期刊论文详细信息
BMC Medicine
Prediction models of colorectal cancer prognosis incorporating perioperative longitudinal serum tumor markers: a retrospective longitudinal cohort study
Research Article
Chunxia Li1  Bingbing Fan1  Jiali Lv1  Tao Zhang2  Ming Lei3  Hongjiang Pu4  Ke Zhao5  Zhenhui Li6  Dafu Zhang7  Xiaolin Pang8  Dingyun You9 
[1] Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, PO Box 100, 44 Wenhuaxi Road, 250012, Jinan, Shandong, China;Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, PO Box 100, 44 Wenhuaxi Road, 250012, Jinan, Shandong, China;Institute for Medical Dataology, Shandong University, 250002, Jinan, China;Department of Clinical Laboratory Medicine, the Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, 650118, Kunming, China;Department of Colorectal Surgery, the Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, 650118, Kunming, China;Department of Radiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 510080, Guangzhou, China;Guangdong Cardiovascular Institute, 510080, Guangzhou, China;Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 510080, Guangzhou, China;Department of Radiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 510080, Guangzhou, China;Guangdong Cardiovascular Institute, 510080, Guangzhou, China;Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 510080, Guangzhou, China;Department of Radiology, the Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, No.519 Kunzhou Road, Xishan District, 650118, Kunming, Yunnan, China;Department of Radiology, the Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, No.519 Kunzhou Road, Xishan District, 650118, Kunming, Yunnan, China;Department of Radiotherapy, the Sixth Affiliated Hospital of Sun Yat-Sen University, 510655, Guangzhou, China;School of Biomedical Engineering Research, Kunming Medical University, No.1168 Chunrongxi Road, Chenggong District, 650500, Kunming, Yunnan, China;
关键词: Colorectal cancer;    Perioperative serum tumor markers;    Dynamic prediction;    Overall survival;   
DOI  :  10.1186/s12916-023-02773-2
 received in 2022-07-15, accepted in 2023-02-08,  发布年份 2023
来源: Springer
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【 摘 要 】

BackgroundCurrent prognostic prediction models of colorectal cancer (CRC) include only the preoperative measurement of tumor markers, with their available repeated postoperative measurements underutilized. CRC prognostic prediction models were constructed in this study to clarify whether and to what extent the inclusion of perioperative longitudinal measurements of CEA, CA19-9, and CA125 can improve the model performance, and perform a dynamic prediction.MethodsThe training and validating cohort included 1453 and 444 CRC patients who underwent curative resection, with preoperative measurement and two or more measurements within 12 months after surgery, respectively. Prediction models to predict CRC overall survival were constructed with demographic and clinicopathological variables, by incorporating preoperative CEA, CA19-9, and CA125, as well as their perioperative longitudinal measurements.ResultsIn internal validation, the model with preoperative CEA, CA19-9, and CA125 outperformed the model including CEA only, with the better area under the receiver operating characteristic curves (AUCs: 0.774 vs 0.716), brier scores (BSs: 0.057 vs 0.058), and net reclassification improvement (NRI = 33.5%, 95% CI: 12.3 ~ 54.8%) at 36 months after surgery. Furthermore, the prediction models, by incorporating longitudinal measurements of CEA, CA19-9, and CA125 within 12 months after surgery, had improved prediction accuracy, with higher AUC (0.849) and lower BS (0.049). Compared with preoperative models, the model incorporating longitudinal measurements of the three markers had significant NRI (40.8%, 95% CI: 19.6 to 62.1%) at 36 months after surgery. External validation showed similar results to internal validation. The proposed longitudinal prediction model can provide a personalized dynamic prediction for a new patient, with estimated survival probability updated when a new measurement is collected during 12 months after surgery.ConclusionsPrediction models including longitudinal measurements of CEA, CA19-9, and CA125 have improved accuracy in predicting the prognosis of CRC patients. We recommend repeated measurements of CEA, CA19-9, and CA125 in the surveillance of CRC prognosis.

【 授权许可】

CC BY   
© The Author(s) 2023

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