| Objectives Colorectal cancer is the third most common malignant tumor.Although the treatment of colorectal cancer is constantly updated,its therapeutic effect is still uncertain,which seriously affects the health of patients and increases the family burden.The biological characteristics of the left and right colons are different due to different embryonic origins of the colon and different environmental carcinogens.There is a lack of good,widely accepted prognostic assessment systems.Therefore,the purpose of this study is as follows:1.To study the association between nerve infiltration,lymphatic vascular tumor thrombus/infiltration,systemic inflammation and clinicopathological parameters in patients with colon cancer,two nomograms based on multivariables were constructed and validated.2.To explore the relationship between preoperative peripheral inflammatory factors,tumor markers,postoperative pathological parameters and overall survival in patients with colon cancer,then to construct the prognostic model by visual rograph and verify the reliability and applicability of the model,so as to guide physicians to make clinical treatment decisions for patients.Methods 1.Patients with colon cancer who underwent surgical treatment in three hospitals from January 2010 to December 2019 were collected（divided into test group and verification group）:basic data,including age,gender and BMI;Preoperative inflammatory factors,including PLR,NLR,CAR,LMR,prognostic nutritional index and systemic immune inflammatory factors;Preoperative tumor markers,including CEA,CA125,CA153,CA199;Preoperative immune indexes including C3,C4,IGA,IGG and IGM;Intraoperative information,including tumor site,tumor size,and obstruction;Postoperative pathology,including T stage,N stage,M stage,degree of tissue differentiation,nerve infiltration,vascular tumor thrombus/infiltration;Postoperative pathological immunohistochemical results,including CK7,CK20,VILLIN,βcatenin,p53,K67.IBM SPSS25.0 software was used to calculate the optimal truncation values of PLR,NLR,CAR and LMR,prognostic nutrition index and SII in the test group,and they were divided into high and low groups.Single factor Logistics regression was used to analyze the factors affecting nerve infiltration and vascular tumor thrombi/infiltration in colon cancer,and the variables with P<0.1 were included in the multivariate analysis.The independent risk factors for nerve invasion and vascular tumor thrombi/invasion were analyzed by multiple factors.Use R software to establish nomogram prediction models for colon cancer nerve invasion and vascular tumor thrombi/invasion,verify the prediction model with validation group data,and evaluate the differentiation,calibration and clinical utility of the prediction model using consistency index,subject operating characteristic curve,calibration diagram and decision curve.2.805 patients with colon cancer who underwent surgical treatment in Guangxi Cancer hospital from January 2010 to December 2019 were collected and divided into test group and verification group:basic data（including age,gender and BMI）;Preoperative inflammatory factors,including platelet/lymphocyte,neutrophil/lymphocyte,C-reactive protein/albumin,lymphocyte/eosinophils,prognostic nutritional index and systemic immune inflammatory factors;Preoperative tumor markers,including CEA,CA125,CA153,CA199;Preoperative immune indexes including C3,C4,IGA,IGG and IGM;Intraoperative information,including tumor site,tumor size,and obstruction;Postoperative pathology,including T stage,N stage,M stage,degree of tissue differentiation,nerve infiltration,lymphatic vascular carcinoma thrombus/infiltration;Postoperative pathological immunohistochemical results,including CK7,CK20,VILLIN,βcatenin,P53,Ki67;Survival situation and survival time.IBM SPSS25.0 software was used to calculate the optimal truncation values of PLR,NLR,CAR and LMR,prognostic nutrition index and SII in the test group,and they were divided into high and low groups.The factors influencing the prognosis of colon cancer were analyzed by univariate analysis,and the variables with P<0.1 were included in multivariate analysis.Cox proportional risk regression model was used to analyze the independent risk factors affecting the overall survival of patients.Kaplan-meier method combined with log-rank test was used for survival analysis and survival curve was drawn.Use R software to establish a Nomogram prediction model for 3-year and 5-year postoperative survival of colon cancer,verify the model with validation group data,and evaluate the differentiation,calibration and clinical utility of the model using consistency index,subject operating characteristic curve,calibration diagram and decision curve.Results 1.Development and validation of diagnostic models for nerve infiltration and lymphatic vascular tumor plug/infiltration in colon cancerUnivariate analysis of this study showed that there were statistically significance or approximately statistically significance between preoperative NLR（P=0.067）,preoperative LMR（P=0.020）,preoperative SII（P=0.035）,preoperative intestinal obstruction（P=0.092）,preoperative CEA（P=0.004）,preoperative CA199（P=0.001）,CT-T staging（P=0.000）,CT-lymph node metastasis（P=0.000）and nerve invasion.Multivariate analysis results showed that preoperative LMR（P=0.074）,preoperative SII（P=0.098）,preoperative CA199（P=0.024）,CT-T stage（P=0.000）and CT-lymph node metastasis（P=0.001）were independent risk factors for nerve invasion.Preoperative PLR（P=0.008）,preoperative LMR（P=0.021）,preoperative SII（P=0.076）,preoperative CEA（P=0.003）,preoperative CA199（P=0.022）,T stage（P=0.000）,lymph node metastasis（P=0.000）and lymphatic vascular carcinoma thrombus/invasion were compared.The differences were statistically significant or nearly statistically significant.Multivariate regression showed that preoperative PLR（P=0.006）,preoperative LMR（P=0.072）,T stage（P=0.010）and lymph node metastasis（P=0.000）were independent risk factors for lymphangiocarcinoma thrombolysis/invasion.For variables P<0.1 from multivariate analysis to be incorporated into the model construction,a Nomogram prediction model is established based on the above indexes,with internal and external C-indexes of 0.677 and 0.682,respectively.The internal and external C-index of lymphatic vascular infiltration/tumor plug were 0.812and 0.530,respectively.Nerve infiltrates and vascular tumor thrombi/infiltrates calibration plots showed good fit.The decision curve showed a range of predicted net benefit rates of 10-80%for nerve infiltration and 10-70%for lymphatic vascular infiltration/tumor plug,respectively.2.Establishment and verification of prediction model for postoperative colon cancer based on nomographThe single Cox regression analysis of this study showed that:Nerve infiltration（P=0.001）,lymphatic vascular infiltration/tumor thrombolus（P=0.000）,degree of tissue differentiation（P=0.028）,prognostic nutritional index（P=0.016）,T stage（P=0.001）,lymph node metastasis（P=0.000）,organ metastasis（P=0.000）,surgical method（P=0.007）,preoperative CEA（P=0.000）,preoperative CA125（P=0.000）,CA199（P=0.000）,CA153（P=0.010）,IGA（P=0.010）were prognostic factors affecting overall survival.NLR（P=0.058）,CAR（P=0.050）and SII（P=0.075）were factors that might affect prognosis.The prognostic factors that were significant for single factor（P<0.1）were included in the multivariate analysis.COX multivariate analysis showed that preoperative CEA level（P=0.037）,preoperative CA125（P=0.000）,SII（P=0.004）,prognostic nutritional index（P=0.014）,lymph node metastasis（P=0.000）,organ metastasis（P=0.000）and nerve infiltration（P=0.035）were independent prognostic factors of colon cancer after surgery.For variables P<0.05 from multivariate analysis to be included in the model construction,a Nomogram prediction model will be established based on the above indexes and evaluated by 1-year,3-year and5-year time-dependent receiver operating characteristic（ROC）analysis.In the test set,the time-ROC of 1,3 and 5 years was 0.817,0.807 and 0.787.In the validation set,the time-ROC values of 1-year,3-year and 5-year overall survival were 0.878,0.797 and 0.696,respectively.The calibration curves of the model showed good probability agreement between the predicted and observed values.The decision curve showed that the net benefit rate range of patients was<87%,and the model had high differentiation,calibration and clinical practicability.Conclusions 1.Preoperative LMR,preoperative SII,preoperative CA199,T stage and lymph node metastasis were independent risk factors for the occurrence of nerve invasion.Preoperative PLR,preoperative LMR,CT-T stage and CT-lymph node metastasis were independent risk factors for the occurrence of lymphatic vascular carcinoma thrombolysis/invasion.2.Preoperative CEA level,preoperative CA125,SII,prognostic nutritional index,lymph node metastasis,organ metastasis and nerve infiltration were independent factors affecting postoperative survival of colon cancer.The prediction model of postoperative overall survival rate of colon cancer established in this study has high clinical practicability. |
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