Nomograms for Predicting Overall and Cancer-Specific Survival Among Second Primary Endometrial Cancer in Primary Colorectal Carcinoma Patients.

IF 2.7 4区医学 Q2 HEALTH CARE SCIENCES & SERVICES Risk Management and Healthcare Policy Pub Date : 2024-12-04 eCollection Date: 2024-01-01 DOI:10.2147/RMHP.S481880

Linli Liu

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Abstract

Background: Endometrial cancer (EC) is one of the most frequent gynecologic cancers, approximately 20% of patients are regarded as high-risk with poor prognosis. However, more details of patients with second primary endometrial cancer (SPEC) after colorectal cancer (CRC) remain poorly understood. We therefore proposed to construct two nomograms to predict 3- and 5-year overall survival (OS) and cancer-specific survival (CSS) rates to facilitate clinical application.

Methods: A total of 1631 participants were identified in the SEER database from 1973 to 2020. We constructed and validated the nomograms for predicting OS and CSS. The receiver operating characteristic curves, calibration plot, decision curve analysis, C-index, net reclassification improvement, and integrated discrimination improvement were applied to evaluate the predictive performance. Finally, the Prognostic index was calculated and used for risk stratification of Kaplan-Meier survival analysis based on different treatment options.

Results: Nomograms of OS and CSS were formulated based on the independent prognostic factors utilizing the training set. The 3- and 5- years of OS nomogram demonstrated good discrimination (AUC = 0.840 and 0.829, respectively), well-calibrated power, and excellent clinical effectiveness. Our nomograms of predicting OS and CSS had a concordance index of 0.801 and 0.866 compared with 0.676 and 0.746 for the AJCC staging system, and more importantly, demonstrated a better forecast accuracy. Chemoradiotherapy displayed a significant survival benefit in the high-risk groups, but proceeding to surgery plus chemotherapy showed a favorable survival for the low groups based on all patients.

Conclusion: We developed and internally validated multivariable models that predict OS and CSS risk of SPEC in patients with a CRC to help clinicians make applicable clinical decisions for patients.

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预测原发性结直肠癌患者第二原发性子宫内膜癌的总生存率和癌症特异性生存率的nomogram。

背景：子宫内膜癌（endomecancer， EC）是最常见的妇科肿瘤之一，约20%的患者被认为是高危患者，预后较差。然而，对结直肠癌（CRC）后第二原发性子宫内膜癌（SPEC）患者的更多细节仍然知之甚少。因此，我们建议构建两种形态图来预测3年和5年总生存率（OS）和癌症特异性生存率（CSS），以促进临床应用。方法：从1973年到2020年，在SEER数据库中共识别了1631名参与者。我们构建并验证了用于预测OS和CSS的nomogram。采用受试者工作特征曲线、校正图、决策曲线分析、c指数、净重分类改进和综合判别改进来评价预测效果。最后，计算预后指数，并根据不同的治疗方案进行Kaplan-Meier生存分析的风险分层。结果：利用训练集根据独立预后因素制定OS和CSS的nomogram。3年和5年OS nomogram具有良好的辨别力（AUC分别为0.840和0.829），校正功率良好，临床疗效优异。我们预测OS和CSS的nomogram一致性指数分别为0.801和0.866，而AJCC分期系统的nomogram一致性指数分别为0.676和0.746，更重要的是，我们的nomogram预测OS和CSS的准确率更高。放化疗在高危人群中显示出显著的生存优势，但在所有患者中，进行手术加化疗对低危人群的生存有利。结论：我们开发并内部验证了预测结直肠癌患者SPEC OS和CSS风险的多变量模型，以帮助临床医生为患者做出适用的临床决策。

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来源期刊

Risk Management and Healthcare Policy Medicine-Public Health, Environmental and Occupational Health

CiteScore

6.20

自引率

2.90%

发文量

242

审稿时长

16 weeks

期刊介绍： Risk Management and Healthcare Policy is an international, peer-reviewed, open access journal focusing on all aspects of public health, policy and preventative measures to promote good health and improve morbidity and mortality in the population. Specific topics covered in the journal include: Public and community health Policy and law Preventative and predictive healthcare Risk and hazard management Epidemiology, detection and screening Lifestyle and diet modification Vaccination and disease transmission/modification programs Health and safety and occupational health Healthcare services provision Health literacy and education Advertising and promotion of health issues Health economic evaluations and resource management Risk Management and Healthcare Policy focuses on human interventional and observational research. The journal welcomes submitted papers covering original research, clinical and epidemiological studies, reviews and evaluations, guidelines, expert opinion and commentary, and extended reports. Case reports will only be considered if they make a valuable and original contribution to the literature. The journal does not accept study protocols, animal-based or cell line-based studies.