A Nomogram to Predict Adequate Lymph Node Recovery before Resection of Colorectal Cancer

Autor: Qi-feng Luo, Zhen-ling Dai, Zhenyu Zhang, Shiva Basnet, Nan Liu, Cong Li, Xiao-wei Yin, Wei Gao, Hai-yan Ge
Jazyk: angličtina
Rok vydání: 2016
Předmět:
Oncology
Male
Multivariate analysis
Colorectal cancer
Neutrophils
Physiology
lcsh:Medicine
Logistic regression
White Blood Cells
0302 clinical medicine
Mathematical and Statistical Techniques
Animal Cells
Medicine and Health Sciences
Lymphocytes
lcsh:Science
Lymph node
Multidisciplinary
Hematology
Middle Aged
Prognosis
Body Fluids
medicine.anatomical_structure
Blood
030220 oncology & carcinogenesis
Lymphatic Metastasis
Physical Sciences
030211 gastroenterology & hepatology
Female
Lymph
Anatomy
Cellular Types
Colorectal Neoplasms
Statistics (Mathematics)
Research Article
Platelets
medicine.medical_specialty
Anemia
Immune Cells
Immunology
Surgical and Invasive Medical Procedures
Research and Analysis Methods
Lymphatic System
03 medical and health sciences
Internal medicine
medicine
Humans
Statistical Methods
Aged
Probability
Retrospective Studies
Colorectal Cancer
Blood Cells
Receiver operating characteristic
business.industry
lcsh:R
Biology and Life Sciences
Cancers and Neoplasms
Cell Biology
Nomogram
medicine.disease
Blood Counts
Nomograms
Multivariate Analysis
Lymph Node Excision
lcsh:Q
Lymph Nodes
business
Mathematics
Zdroj: PLoS ONE, Vol 11, Iss 12, p e0168156 (2016)
PLoS ONE
ISSN: 1932-6203
Popis: Increased lymph node count (LNC) has been associated with prolonged survival in colorectal cancer (CRC), but the underlying mechanisms are still poorly understood. The study aims to identify new predictors and develop a preoperative nomogram for predicting the probability of adequate LNC (≥ 12). 501 eligible patients were retrospectively selected to identify clinical-pathological factors associated with LNC ≥ 12 through univariate and multivariate logistic regression analyses. The nomogram was built according to multivariate analyses of preoperative factors. Model performance was assessed with concordance index (c-index) and area under the receiver operating characteristic curve (AUC), followed by internal validation and calibration using 1000-resample bootstrapping. Clinical validity of the nomogram and LNC impact on stage migration were also evaluated. Multivariate analyses showed patient age, CA19-9, circulating lymphocytes, neutrophils, platelets, tumor diameter, histology and deposit significantly correlated with LNC (P < 0.05). The effects were marginal for CEA, anemia and CRC location (0.05 < P < 0.1). The multivariate analyses of preoperative factors suggested decreased age, CEA, CA19-9, neutrophils, proximal location, and increased platelets and diameter were significantly associated with increased probability of LNC ≥ 12 (P < 0.05). The nomogram achieved c-indexes of 0.75 and 0.73 before and after correction for overfitting. The AUC was 0.75 (95% CI, 0.70-0.79) and the clinically valid threshold probabilities were between 10% and 60% for the nomogram to predict LNC < 12. Additionally, increased probability of adequate LNC before surgery was associated with increased LNC and negative lymph nodes rather than increased positive lymph nodes, lymph node ratio, pN stages or AJCC stages. Collectively, the results indicate the LNC is multifactorial and irrelevant to stage migration. The significant correlations with preoperative circulating markers may provide new explanations for LNC-related survival advantage which is reflected by the implication of regional and systemic antitumor immune responses.
Databáze: OpenAIRE
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