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北京大学学报（医学版） ›› 2020, Vol. 52 ›› Issue (2): 353-361. doi: 10.19723/j.issn.1671-167X.2020.02.025

• 技术方法 • 上一篇    下一篇

结直肠间质瘤临床病理特征及预后分析

王文鹏1,王捷夫1,胡均1,王俊锋1,刘嘉1,孔大陆1,△(),李健2   

  1. 1. 大连医科大学附属第一医院放射科, 辽宁大连 116011
    2. 北京大学医学部医学技术研究院, 北京 100191
  • 收稿日期:2019-11-18 出版日期:2020-04-18 发布日期:2020-04-18
  • 通讯作者: 孔大陆 E-mail:kongdalu@tjmuch.com
  • 基金资助:
    国家自然科学基金(81101870);国家临床重点专科建设项目(2013-544);天津市卫生健康委员会重点项目(16kg127)

Clinicopathological features and prognosis of colorectal stromal tumor

Wen-peng WANG1,Jie-fu WANG1,Jun HU1,Jun-feng WANG1,Jia LIU1,Da-lu KONG1,△(),Jian LI2   

  1. 1. Department of Radiology, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning, China
    2. Institute of Medical Technology, Peking University Health Science Center, Beijing 100191, China
  • Received:2019-11-18 Online:2020-04-18 Published:2020-04-18
  • Contact: Da-lu KONG E-mail:kongdalu@tjmuch.com
  • Supported by:
    Supported by the National Natural Science Foundation of China(81101870);the National Key Clinical Specialty Construction Project(2013-544);the Key Project of Tianjin Health and Family Planning Commission(16kg127)

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摘要：

目的 探究结直肠间质瘤预后相关因素,并通过列线图预测该肿瘤生存概率,为指导临床评估预后提供依据.方法: 通过监测流行病学和最终结果(surveillance, epidemiology, and end results, SEER)数据库获取1992年1月至2015年12月结直肠间质瘤临床病理及预后相关资料,对入组患者进行生存分析,将分析得到的独立预后因素绘制成列线图,之后采用校准曲线评估列线图预测生存准确性.结果: 546例结直肠间质瘤患者被纳入研究.中位发病年龄64岁,区域淋巴结转移率9.4%.546例患者多因素生存分析显示发病年龄 > 64岁,未婚/离婚,结肠间质瘤(与直肠间质瘤相比),非手术治疗,组织分化级别高,区域淋巴结转移及远处转移具有更差的肿瘤特异性生存和总生存(P均<0.05), 美国东部地区诊治患者比西部地区患者具有更长的总生存时间(P = 0.027),以上独立预后因素预测肿瘤特异性生存率和总生存率的C指数分别为0.76(95%CI: 0.72-0.80)和0.75(95%CI: 0.72-0.78).在174例组织分化级别和肿瘤部位明确的患者中,影响肿瘤特异性生存和总生存的独立预后因素为年龄,组织分化级别和是否行手术治疗(P均<0.05),而肿瘤部位仅与肿瘤特异性生存显著相关(P = 0.041),未证实与总生存显著相关(P = 0.057),采用这4个预后影响因素预测546例患者肿瘤特异性生存率和总生存率的C指数分别是0.71(95%CI: 0.66-0.75)和0.73(95%CI: 0.70-0.77), 能较准确预测结直肠间质瘤患者总生存率.结论: 结直肠间质瘤预后受多个临床病理因素影响,列线图能为预测结直肠间质瘤患者生存率提供依据.

关键词: 结直肠间质瘤, 临床病理特征, 预后, 列线图

Abstract:

Objective: The incidence of colorectal stromal tumor is low among digestive tract tumors, therefore the literatures about clinicopathological features and prognosis of colorectal stromal tumor are few at home and abroad. In this study, we performed survival analyses for colorectal stromal tumor. The nomogram made by prognostic factors provided basis for evaluation of prognosis.Methods: The clinico-pathological and prognostic data of colorectal stromal tumor between January 1992 and December 2015 were collected from the surveillance, epidemiology, and end results (SEER) database. The survival analyses were made by SPSS 24.0 software. The nomogram and calibration curve were made by RMS package in R 3.5.2 software.Results: In the study, 546 patients with colorectal stromal tumor were included. The median age of onset was 64 years. The regional lymph node metastasis (LNM) rate was 9.4%. The multivariate Cox regression analyses of the 546 cases showed that the older age of onset (>64 years), single or divorce, colon tumor (compared with rectal tumor), non-surgery, high histological grade, LNM and distant metastasis were associated with worse cancer specific survival (CSS) and overall survival (OS), P < 0.05 for all. The treatment district was independent prognostic factor of OS (P = 0.027). The C-index of independent prognostic factors predicting CSS and OS probability were 0.76 (95%CI: 0.72-0.80) and 0.75 (95%CI: 0.72-0.78), respectively. Multivariate analyses were further carried out in the 174 patients with definite histological grade and tumor location, which revealed that the age of onset, histological grade, surgery or not were independent prognostic factors of CSS and OS (P < 0.05 for all). Tumor location was associated with CSS (P = 0.041) but not OS (P = 0.057) among the 174 cases. Four independent prognostic factors influencing the 174 patients' prognosis were used to make nomogram for predicting survival probability of 546 cases. The C-index of four prognostic factors predicting probability of CSS and OS of the 546 cases were separately 0.71 (95%CI: 0.66-0.75) and 0.73 (95%CI: 0.70-0.77). The nomogram had more accuracy for predicting OS probability of colorectal stromal tumors.Conclusion: The prognosis of colorectal stromal tumor was affected by multiple clinicopathological factors. The nomogram provided the basis for predicting the survival probability of patients with colorectal stromal tumor.

Key words: Colorectal stromal tumor, Clinicopathological features, Prognosis, Nomogram

中图分类号: 

  • R735.3

表1

546例结直肠间质瘤临床病理资料及随访资料"

Variables n (%)
Age/years
≤ 64 273 (50)
> 64 273 (50)
Gender
Male 302 (55.3)
Female 244 (44.7)
Marital status
Married 321 (58.8)
Single/divorced 192 (35.2)
Unknown 33 (6.0)
Ethnicity
Caucasian 361 (66.1)
African-American 93 (17.0)
Other 91 (16.7)
Unknown 1 (0.2)
Date range/year
1992-2007 276 (50.5)
2008-2015 270 (49.5)
SEER registry in America
Eastern 238 (43.6)
Western 308 (56.4)
Tumor location
Colon 241 (44.1)
Rectum 280 (51.3)
Unknown 25 (4.6)
Surgery or not
Yes 428 (78.4)
No 109 (20.0)
Unknown 9 (1.6)
Differentiation grade
Ⅰ 35 (6.4)
Ⅱ 56 (10.3)
Ⅲ 34 (6.2)
Ⅳ 54 (9.9)
Unknown 367 (67.2)
Tumor size/cm*
≤ 2 65 (11.9)
> 2-5 89 (16.3)
> 5-10 120 (22.0)
> 10 50 (9.2)
Unknown 222 (40.7)
Lymphadenectomy
No 310 (56.8)
Yes 204 (37.4)
Unknown 32 (5.9)
LNM
Negative 184 (33.7)
Positive 19 (3.5)
Unknown 343 (62.8)
LNM rate 19/203 (9.4)
Distant metastasis
No 292 (53.5)
Yes 47 (8.6)
Unknown 207 (37.9)
Cancer-specific death
Yes 123 (22.5)
No 423 (77.5)
Overall survival status
Dead 239 (43.8)
Alive 307 (56.2)

表2

546例结直肠间质瘤单因素预后分析"

Variables n CSS P OS P
5-year survival rate/% 10-year survival rate/% 5-year survival rate/% 10-year survival rate/%
Age/years < 0.001 < 0.001
≤ 64 273 85.2 76.8 79.1 66.5
> 64 273 71.4 56.3 49.4 25.0
Gender 0.792 0.934
Male 302 78.7 67.5 64.8 46.1
Female 244 78.8 68.4 63.6 46.0
Marital status 0.027 0.007
Married 321 80.6 70.6 67.8 50.1
Single/Divorced 192 73.8 61.2 56.8 38.5
Unknown 33 88.6 78.8 74.4 45.5
Ethnicity 0.154 0.035
Caucasian 361 75.9 65.9 59.7 44.0
African-American 93 87.1 74.5 73.8 48.6
Other/Unknown 92 80.7 67.7 72.6 49.5
Date range/year 0.146 0.733
1992-2007 276 76.0 66.7 62.5 46.5
2008-2015 270 82.6 70.0 66.1 43.7
SEER registry in America 0.029 0.063
Eastern 238 81.8 76.9 68.7 52.7
Western 308 76.3 62.9 61.0 42.2
Tumor location 0.002 < 0.001
Colon 241 69.1 60.6 53.4 41.0
Rectum 280 86.6 74.2 73.9 53.5
Unknown 25 84.8 68.9 66.2 12.1
Surgery or not < 0.001 < 0.001
No/Unknown 118 61.3 31.7 38.9 20.1
Surgery 428 82.1 73.3 70.6 51.7
Differentiation grade < 0.001 < 0.001
Ⅰ 35 97.1 83.3 93.5 74.8
Ⅱ 56 90.1 84.1 82.9 71.0
Ⅲ 34 55.8 55.8 41.5 26.0
Ⅳ 54 67.8 40.5 48.5 22.2
Unknown 367 79.4 68.5 64.0 47.3
Tumor size/cm* 0.001 < 0.001
≤2 65 95.0 95.0 82.8 77.6
>2-5 89 89.4 61.3 73.8 48.5
>5-10 120 83.3 76.8 69.9 55.7
>10 50 74.9 59.0 61.9 37.5
Unknown 222 69.7 61.6 54.7 38.8
Lymphadenectomy 0.325 0.652
No/Unknown 342 82.2 69.7 65.4 47.5
Yes 204 75.0 66.9 62.4 45.1
LNM < 0.001 < 0.001
Negative/Unknown 527 79.7 70.6 65.2 48.4
Positive 19 41.9 20.9 38.3 6.4
Distant metastasis < 0.001 < 0.001
No/Unknown 499 81.9 71.3 67.5 48.6
Yes 47 32.6 32.6 23.6 23.6

表3

546例结直肠间质瘤多因素预后分析"

Variables n CSS P OS P
HR 95%CI HR 95%CI
Age/years
≤ 64 273 1 1
> 64 273 2.53 1.71-3.73 < 0.001 3.82 2.83-5.14 < 0.001
Gender
Male 302 1 1
Female 244 0.81 0.55-1.19 0.284 0.83 0.62-1.09 0.182
Marital status
Married 321 1 1
Single/divorced 192 1.71 1.14-2.57 0.010 1.51 1.12-2.03 0.006
Unknown 33 0.67 0.23-1.92 0.456 0.74 0.38-1.46 0.391
Ethnicity
Caucasian 361 1 1
African-American 93 0.79 0.43-1.45 0.449 0.90 0.60-1.36 0.618
Other/Unknown 92 0.93 0.55-1.58 0.788 0.76 0.51-1.14 0.191
Date range/year
1992-2007 276 1 1
2008-2015 270 0.95 0.56-1.59 0.834 1.22 0.84-1.76 0.295
SEER registry in America
Eastern 238 1 1
Western 308 1.46 0.97-2.20 0.073 1.39 1.04-1.86 0.027
Tumor location
Colon 241 1 1
Rectum 280 0.58 0.38-0.89 0.012 0.67 0.50-0.91 0.010
Unknown 25 0.50 0.20-1.23 0.129 0.70 0.39-1.24 0.219
Surgery or not
No/Unknown 118 1 1
Surgery 428 0.40 0.24-0.70 0.001 0.46 0.32-0.68 < 0.001
Differentiation grade
Ⅰ 35 1 1
Ⅱ 56 2.07 0.40-10.71 0.385 1.74 0.64-4.73 0.274
Ⅲ 34 5.54 1.15-26.59 0.032 4.18 1.58-11.05 0.004
Ⅳ 54 7.75 1.67-35.94 0.009 6.22 2.45-15.82 < 0.001
Unknown 367 3.90 0.88-17.20 0.072 3.09 1.28-7.47 0.012
Tumor size/cm*
≤ 2 65 1 1
> 2-5 89 1.72 0.45-6.54 0.423 1.23 0.57-2.68 0.603
> 5-10 120 2.03 0.58-7.14 0.268 1.49 0.72-3.08 0.286
> 10 50 3.11 0.85-11.30 0.085 1.87 0.86-4.06 0.115
Unknown 222 3.84 1.13-13.06 0.031 2.81 1.39-5.67 0.004
Lymphadenectomy
No/Unknown 342 1 1
Yes 204 1.00 0.63-1.60 0.987 0.90 0.64-1.25 0.519
LNM
Negative/Unknown 527 1 1
Positive 19 2.88 1.41-5.88 0.004 2.50 1.41-4.42 0.002
Distant metastasis
No/Unknown 499 1 1
Yes 47 2.55 1.48-4.40 0.001 1.91 1.24-2.95 0.003

表4

174例组织学分级和肿瘤部位明确的结直肠间质瘤多因素预后分析"

Variables n CSS P OS P
HR 95%CI HR 95%CI
Age/years
≤ 64 83 1 1
> 64 91 2.27 1.05-4.91 0.037 4.97 2.70-9.15 < 0.001
Gender
Male 89 1 1
Female 85 1.02 0.48-2.18 0.963 1.12 0.64-1.98 0.696
Marital status
Married 107 1 1
Other 67 0.58 0.24-1.38 0.215 0.99 0.55-1.80 0.972
Ethnicity
Caucasian 121 1 1
African-American 28 0.69 0.21-2.35 0.557 0.51 0.20-1.27 0.149
Other/Unknown 25 1.43 0.48-4.21 0.520 0.69 0.27-1.77 0.441
Date range/year
1992-2007 86 1 1
2008-2015 88 0.36 0.10-1.31 0.120 0.76 0.28-2.08 0.589
SEER registry in America
1992-2007 74 1 1
2008-2015 100 0.92 0.42-2.02 0.827 1.08 0.61-1.93 0.795
Tumor location
Colon 91 1 1
Rectum 83 0.43 0.19-0.97 0.041 0.58 0.34-1.02 0.057
Surgery or not
No/Unknown 13 1 1
Surgery 161 0.15 0.04-0.58 0.006 0.29 0.11-0.81 0.018
Differentiation grade
Ⅰ 34 1 1
Ⅱ 54 2.93 0.54-15.96 0.213 2.35 0.77-7.18 0.133
Ⅲ 32 7.93 1.47-42.75 0.016 4.39 1.43-13.47 0.010
Ⅳ 54 8.59 1.73-42.57 0.008 7.02 2.38-20.70 < 0.001
Tumor size/cm*
≤ 2 27 1 1
> 2-5 30 0.46 0.07-2.91 0.412 0.77 0.14-4.34 0.766
> 5-10 33 0.41 0.06-2.93 0.378 1.56 0.28-8.59 0.610
> 10 14 0.72 0.09-5.66 0.754 1.81 0.32-10.32 0.506
Unknown 70 0.29 0.03-2.49 0.258 1.23 0.19-7.88 0.826
Lymphadenectomy
No/Unknown 92 1 1
Yes 82 2.14 0.91-5.04 0.083 1.25 0.66-2.36 0.491
LNM
Negative/Unknown 164 1 1
Positive 10 1.30 0.45-3.72 0.631 1.57 0.64-3.85 0.322
Distant metastasis
No/Unknown 155 1 1
Yes 19 2.19 0.94-5.11 0.070 1.64 0.82-3.25 0.159

图1

结直肠间质瘤肿瘤特异性生存(A)和总生存(B)预测列线图"

图2

结直肠间质瘤5年肿瘤特异性生存(A),10年肿瘤特异性生存(B),5年总生存(C)和10年总生存(D)预测校准曲线"

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