结直肠癌术后患者异时性进展期腺瘤风险筛查模型的构建及验证

doi:10.3969/j.issn.1006-7795.2023.02.017

首都医科大学学报 ›› 2023, Vol. 44 ›› Issue (2): 295-301.doi: 10.3969/j.issn.1006-7795.2023.02.017

结直肠癌术后患者异时性进展期腺瘤风险筛查模型的构建及验证

郭春梅¹，刘红¹，焦月²，张倩²，王沧海¹，王亚丹¹，蔺武¹，魏南¹，张澍田²，吴静^1，2*

1.首都医科大学附属北京世纪坛医院消化内科，北京，100038； 2.首都医科大学附属北京友谊医院消化内科，北京，100050

收稿日期:2022-09-26 出版日期:2023-04-21 发布日期:2023-04-18
通讯作者: 吴静 E-mail:wujing36youyi@ccmu.edu.cn
基金资助:
北京市属医院科研培育项目(PX2021030)，首都卫生发展科研专项 (2020-4-2085)

Design and verification of screening model of metachronous advanced adenoma for postoperative colorectal cancer patients

Guo Chunmei¹, Liu Hong¹, Jiao Yue², Zhang Qian², Wang Canghai¹, Wang Yadan¹, Lin Wu¹, Wei Nan¹, Zhang Shutian², Wu Jing^1,2*

1. Gastroenterology Department, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China; 2. Gastroenterology Department, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China

Received:2022-09-26 Online:2023-04-21 Published:2023-04-18
Supported by:
This study was supported by Beijing Municipal Administration of Hospitals Incubating Program(PX2021030), Capitals Funds for Health Improvement and Research (2020-4-2085)

摘要/Abstract

摘要： 目的筛选结直肠癌术后患者发生异时性进展期腺瘤的危险因素，构建个体化风险筛查模型并验证模型的筛查效果。方法将2007年4月至2017年10月行结直肠癌根治术的734例患者分为建模组和验证组，术后3年结肠镜随访。建模组采用单因素及多因素Logistic回归分析，建立风险筛查模型。利用验证组验证模型的筛查效果。结果 734例患者包括建模组485例，验证组249例。平均年龄为（64.6±11.5）岁，男性440例，女性294例。总的异时性进展期腺瘤发生率为11.9%（建模组12.0%，验证组11.6%）。多因素Logistic回归分析显示，男性、糖尿病病史、右半结肠癌、中低分化腺癌、腺癌合并腺瘤，腺癌合并进展期腺瘤为异时性进展期腺瘤的独立预测因素。根据Logistic多因素分析结果，建立筛查结直肠癌术后出现异时性进展期腺瘤的模型，并建立风险筛查列线图。受试者工作特征 (receiver operating characteristic，ROC)曲线分析结果显示，该模型的受试者工作特征曲线下面积 (area under the curve，AUC)=0.957(95%CI:0.935～0.973)，模型筛查临界值为0.938 7。验证结果显示，构建的筛查模型的灵敏度=93.1%，特异度= 89.1%，并且筛查结果与实际结果的一致性较高（Kappa=0.62）。结论以男性、糖尿病病史、右半结肠癌、中低分化腺癌、腺癌合并腺瘤、腺癌合并进展期腺瘤七个因素，构建的结直肠癌术后出现异时性进展期腺瘤筛查模型，具有较高的真实性和与实际结果的一致性，有临床应用价值。

关键词: 结直肠癌, 异时性进展期腺瘤, 筛查模型, 验证

Abstract: Objective To analysis the potential risk factors for metachronous advanced adenoma (MAA) in postoperative colorectal cancer (CRC) patients, so as to develop an individual surveillance scheme and verify it. Methods Totally 734 CRC patients who underwent surgery from April 2007 to October 2017 were divided into derivation group and validation group, and underwent surveillance colonoscopy for 3 years. Univariate and multivariate logistic analysis were conducted to establish screening model, and verify it in validation group. Results Totally 734 patients (male/female: 440/294) were finally included. The average age was (64.6 ±11.5) years, and the overall MAA incidence was 11.9% (12.0％ in derivation group and 11.6％ in validation group). Male, diabetes mellitus, right-sided colon cancer, moderately and poorly differentiated adenocarcinoma, synchronous adenoma, synchronous advanced adenoma were independent risk factors for MAA. According to the results of multivariate logistic analysis, MAA screening model and nomogram were established. The area under the curve (AUC) of MAA screening model was 0.957(95% CI: 0.935－0.973), and critical value was 0.938 7. External validation showed that the sensitivity was 93.1%, specificity was 89.1%, and the consistency between screening results and actual results was high (Kappa=0.62). Conclusions The screening model of metachronous advanced adenoma for postoperative CRC patients was constructed based on seven factors: male, diabetes history, right-sided colon cancer, moderately and poorly differentiated adenocarcinoma, synchronous adenoma, and synchronous advanced adenoma. It had high authenticity and consistency with actual results, and showed clinical application value.

Key words: colorectal cancer, metachronous advanced adenoma, screening model, verification

中图分类号:

R735

郭春梅, 刘红, 焦月, 张倩, 王沧海, 王亚丹, 蔺武, 魏南, 张澍田, 吴静. 结直肠癌术后患者异时性进展期腺瘤风险筛查模型的构建及验证[J]. 首都医科大学学报, 2023, 44(2): 295-301.

Guo Chunmei, Liu Hong, Jiao Yue, Zhang Qian, Wang Canghai, Wang Yadan, Lin Wu, Wei Nan, Zhang Shutian, Wu Jing. Design and verification of screening model of metachronous advanced adenoma for postoperative colorectal cancer patients[J]. Journal of Capital Medical University, 2023, 44(2): 295-301.

参考文献

［1］Luo A, Dong H, Lin X, et al. Time trends of major cancers incidence and mortality in Guangzhou, China 2004－2015: a joinpoint and age-period-cohort analysis［J］. Cancer Med, 2021,10(8):2865－2876.
［2］中华医学会消化病学分会, 中华医学会消化病学分会肿瘤协作组. 中国结直肠癌预防共识意见(2016年,上海)［J］. 中华消化杂志, 2016,36(11):721－733.
［3］Park M Y, Park I J, Ryu H S, et al. Optimal postoperative surveillance strategies for colorectal cancer: a retrospective observational study［J］. Cancers (Basel), 2021,13(14):3502.
［4］王润东, 赵胜兵, 潘鹏, 等. 国内结肠镜开展及肠镜医师认知情况调查［J］. 中华消化内镜杂志, 2021,38(2):115－119.
［5］Lai E J, Calderwood A H, Doros G, et al. The Boston bowel preparation scale: a valid and reliable instrument for colonoscopy-oriented research［J］. Gastrointest Endosc, 2009,69(3 Pt 2):620－625.
［6］Kaminski M F, Regula J, Kraszewska E, et al. Quality indicators for colonoscopy and the risk of interval cancer［J］. N Engl J Med, 2010,362(19):1795－1803.
［7］Kikuchi D, Hoteya S, Iizuka T, et al. Diagnostic algorithm of magnifying endoscopy with narrow band imaging for superficial non-ampullary duodenal epithelial tumors［J］. Dig Endosc, 2014,26（Suppl 2):16－22.
［8］Patel A, Williams N, Parsons N, et al. Risk factors for metachronous adenoma in the residual colon of patients undergoing curative surgery for colorectal cancer［J］. Int J Colorectal Dis, 2017,32(11):1609－1616.
［9］Lieberman D A, Rex D K, Winawer S J, et al. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer［J］. Gastroenterology, 2012,143(3):844－857.
［10］Hassan C, Wysocki P T, Fuccio L, et al. Endoscopic surveillance after surgical or endoscopic resection for colorectal cancer: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Digestive Oncology (ESDO) Guideline［J］. Endoscopy, 2019,51(3):266－277.
［11］Fuccio L, Rex D, Ponchon T, et al. New and recurrent colorectal cancers after resection: a systematic review and meta-analysis of endoscopic surveillance studies［J］. Gastroenterology, 2019,156(5):1309－1323.
［12］Fuccio L, Spada C, Frazzoni L, et al. Higher adenoma recurrence rate after left- versus right-sided colectomy for colon cancer［J］. Gastrointest Endosc, 2015,82(2):337－343.
［13］Chang J J, Chien C H, Chen S W, et al. Long term outcomes of colon polyps with high grade dysplasia following endoscopic resection［J］. BMC Gastroenterol, 2020,20(1):376.
［14］Moon C M, Cheon J H, Choi E H, et al. Advanced synchronous adenoma but not simple adenoma predicts the future development of metachronous neoplasia in patients with resected colorectal cancer［J］. J Clin Gastroenterol, 2010,44(7):495－501.
［15］韩子翰, 陈佳佳, 冯楠, 等. 2型糖尿病合并结直肠癌的临床病理特征［J］. 中华胃肠外科杂志, 2019,22(10):966－971.
［16］张江国, 汪之沫. 代谢及肿瘤相关因素在结直肠癌切除术后患者异时性腺瘤发生中的作用研究［J］. 重庆医学, 2019,48(19):3287－3291.
［17］谢亦乐, 房静远. 早发型结直肠癌研究进展［J］. 中华消化杂志, 2021,41(11):783－786.
［18］Yun G Y, Moon H S, Kwon I S, et al. Left-sided colectomy: one of the important risk factors of metachronous colorectal adenoma after colectomy for colon cancer［J］. Dig Dis Sci, 2018,63(4):1052－1061.
［19］钟敏儿, 吴斌. 左、右半结直肠癌差异性研究进展［J］. 中国医学科学院学报, 2021,43(6):980－985.
［20］Guo C, Wu J, Jiao Y, et al. Design and verification of individualized follow-up strategy of colonoscopy for postoperative patients with colorectal cancer［J］. Eur J Gastroenterol Hepatol, 2022,34(1):48－55.
［21］Kawai K, Sunami E, Tsuno N H, et al. Polyp surveillance after surgery for colorectal cancer［J］. Int J Colorectal Dis, 2012,27(8):1087－1093.
［22］Choe E K, Park K J, Chung S J, et al. Colonoscopic surveillance after colorectal cancer resection: who needs more intensive follow-up?［J］. Digestion, 2015,91(2):142－149.

[1]	尹雪, 于明航, 王玺, 陈京龙. 肝癌中SWI/SNF复合物突变与免疫检查点抑制剂治疗应答反应的研究进展[J]. 首都医科大学学报, 2023, 44(5): 768-774.
[2]	宁婷婷, 王照情, 张楠, 朱圣韬. ACE2在结肠癌中表达的临床意义及结肠癌细胞对以ACE2为受体的三种人冠状病毒的易感性分析[J]. 首都医科大学学报, 2023, 44(4): 663-668.
[3]	郭继红, 朱宁, 葛洋, 安广宇. 晚期胰腺癌患者的临床特征及预后分析[J]. 首都医科大学学报, 2023, 44(3): 501-506.
[4]	孙婧, 史幼梧, 杜丰, 杨颖, 孙志伟, 余靖, 肖艳洁, 张晓东, 贾军. 消化道肿瘤免疫相关不良事件的临床分析[J]. 首都医科大学学报, 2023, 44(2): 343-350.
[5]	李荣雪, 张倩, 邢洁, 孙秀静, 李鹏, 焦月, 张澍田. 超声内镜对早期结直肠癌的诊断价值分析[J]. 首都医科大学学报, 2023, 44(1): 126-130.
[6]	邵琳琳, 朱思莹, 邢洁, 武珊珊, 朱圣韬, 张澍田. 原发性胃肠道淋巴瘤的临床特征和内镜特点分析[J]. 首都医科大学学报, 2022, 43(2): 205-209.
[7]	李雪, 邢洁, 张倩, 李鹏, 吕富靖, 张澍田. 窄带成像技术联合放大内镜JES分型对早期食管癌的诊断价值[J]. 首都医科大学学报, 2022, 43(2): 210-215.
[8]	孙婧, 史幼梧, 贾军, 杨颖, 孙志伟, 杜丰, 余靖, 肖艳洁, 张晓东. 血液炎症相关指标在晚期胰腺癌中的预后价值[J]. 首都医科大学学报, 2022, 43(2): 299-304.
[9]	孙灿, 邢洁, 张希, 孙秀静, 张澍田. 内镜下黏膜剥离术治疗低位直肠早癌的临床分析[J]. 首都医科大学学报, 2022, 43(1): 34-37.
[10]	马宗慧, 张倩, 邢洁, 朱圣韬, 李鹏, 张澍田, 孙秀静. 早期胃癌内镜下治疗的非治愈性切除率及影响因素[J]. 首都医科大学学报, 2022, 43(1): 17-21.
[11]	程芮, 朱思莹, 刘思茂, 周艳华, 宗晔, 李鹏, 张澍田. 内镜下治疗食管胃底静脉曲张伴发上消化道肿物的经验[J]. 首都医科大学学报, 2022, 43(1): 22-27.
[12]	何振, 刘娟, 冀明, 李鹏, 张澍田. 内镜下黏膜剥离术治疗累及肛门齿状线直肠病变的临床效果评价[J]. 首都医科大学学报, 2022, 43(1): 38-41.
[13]	杨怿, 李雪, 程芮, 陈炜, 陈楚岩, 张澍田. 消化道早癌内镜成像技术的研究进展[J]. 首都医科大学学报, 2022, 43(1): 47-52.
[14]	司海, 刘然, 熊中原, 曹邦伟. 细胞角蛋白的表达水平与结直肠癌临床病理学特征的相关性研究[J]. 首都医科大学学报, 2022, 43(1): 127-131.
[15]	安松林, 马玲, 赵月, 李雁. 主要促进因子超家族成员MFSD2A对肝癌细胞增殖、凋亡和侵袭的影响[J]. 首都医科大学学报, 2021, 42(6): 1000-1006.

结直肠癌术后患者异时性进展期腺瘤风险筛查模型的构建及验证

Design and verification of screening model of metachronous advanced adenoma for postoperative colorectal cancer patients

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价