Abstract:

Establishment of a prognostic nomogram in peritoneally metastasized colorectal cancer patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy        SI Bao-cai，LIU Lu-guang，Hao Hong-bo，et al. Department of Gastrointestinal Surgery，Shandong Provincial Hospital Affiliated to Shandong University，Jinan 250022，China
Corresponding author：SI Bao-cai，E-mail：sbc_sdsl@163.com
Abstract    Objective    To analyze the prognostic factors in peritoneally metastasized colorectal cancer (PMCRC) patients treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) to establish a prognostic nomogram and validate its accuracy. Methods    Clinical characteristics of 146 PMCRC patients treated with CRS and HIPEC at Shandong Provincial Hospital affiliated to Shandong University from January 2006 to December 2015 were retrospectively analyzed. All the patients were peritoneally metastasis confirmed by histological examination. COX proportional regression model was used to conduct the univariate and multivariate analyses to determine the prognostic factors. Then the R software was adopted to establish a nomogram prognostic model. Bootstrap method was used to validate the nomogram model which was also compared with Peritoneal Surface Disease Severity Score (PSDSS). Results  (1) Three-year disease free survival (DFS) was 30.8% in this study. Age，pN status，peritoneal cancer index (PCI) and histology were independent prognostic factors of DFS (P<0.05). (2) The nomogram model showed a C-index of 0.712 higher than that of PSDSS 0.683，and had good agreement with actual DFS. Conclusion    The nomogram established based on age，pN status，PCI and histology was accurate in predicting DFS of patients undergoing CRS and HIPEC，with a higher C-index than PSDSS，which showed a good agreement with the actual DFS. It would be useful for guiding the strategy of clinical treatment.

Key words: peritoneal metastasis, colorectal cancer, cytoreductive surgery, hyperthermic intraperitoneal chemotherapy, disease free survival, nomogram

摘要：

目的    建立经细胞减灭术联合腹腔热灌注化疗（CRS+HIPEC）治疗腹膜转移结直肠癌（PMCRC）病人的预后列线图预测模型并进行验证。方法    回顾性分析2006年1月至2015年12月山东大学附属省立医院接受CRS+HIPEC治疗的146例PMCRC病人的临床资料，所有病例均经病理学检查证实为腹膜转移。应用Cox回归模型对可能影响预后的临床病理学因素进行单因素及多因素分析，确定独立预后因素；应用R软件建立列线图预测模型，采用Bootstrap法进行模型验证，并与腹膜表面疾病严重程度评分（PSDSS）进行比较。结果    随访16（8~30）个月，PMCRC病人3年无病存活率（DFS）为30.8%。年龄、肿瘤pN分期、腹膜癌病指数（PCI）评分及肿瘤组织学类型为PMCRC病人的独立预后因素（P＜0.05），根据这4项指标建立的列线图模型预测DFS的一致性指数明显高于PSDSS评分系统（0.712 vs. 0.683），且与实际DFS具有较好的一致性。结论    基于年龄、肿瘤pN分期、PCI评分及肿瘤组织学类型4项独立预后因素建立的预测经CRS+HIPEC治疗PMCRC病人DFS的列线图模型，准确度高，区分度明显优于PSDSS评分系统，且与实际DFS具有较好的一致性，对临床治疗策略制定具有指导意义。

关键词: 腹膜转移, 结直肠癌, 细胞减灭术, 腹腔热灌注化疗, 无病存活率, 列线图