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结直肠恶性肿瘤术后早期肝转移的多因素分析及建立风险预测模型
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Abstract:
目的：探究结直肠恶性肿瘤行根治术后发生早期肝转移的影响因素，并且建立早期肝转移的风险预测模型。方法：回顾性分析黑龙江省第二肿瘤医院5年间(2018年1月~2023年1月) 230例罹患结直肠恶性肿瘤且行结直肠手术患者的一般临床资料，包括围手术期、术后病理、门诊及再次住院随访资料。根据是否发生早期肝转移分为早期转移组(n = 30例)和未转移组(n = 200例)，早期肝转移定为术后6个月内。统计学应用SPSS 23.0软件进行数据分析，单因素及多因素采用COX回归分析影响结直肠恶性肿瘤术后早期肝转移发生的独立危险因素，应用独立危险因素构建列线图模型预测患者早期肝转移风险，并绘制感受性曲线(SC, sensitivity curve)评价线性列线图的预测能力。校正曲线验证风险模型的预测效能。结果：230例患者早期肝转移发生率为13%。单因素COX分析早期转移组患者术前癌胚抗原(CEA) ≥ 5 μg/L、区域淋巴结清扫数量、手术方法、低分化肿瘤、肿瘤最大横截面 ≥ 5 cm、T分期(T3~4)、N分期(N1~2)比例高于未转移组，差异具有统计学意义(P < 0.05)；多因素COX回归分析显示，肿瘤最大横截面积 ≥ 5 cm、T分期(T3~4)、N分期(N1~2)、低分化肿瘤为影响结直肠恶性肿瘤术后早期肝转移发生的独立危险因素(P < 0.05)。构建结直肠恶性肿瘤术后早期肝转移线性列线图风险预测模型，肿瘤最大横截面积 ≥ 5 cm、T分期(T3~4)、N分期(N1~2)、低分化肿瘤的相应得分总和对应早期肝转移风险值。绘制感受性曲线(SC)评价线性列线图，结果显示曲线下面积(area of under curve, AUC)为0.953 (95%CI: 0.9086~0.9964)。校正曲线显示，该线性列线图风险模型的预测概率和实际结直肠恶性肿瘤术后早期肝转移概率具有良好的一致性(P > 0.05)。结论：肿瘤最大横截面积 ≥ 5cm、T分期(T3~4)、N分期(N1~2)、低分化肿瘤是结直肠恶性肿瘤术后早期肝转移发生的独立风险因素，且构建的线性列线图预测模型对结直肠恶性肿瘤术后早期肝转移的预测效能评价良好。
Objective: To explore the influencing factors of early liver metastasis after radical resection of colorectal malignancies and establish a risk prediction model for early liver metastasis. Methods: General clinical data, including perioperative, postoperative pathology, outpatient and re-hospitalization follow-up data, of 230 patients with colorectal malignant tumors who underwent colorectal surgery in The Second Cancer Hospital of Heilongjiang Province in the past 5 years (January 2018 to January 2023) were retrospectively analyzed. The patients were divided into early metastatic group (n = 30 cases) and non-metastatic group (n = 200 cases) according to whether early liver metastasis occurred. Early liver metastasis was defined as 6 months after surgery. SPSS 23.0 statistical software was applied for data analysis, COX regression was used to analyze the independent risk factors affecting the occurrence of early postoperative liver metastasis of colorectal malignancy for both single factor and multiple factors, independent risk factor for constructing nomogram model is applied to forecast early liver metastasis in patients with risk, and the sensitivity curve (SC) was drawn to evaluate the predictive power of linear nomogram. The
| [1] | 中华医学会外科学分会胃肠外科学组, 中华医学会外科学分会结直肠肛门外科学组, 中国抗癌协会大肠癌专业委员会. 结直肠癌肝转移诊断和综合治疗指南(V2013) [J]. 中华胃肠外科杂志, 2013, 16(8): 780-788. |
| [2] | Giannis, D., Sideris, G., Kakos, C.D., Katsaros, I. and Ziogas, I.A. (2020) The Role of Liver Transplantation for Colorectal Liver Metastases: A Systematic Review and Pooled Analysis. Transplantation Reviews, 34, Article ID: 100570. https://doi.org/10.1016/j.trre.2020.100570 |
| [3] | Meyer, Y., Olthof, P.B., Grünhagen, D.J., de Hingh, I., de Wilt, J.H.W., Verhoef, C., et al. (2022) Treatment of Metachronous Colorectal Cancer Metastases in the Netherlands: A Population-Based Study. European Journal of Surgical Oncology, 48, 1104-1109. https://doi.org/10.1016/j.ejso.2021.12.004 |
| [4] | 徐锰超, 谢玉玺, 邵元伟. 磁共振弥散加权成像ADC值联合血清肿瘤标志物对结直肠癌患者术后复发转移的预测价值[J]. 中国CT和MRI杂志, 2024, 22(1): 137-140. |
| [5] | 虞竹雯, 许超, 朱世祺, 等. 血清THBS-2联合CEA判断结直肠癌伴肝转移列线图模型的建立[J]. 中华转移性肿瘤杂志, 2024, 7(4): 339-343. |
| [6] | Dong, W., Ni, H. and Cai, C. (2023) Establishment of a Nomogram Model for Prediction of Postoperative Heterochronous Liver Metastasis in Young and Middle-Aged Patients with Rectal Cancer. World Chinese Journal of Digestology, 31, 589-597. https://doi.org/10.11569/wcjd.v31.i14.589 |
| [7] | Wehrle, C.J., Perlmutter, B., Hong, H., Chang, J., Stackhouse, K.A., Naples, R., et al. (2023) Impact of Autotransfusion on Recurrence of Colorectal Cancer Liver Metastasis: Long‐Term Follow‐Up of Patients Undergoing Curative Intent Hepatectomy. Journal of Surgical Oncology, 129, 793-801. https://doi.org/10.1002/jso.27569 |
| [8] | Vadisetti, S.N., Kazi, M., Patkar, S., Mundhada, R., Desouza, A., Saklani, A., et al. (2024) Patterns and Predictors of Recurrence after Curative Resection of Colorectal Liver Metastasis (CRLM). Journal of Gastrointestinal Cancer, 55, 1559-1568. https://doi.org/10.1007/s12029-024-01105-8 |
| [9] | Molla, M., Fernandez-Plana, J., Albiol, S., Fondevila, C., Vollmer, I., Cases, C., et al. (2021) Limited Liver or Lung Colorectal Cancer Metastases. Systemic Treatment, Surgery, Ablation or SBRT. Journal of Clinical Medicine, 10, Article 2131. https://doi.org/10.3390/jcm10102131 |
| [10] | 王锡山. 结直肠癌综合治疗的规范化实施[J]. 中国实用外科杂志, 2010, 30(4): 260-264. |
| [11] | 周延岩, 许鑫森, 王志鑫, 等. 肿瘤直径与肝细胞癌肝切除患者预后的关系[J]. 中华肝脏外科手术学电子杂志, 2015, 4(4): 227-231. |
| [12] | 崔笑, 郭子成, 薛鸿, 等. 胰十二指肠切除术治疗十二指肠乳头癌-肿瘤大小和淋巴结转移影响术后长期生存[J]. 中华普通外科杂志, 2024, 39(9): 686-691. |
| [13] | Edge, S.B. and Compton, C.C. (2010) The American Joint Committee on Cancer: The 7th Edition of the AJCC Cancer Staging Manual and the Future of TNM. Annals of Surgical Oncology, 17, 1471-1474. https://doi.org/10.1245/s10434-010-0985-4 |
| [14] | Gospodarowicz, M.K., Wittekind, C. and Sobin, L.H. (2012) TNM Classification of Malignant Tumours. Journal of Clinical Pathology, 51, 84-87. |
| [15] | Hou, S., Li, L., Hou, H., Zhou, T. and Zhou, H. (2024) Establishment of Nomogram to Predict Overall Survival and Cancer-Specific Survival of Local Tumor Resection in Patients with Colorectal Cancer Liver Metastasis with Unresectable Metastases: A Large Population-Based Analysis. Discover Oncology, 15, Article No. 315. https://doi.org/10.1007/s12672-024-01182-y |
| [16] | 董雯, 边冬梅, 田晓娟, 等. 结肠癌远期预后的影响因素分析及Nomogram预测模型的建立[J]. 结直肠肛门外科, 2021, 27(4): 356-359. |
| [17] | 王胜利, 何新阳. 结直肠癌肝转移相关临床病理因素研究[J]. 肝胆外科杂志, 2013, 21(4): 284-287. |
| [18] | 郑款恒, 钟平, 李峰, 等. 不同T分期结直肠癌发生肝肺转移患者的临床病理特征及预后[J]. 中华实验外科杂志, 2022, 39(4): 710-715. |
