预测散发早发性结直肠癌根治术后复发转移风险的列线图模型构建及验证OA

Objective To investigate the risk factors for recurrence and metastasis after radical resection of sporadic early-onset colorectal cancer(EOCRC),and to construct and validate a nomogram model for predicting the risk of postoperative recurrence and metastasis in sporadic EOCRC.Methods A retrospective cohort study was conducted.Clinicopathological and survival follow-up data of 199 patients with sporadic EOCRC admitted to Ningbo Medical Center Lihuili Hospital from January 2017 to December 2023 were collected.The primary endpoint was recurrence-free survival(RFS).Univariate and multivariate Cox regression analyses were used to screen independent influencing factors for postoperative recurrence and metastasis in sporadic EOCRC,and a prediction model was established and presented as a nomogram.The model's discrimination,calibration,and clinical net benefit were evaluated by AUC,C-index,time-dependent ROC curves,calibration curves,and decision curve analysis,and compared with the 8th edition of the American Joint Committee on Cancer(AJCC)TNM staging system.Risk stratification was performed based on the optimal cutoff value,and Kaplan-Meier survival curves were plotted to verify the stratification efficiency.Results The overall recurrence and metastasis rate was 25.1％(50/199 cases),with a median recurrence time of 13(9.25,21.75)months.Multivariate Cox regression analysis showed that age was an independent protective factor for postoperative recurrence and metastasis,while T stage and perineural invasion were independent risk factors(all P＜0.05).The C-index of the nomogram model was 0.740(95％CI:0.670-0.810).The AUCs for predicting 1-,3-,and 5-year RFS were 0.769,0.816,and 0.812,respectively,with favorable calibration and clinical net benefit.Its discrimination,net benefit,and risk stratification ability were significantly better than those of the 8th edition AJCC TNM staging system(C-index=0.664),and the separation of survival curves was superior.Conclusion Age,T stage,and perineural invasion are independent influencing factors for postoperative recurrence and metastasis in sporadic EOCRC.The nomogram model constructed based on the above indicators shows better predictive performance than the traditional TNM staging system and has favorable clinical application value,which can provide a reference for individualized diagnosis and treatment.