| Objective:Colorectal cancer has a high incidence,poor prognosis,and recurrence and metastasis are the main causes of death in colorectal cancer patients.In previous studies,it was found that serological markers can reflect the prognosis of colorectal cancer,the detection is convenient,and it is easier to be used in clinical applications.It is expected to play a more important role in the prognosis of colorectal cancer.This study included the common serological indicators and other clinicopathological parameters of patients with advanced colorectal cancer,to explore serological markers that may predict prognosis,and establish a prognostic model for patients with advanced colorectal cancer.Determine the prognosis of patients with advanced colorectal cancer before treatment.Methods: This study is a retrospective study,screening patients with advanced colorectal disease who were admitted to the Department of Oncology of the First Affiliated Hospital of China Medical University from January 2010 to February 2018,to screen and collect clinical pathology and follow-up data.The last follow-up time is November 30,2018.The primary study endpoint was OS(Overall Survival,defined as the time from the diagnosis of advanced colorectal cancer to death for any reason or the time of the last follow-up).The training set and verification set were constructed according to the time point of diagnosis,included in the training set from 2010 to 2015,and included in the verification set from 2016 to 2018.Chi-square test was used to compare the differences between the two sets.SPSS22.0 was used for statistical analysis.In the training set,the COX proportional hazards regression model was used for univariate analysis of clinicopathological parameters,and then factors with statistical significance in univariate analysis were included in multivariate analysis(P <0.05).The COX proportional hazards regression method builds a prognostic model based on the training set and performs risk stratification.The prognostic model obtained is tested internally through the verification set.The survival curve was created by the Kaplan-Meier method,and the difference between the curves was evaluated by the log-rank test.Use R language to draw time-dependent ROC curve,and analyze sensitivity and specificity.When the semi-parameter is used,the AUC function on time t is constructed according to the AUC method.Results:A total of 523 patients with advanced colorectal cancer were included in this study,followed up to November 30,2018,and the 523 patients included in this study were grouped according to the time of first recurrence and metastasis,2010 to 2015(372 in the training set),2016 From February to February 2018(151 in the verification set).In the COX survival analysis of 372 patients with advanced colorectal cancer in the training set,the univariate analysis showed the number of metastases at the first diagnosis,peritoneal metastasis,pathological type,platelet lymphocyte ratio(PLR),lymphocyte monocyte ratio(LMR),neutrophil lymphocyte ratio(NLR),CEA,CA199,fibrinogen(Fg),and lactate dehydrogenase(LDH)can predict overall survival(P <0.05).Incorporate statistically significant indicators in univariate analysis into multivariate analysis.The results suggest that peritoneal metastasis,pathological type,PLR,CA199,and LDH are independent prognostic factors that affect the overall survival(OS)of advanced colorectal cancer.Use the above independent factors to establish a prognostic model based on the training set,calculate the prognostic score for each patient according to the model,take the median,and divide the training set into a high-risk group and a low-risk group.In the verification set of 151 patients,the prognostic model was used to calculate the prognostic score,and the patients in the verification set were divided into high-risk group and low-risk group.Kaplan-Meier survival curve analysis was performed on the training set and the verification set,which showed that the prognostic difference between the high-risk group and the low-risk group was statistically significant.ROC curve analysis results show that the sensitivity and specificity of this prognostic model,at 12 months,36 months,and 60 months,is better than the five prognostic factors alone in predicting the prognosis of advanced colorectal cancer.With time,the AUC(t)curve is above the straight line with AUC(t)= 0.5,the highest AUC is 0.73,and the AUC(t)curve of the prognostic model of advanced colorectal cancer is clearly seen above the peritoneal metastasis,pathological type,PLR,CA199,and LDH curve,suggesting that the prognostic model of advanced colorectal cancer can improve the predictive ability.Conclusion: Peritoneal metastasis,pathological type,PLR,CA199 and LDH,are independent prognostic factors affecting overall survival in patients with advanced colorectal cancer.The prognostic model of advanced colorectal cancer,including the above five independent prognostic factors,performed well in the training set and verification set,and the prognosis of patients in the high-risk group was poor. |
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