关键词: 结直肠肿瘤, 远处转移, 预后, 列线图

Abstract: Establishment and validation of a survival prediction model for patients with initially resectable stage Ⅳ colorectal cancer        ZHANG Lei，SHI Fei-yu，HU Chen-hao，et al. Department of General Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061,China
Corresponding author: SHE Jun-jun, E-mail: junjunshe1975@sina.com
Abstract    Objective    To explore the independent risk factors affecting the prognosis of patients with initially surgically resectable stage Ⅳ colorectal cancer, and to construct and validate an individualized survival prediction model. Methods    The clinical data of 445 patients with stage Ⅳ colorectal cancer who underwent surgery in the First Affiliated Hospital of Xi’an Jiaotong University from January 1, 2014 to December 31, 2019 were retrospectively analyzed. Using R software to implement random sampling, 356 patients (4/5) were selected as the training group, and the remaining 89 patients (1/5) were selected as the verification group. In the training group, Cox proportional risk model was used to analyze the independent risk factors for prognosis of patients with initially surgically resectable IV colorectal cancer. Nomograms for predicting the overall survival (OS) and progression-free survival (PFS) of patients with initially surgically resectable stage Ⅳ colorectal cancer were established by the R language software. The accuracy of these models were evaluated by calculating the area under the receiver operating characteristic curve (ROC) of the training group and the verification group. Calibration curve was also used to evaluate nomograms' prediction efficiency. Results  Age, resection effect , CRS score and postoperative adjuvant therapy were independent risk factors for prognosis in patients with initially surgically resectable stage Ⅳ colorectal cancer. Based on the screened risk factors, nomogram models were successfully constructed to predict the OS and PFS of patients with initial operable stage Ⅳ colorectal cancer. The areas under the ROC curve of the 5-year OS and 5-year PFS in the training group and the verification group were 0.736, 0.784, 0.794, and 0.756, respectively. The calibration curves of both the training group and the verification group showed high consistence. Conclusion    Advanced age, palliative resection, CRS score of 3-5, and no postoperative adjuvant therapy were independent risk factors for the prognosis of patients with initially surgically resectable stage Ⅳ colorectal cancer. These survival prediction models may accurately predict the prognosis of patients with initially operable stage Ⅳ colorectal cancer, and provide reference and help for clinical decision-making.

Key words: colorectal neoplasms, distant metastasis, prognosis, nomogram