Analysis Of Prognostic Risk Factors And Establish A Nomogram For Obstructive Colorectal Cancer

Objective: To investigate the prognosis of patients with obstructive colorectal cancer and to establish the Nomogram model for predicting the prognosis of patients with obstructive colorectal cancer.Method: The clinical and pathological data of 129 patients with obstructive colorectal cancer were retrospectively analyzed.The Kaplan-Meier method was used to analyze the univariate survival rate;Factors significant in univariate analysis were analyzed by means of COX stepwise regression;R software was usied to establish a predictive Nomogram model based on multivariate analysis,using internal validation to evaluate the model.Results:1.Univariate analysis of patients with obstructive colorectal cancerUnivariate analysis showed that the neutrophil percentage(?75% /<75%: 1 year survival rate 89.4%/74.8%;3 year survival rate 68.2%/55.1%,P=0.031),CEA level(?5ng/ml/<5ng/ml: 1 year survival rate 95.9%/76.7%;3-year survival rate 75.7%/57.3%,P=0.001),CA19-9 level(?27U/ml/<27U/ml: 1 year survival rate 89.5%/77.4%;3 year survival rate 68.5%/55.3%,P=0.016),N stage(N2 /N1 / N0: 1 year survival rate 73.2%/80.3%/93.1%;3-year survival rate 41.3%/45%/90.9%,P=0.001),M stage(M1 /M0: 1 year survival rate 67.3%/92.6%;3 year survival rate 43.2%/72.9%,P<0.001),TNM stage(?/?/?+?: 1 year survival rate 67.3%/87.5%/97.6%;3 year survival rate 43.2%/51%/94.8%%,P<0.01)and surgical procedure(Radical resection / Palliative resection: M1 /M0: 1 year survival rate 93.5%/67.7%;3 year survival rate 75.9%/39.5%%,P<0.001)were the risk factors of prognosis in patients with obstructive colorectal cancer.Multivariate COX stepwise regression analysis showed that the independent factors influencing the prognosis of patients with obstructive colorectal cancer were CEA(?5ng/ml/<5ng/ml: HR=2.872,95%CI=1.065-7.740,P=0.037),N stage(N1/N0: HR=3.187,95%CI=1.137-8.938,P=0.028;N2/N0: HR=4.098,95%CI=1.393-12.051,P=0.010)and surgical procedure(Radical resection/Palliative resection: HR=0.299,95%CI=0.139-0.643,P=0.002).2.Nomogram constructed for obstructive colorectal cancer patientsThe C-index for predicting the overall survival of patients with obstructive colorectal cancer was 0.804(95%CI=0.738-0.870),and the calibration curve showed that the survival rate of data for validation was in agreement with the survival rate of Nomogram model,indicating that the Nomogram has better accurancy and consistency.Conclusion:1.The level of CEA,N stage and Surgical procedure are independent prognostic factors in patients with obstructive colorectal cancer.The prognosis of patients with elevated CEA is worse.The more positive lymph node metastases,the shorter the average survival.Patients who underwent radical surgery had longer survival than patients who underwent palliative operation.2.The Nomogram constructed in this study shows good predictive ability through internal verification,the prognosis of patients with obstructive colorectal cancer can be individually predicted with the help of the model.3.Among the three most important factors that affect prognosis,only the choice of Surgical procedure is what clinicians can do.For the oCRC,we should try to be as radical as possible in order to improve the survival rate of patients with oCRC under the premise of safety.