基于炎症复合指标和临床病理特征构建老年结直肠癌术后复发转移预测模型

Construction of a nomogram prediction model for postoperative recurrence and metastasis in elderly patients with colorectal cancer based on inflammatory composite indicators and clinicopathological parameters

摘要

目的：基于炎症复合指标和临床病理特征构建老年结直肠癌患者术后复发转移的列线图预测模型。方法：选取2021年8月至2024年7月河北中石油中心医院收治的262例老年结直肠癌患者的临床资料，统计随访期间复发转移情况。根据术前实验室检查结果计算全身炎症反应指数（SIRI）、泛免疫炎症值（PIV）、C反应蛋白/白蛋白比值（CAR），并收集相关临床资料和病理特征。应用多因素Logistic回归分析影响结直肠癌患者术后复发转移的危险因素，基于危险因素构建列线图预测模型并进行内部验证。结果：中位随访时间21（5~40）月，术后复发72例，转移41例。复发转移组SIRI、PIV、CAR，TNM分期Ⅲ期、脉管癌栓、神经浸润、淋巴结转移比例均高于非复发转移组（P＜0.05）。TNM分期Ⅲ期、高SIRI、高PIV、高CAR是结直肠癌患者术后复发转移的危险因素（P＜0.05）。基于危险因素构建列线图预测模型，经验证该预测模型具有较好的鉴别力[曲线下面积（AUC）为0.892，P<0.05]、校准度（平均绝对误差=0.009）和临床净获益。结论：TNM分期晚、高SIRI、高PIV和高CAR是老年结直肠癌患者术后复发转移的危险因素，基于危险因素构建列线图预测模型具有较高的预测价值。

Abstract

Objective: To construct and verify the nomogram prediction model of postoperative recurrence and metastasis in elderly patients with colorectal cancer based on inflammatory complex indexes and clinicopathological parameters. Methods: Clinical data of 262 patients with colorectal cancer admitted to Hebei Petro China Central Hospita from August 2021 to July 2024 were retrospectively collected, and the recurrence and metastasis during follow-up were analyzed. Systemic inflammatory response index(SIRI), pan-immune inflammatory value(PIV) and C-reactive protein/albumin ratio(CAR) were calculated according to preoperative blood routine and biochemical laboratory results, and related clinical data clinicopathological parameters were collected. Multivariate Logistic regression was used to analyze the risk factors affecting postoperative recurrence and metastasis of colorectal cancer patients, and the prediction model based on the risk factors was constructed and verified internally. Results: A median follow-up of 21 months(5~40 months) showed 72 cases of recurrence and 41 cases of metastasis. The proportions of SIRI, PIV, CAR, TNM stage III, vascular cancer thrombus, nerve invasion and lymph node metastasis in the recurrence and metastasis group were higher than those in the non-recurrence and metastasis group(P＜0.05). TNM stage III, high SIRI, high PIV and high CAR were risk factors for postoperative recurrence and metastasis of colorectal cancer patients(P＜0.05). A nomogram prediction model was constructed based on risk factors. It was verified that the prediction model had good discrimination(AUC=0.89256, P＜0.05), calibration(mean absolute error=0.009) and clinical practicability. Conclusion: Advanced TNM stage, increased SIRI, elevated PIV and high CAR are risk factors for postoperative recurrence and metastasis in elderly patients with colorectal cancer. The nomogram prediction model constructed using these factors shows satisfactory predictive performance.

关键词

结直肠癌 / 复发 / 转移 / 全身炎症反应指数 / 泛免疫炎症值 / C反应蛋白/白蛋白比值 / 列线图预测模型

Key words

Colorectal cancer / Recurrence / Metastasis / Systemic inflammatory response index / C-reactive protein/albumin ratio / Pan-immune-inflammation value / Nomogram

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基金资助

廊坊市科技支撑计划项目(2020013089)