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探究不良病理学特征数量对Ⅰ~Ⅲ期结直肠癌复发风险分层的指导作用：对9 875例病例的回顾性队例研究
Exploring the guiding role of the number of adverse pathological features in risk stratification for recurrence of stage Ⅰ-Ⅲ colorectal cancer: a retrospective cohort study of 9 875 cases
- 中国癌症杂志 2024年34卷第6期 页码：527-536
- 作者机构：
复旦大学附属肿瘤医院大肠外二科，复旦大学上海医学院肿瘤学系，上海 200032
- 作者简介：
[ "翁俊勇（ORCID：0000-0003-1826-3952），博士，住院医师。" ]
李心翔（ORCID：0000-0002-3389-0391），主任医师，教授，E-mail xinxiangli@fudan.edu.cn。
- 基金信息：国家自然科学基金(81972260)
DOI：10.19401/j.cnki.1007-3639.2024.06.001
中图分类号： R735.3+7收稿：2024-04-18，
修回：2024-06-10，
纸质出版：2024-06-30
- 稿件说明：
移动端阅览
翁俊勇, 叶紫岚, 张若昕, 等. 探究不良病理学特征数量对Ⅰ~Ⅲ期结直肠癌复发风险分层的指导作用：对9 875例病例的回顾性队例研究[J]. 中国癌症杂志, 2024,34(6):527-536.
Junyong WENG, Zilan YE, Ruoxin ZHANG, et al. Exploring the guiding role of the number of adverse pathological features in risk stratification for recurrence of stage Ⅰ-Ⅲ colorectal cancer: a retrospective cohort study of 9 875 cases[J]. China Oncology, 2024, 34(6): 527-536.
翁俊勇, 叶紫岚, 张若昕, 等. 探究不良病理学特征数量对Ⅰ~Ⅲ期结直肠癌复发风险分层的指导作用：对9 875例病例的回顾性队例研究[J]. 中国癌症杂志, 2024,34(6):527-536. DOI： 10.19401/j.cnki.1007-3639.2024.06.001.
Junyong WENG, Zilan YE, Ruoxin ZHANG, et al. Exploring the guiding role of the number of adverse pathological features in risk stratification for recurrence of stage Ⅰ-Ⅲ colorectal cancer: a retrospective cohort study of 9 875 cases[J]. China Oncology, 2024, 34(6): 527-536. DOI： 10.19401/j.cnki.1007-3639.2024.06.001.
摘要
背景与目的：
根据目前共识，不良病理学特征仅与Ⅱ期结直肠癌的辅助治疗相关。作为重要的预后影响因素，我们进一步挖掘基于这些不良病理学特征来识别潜在复发和指导临床治疗的可能性。
方法：
本研究是回顾性队列研究。回顾性分析2008年—2018年复旦大学附属肿瘤医院大肠外科行手术治疗的结直肠癌患者的临床数据。本研究经复旦大学附属肿瘤医院伦理委员会批准（审批号：050432-4-2108*），本研究符合赫尔辛基宣言。纳入的9 875例患者中，男性5 859例，女性4 016例，年龄[M（IQR）
]
60（16）岁（范围：16~94岁）。中位随访时间1 779.0（95% CI：1 750.1~1 807.9）d。生存率分析采用Kaplan-Meier法和log-rank检验，使用Cox多因素分析影响结直肠癌总生存（overall survival，OS）、无病生存（disease-free survival，DFS）和5年无复发生存（recurrence-free survival，RFS）的独立危险因素，构建列线图模型来对患者预后进行评估、分层。本队列研究严格遵循《加强流行病学中观察性研究报告质量》（Strengthening the Reporting of Observational Studies in Epidemiology，STROBE）指南中的各项条目。
结果：
根据合并的不良病理学特征数量进行分组，分为5组：Hr_0组（0 incorporating high-risk pathological features，0个不良病理学特征）、Hr_1组（1 incorporating high-risk pathological features）、Hr_2组（2 incorporating high-risk pathological features）、Hr_3组（3 incorporating high-risk pathological features）、Hr_4组（≥4 incorporating high-risk pathological features）。Kaplan-Meier生存曲线结果提示，不同分组之间的OS、DFS和RFS差异均有统计学意义（
P
<
0.001）；针对Ⅱ期结直肠癌进行亚组分析，不同Hr分组OS、DFS和RFS的生存曲线不同分组之间出现重叠，相较于全部病例，不同分组的生存差异明显减小，提示伴有单个不良病理学特征的Ⅱ期肠癌患者可能从辅助化疗中获益；RFS的独立预后危险因素包括：年龄、pT分期、pN分期和Hr分组；OS、DFS和RFS的生存曲线提示Hr_4组预后显著差于Ⅲc期患者；分别有5.2%和14.1%的Ⅰ期和Ⅱ期患者合并2个及以上不良病理学特征（Hr分组≥2）。最后，纳入上述结直肠癌预后独立危险因素构建列线图模型。校准曲线显示实际观察与列线图预测之间具有良好的一致性，决策曲线分析（decision curve analysis，DCA）显示本研究所构建的模型在复发分层中具有良好的效能。
结论：
不良病理学特征数量是Ⅰ~Ⅲ期结直肠癌患者无复发生存的独立预后因素，将其作为多分类变量与年龄、pT、pN分期联合具有良好预后分层、复发分层效力，有望指导临床治疗。
Abstract
Background and purpose:
According to current consensus
adverse high-risk pathological features are only associated with adjuvant therapy for stage Ⅱ colorectal cancer (CRC). As important prognostic factors
we further explored the possibility of identifying patients with potential recurrence and poor prognosis based on these incorporating high-risk pathological features.
Methods:
This is a cohort study. A retrospective analysis was conducted on clinical data of CRC patients who un
derwent surgical treatment at the Second Department of Colorectal Surgery
Fudan University Affiliated Shanghai Cancer Center from 2008 to 2018. This study was approved by the Ethics Committee of the Fudan University Shanghai Cancer Center (approval No.: 050432-4-2108*)
and the study complies with the Declaration of Helsinki. A total of 9 875 patients were enrolled
including 5 859 males and 4 016 females
aged [M (IQR)
]
60 (16) years (range: 16 to 94). Median follow-up time was 1 779.0 days [95% CI: 1 750.1-1 807.9
]
. We used the Kaplan-Meier method to plot survival curves for different groups. Cox multivariate analysis was used to identify independent risk factors for 5-year overall survival (OS)
disease-free survival (DFS) and recurrence-free survival (RFS). Finally
a column chart model was constructed to evaluate and stratify patient prognosis. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist was followed for this cohort study.
Results:
According to the number of incorporating high-risk pathological features
patients were divided into five groups: Hr_0 group (0 incorporating high-risk pathological feature)
Hr_1 group (1 incorporating high-risk pathological feature)
Hr_2 group (2 incorporating high-risk pathological features)
Hr_3 group (3 incorporating high-risk pathological features)
and Hr_4 group (4 or more incorporating high-risk pathological features). The Kaplan-Meier survival curve results indicated significant differences in OS
DFS and RFS among different groups (all
P
<
0.001). Subgroup analysis was conducted on stage Ⅱ colorectal cancer
and the survival curves of OS
DFS and RFS in different Hr groups overlapped with each other. Compared to the overall population
the survival differences in different groups were significantly reduced
indicating that stage Ⅱ colon cancer patients with incorporating high-risk pathological features may benefit from adjuvant chemotherapy. The independent prognostic factors for RFS inclu
ded age
pT stage
pN stage and Hr group. The survival curves of OS
DFS and RFS indicated that the prognosis of Hr_4 group was significantly worse than that of stage Ⅲc patients; 5.2% and 14.1% of stage Ⅰ and Ⅱ patients had two or more incorporating high-risk pathological features (Hr group≥2)
respectively. Finally
a column chart model was constructed by incorporating the independent prognostic risk factors for CRC mentioned above. The calibration curve showed a good consistency between the actual observations and the predictions made by the nomogram
and the decision curve analysis (DCA) indicated that the model constructed in this study had good efficacy in stratifying recurrence.
Conclusion:
The number of incorporating high-risk pathological features is an independent prognostic factor for RFS in patients with stage Ⅰ-Ⅲ CRC. Combining it as a multiclass variable with age
pT and pN stage has good prognostic stratification and recurrence stratification efficacy
which is expected to guide clinical treatment.
关键词
Keywords
references
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