patients treated with neoadjuvant chemoradiotherapy (nCRT) has not been studied.
OBJECTIVE: To explore the predictive value of IBIL before nCRT (pre-IBIL) for the OS and DFS of LARC patients treated with nCRT.
METHODS: A total of 324 LARC patients undergoing nCRT with total mesorectal excision (TME) were enrolled. Preoperative clinical features and postoperative pathological characteristics were collected. Cox regression analysis was performed, and a Cox-based nomogram was developed to predict OS and DFS. We also assessed the predictive performance of the nomogram with calibration plots and receiver operating characteristic (ROC) curves.
RESULTS: Among 324 patients, the median pre-IBIL was 6.2 μmol/L (interquartile range: 4.6 μmol/L-8.4 μmol/L). In the Cox multivariate regression analysis, we found that pre-IBIL, smoking history, tumor regression grade (TRG), vascular invasion, and carbohydrate antigen 19-9 before nCRT (pre-CA19-9) were predictors of OS. Additionally, pre-IBIL, body mass index (BMI), nCRT with surgery interval, TRG, and vascular invasion were predictors of DFS. Predictive nomograms were developed to predict 5-year OS and 5-year DFS with area under the ROC curve values of 0.7518 and 0.7355, respectively. Good statistical performance on internal validation was shown by calibration plots and ROC curves.
CONCLUSIONS: This study demonstrated that pre-IBIL was an independent prognostic factor for OS and DFS in LARC patients treated with nCRT followed by TME. Nomograms incorporating pre-IBIL, BMI, smoking history, nCRT with surgery interval, TRG, vascular invasion, and pre-CA19-9 could be helpful to predict OS and DFS.