转移性结直肠癌生存率、预后因素及预后风险预测评分的建立及验证

目的探讨研究转移性结直肠癌患者的生存率和预后风险因素，构建预后风险预测评分并进行验证。方法选取2010年至2015年美国监测、流行病和结果队列（surveillance，epidemiology，and end results，SEER）诊断的转移性结直肠癌患者。采用Kaplan-Meier法研究患者生存率，并采用多因素Cox回归分析研究影响患者预后的风险因素。基于上述因素构建预后风险预测评分并进行预测准确性的内部评价，同时采用2016年诊断的患者进行预测评分的外部验证。结果研究共选取转移性结直肠癌患者37 092例，5年生存率为10.6%。年龄较高、黑种人、组织学分化程度较低、T分期较高、N分期、高癌胚抗原水平以及骨、脑、肝和肺转移是死亡的风险因素，而女性、已婚状态、有保险、非右半结肠和原发部位手术是死亡的保护性因素。验证性结果显示该预测评分具有较高的内部稳定性和外部适应性。结论转移性结直肠癌患者预后较差，基于预后风险因素建立的预测模型能准确预测患者生存概率，帮助医生制定个体化治疗方案，提高患者生存率。 

Survival,prognostic factors,and establishment and validation of a prognostic riskprediction score for metastatic colorectal cancer

  Objective  To investigate survival and prognostic risk factors in patients with metastatic colorectal cancer and then construct and validate a prognostic risk prediction score.   Methods  Patients who were diagnosed with metastatic colorectal cancer between 2010 and 2015 in the Surveillance, Epidemiology, and End Results (SEER) cohort were included in this study. Kaplan–Meier analysis was used to calculate the survival rate and multivariable Cox regression analysis was used to investigate prognostic risk factors for metastatic colorectal cancer. A prognostic risk prediction score based on the above prognostic factors was constructed, and the score was validated internally. Moreover, external validation was carried out among patients diagnosed with metastatic colorectal cancer in 2016.   Results  A total of 37,092 patients with metastatic colorectal cancer were included, with a 5-year survival rate of 10.6%. Advanced age; Black patients; lower differentiation grade; higher T and N stages; higher levels of carcinoembryonic antigen;and bone, brain, liver, and lung metastasis were risk factors for overall survival. Female sex, married status, insurance status, left-sided colon cancer, and surgery of the primary site were protective factors against mortality. The validation results showed that the prognostic risk prediction score has high reproducibility and external application.   Conclusions  The prognosis of patients with metastatic colorectal cancer is relatively poor. The present risk prediction score, established based on prognostic risk factors, could accurately predict overall survival in patients with metastatic colorectal cancer. The use of the established risk score may help physicians to tailor individualized treatment programs and improve the survival rate in this patient population.