背景:关于原发性肿瘤切除(PTR)对IV期结直肠癌(CRC)患者的益处一直存在争议。人们对如何预测患者从PTR中获益知之甚少。本研究旨在开发一种手术获益预测工具。
方法:从监测中诊断为2010年至2015年的IV期CRC患者,包括流行病学和最终结果数据库。接受PTR的患者比没有接受PTR的患者的中位癌症特异性生存期(CSS)更长的时间被认为可以从手术中受益。Logistic回归分析确定了影响手术获益的预后因素,在此基础上构建了一个列线图。来自我们机构的接受PTR的患者的数据用于外部验证。然后构建了用户友好的网络服务器,以方便临床使用。
结果:PTR组的CSS中位数为23个月,显著长于非PTR组(7个月,P<0.001)。在PTR组中,23.3%的患者没有从手术中获益。Logistic回归分析确定年龄,婚姻状况,肿瘤位置,CEA级别,化疗,转移瘤切除术,肿瘤大小,肿瘤沉积物,检查的淋巴结数量,N级,组织学分级和远处转移的数量与手术获益独立相关。建立的预后列线图在内部和外部验证中均显示出令人满意的性能。
结论:PTR与IV期CRC的CSS延长相关。拟议的列线图可用作基于证据的风险-效益评估平台,以选择合适的PTR患者。
BACKGROUND: There exists continuous controversy regarding the benefit of primary tumor resection (PTR) for stage IV colorectal cancer (CRC) patients. Little is known about how to predict the patients\' benefit from PTR. This study aimed to develop a tool for surgical benefit prediction.
METHODS: Stage IV CRC patients diagnosed between 2010 and 2015 from the Surveillance, Epidemiology and End Results database were included. Patients receiving PTR who survived longer than the median cancer-specific survival (CSS) time of those who did not undergo PTR were considered to benefit from surgery. Logistic regression analysis identified prognostic factors influencing surgical benefit, based on which a nomogram was constructed. The data of patients who underwent PTR from our institution was used for external validation. A user-friendly webserver was then built for convenient clinical use.
RESULTS: The median CSS of the PTR group was 23 months, significantly longer than that of the non-PTR group (7 months, P < 0.001). In the PTR group, 23.3% of patients did not benefit from surgery. Logistic regression analysis identified age, marital status, tumor location, CEA level, chemotherapy, metastasectomy, tumor size, tumor deposits, number of examined lymph nodes, N stage, histological grade and number of distant metastases as independently associated with surgical benefit. The established prognostic nomogram demonstrated satisfactory performance in both the internal and external validation.
CONCLUSIONS: PTR was associated with prolonged CSS in stage IV CRC. The proposed nomogram could be used as an evidenced-based platform for risk-to-benefit assessment to select appropriate patients for undergoing PTR.