BACKGROUND The degree of obstruction plays an important role in decision-making for obstructive colorectal cancer(OCRC).The existing assessment still relies on the colorectal obstruction scoring system(CROSS)which is based on a comprehensive analysis of patients’complaints and eating conditions.The data collection relies on subjective descriptions and lacks objective parameters.Therefore,a scoring system for the evaluation of computed tomography-based obstructive degree(CTOD)is urgently required for OCRC.AIM To explore the relationship between CTOD and CROSS and to determine whether CTOD could affect the short-term and long-term prognosis.METHODS Of 173 patients were enrolled.CTOD was obtained using k-means,the ratio of proximal to distal obstruction,and the proportion of nonparenchymal areas at the site of obstruction.CTOD was integrated with the CROSS to analyze the effect of emergency intervention on complications.Short-term and long-term outcomes were compared between the groups.RESULTS CTOD severe obstruction(CTOD grade 3)was an independent risk factor[odds ratio(OR)=3.390,95%confidence interval(CI):1.340-8.570,P=0.010]via multivariate analysis of short-term outcomes,while CROSS grade was not.In the CTOD-CROSS grade system,for the non-severe obstructive(CTOD 1-2 to CROSS 1-4)group,the complication rate of emergency interventions was significantly higher than that of non-emergency interventions(71.4%vs 41.8%,P=0.040).The postoperative pneumonia rate was higher in the emergency intervention group than in the non-severe obstructive group(35.7%vs 8.9%,P=0.020).However,CTOD grade was not an independent risk factor of overall survival and progression-free survival.CONCLUSION CTOD was useful in preoperative decision-making to avoid unnecessary emergency interventions and complications.
目的:构建Ⅰ期子宫内膜癌预后简易评分系统为临床提供参考工具。方法:回顾性收集2014年至2021年于重庆医科大学附属第一医院接受了手术治疗的Ⅰ期子宫内膜癌患者的病例资料,通过单因素及多因素Cox回归分析筛选与患者复发及死亡相关的影响因子。基于多因素分析结果,构建简易评分系统,利用受试者工作特征(receiver operating characteristic,ROC)曲线及其曲线下面积(area under the curve,AUC)比较评分系统和单一预测因子对患者预后的预测准确度。利用X-title软件确定评分系统的截值点并对患者进行风险分组,比较不同分组患者预后分布情况。结果:多因素分析结果提示,患者年龄(复发:Waldχ^(2)=4.482,P=0.034;死亡:Waldχ^(2)=8.401,P=0.004)、病理分型(复发:Waldχ^(2)=6.692,P=0.010;死亡:Waldχ^(2)=4.222,P=0.040)、肌层浸润情况(复发:Waldχ^(2)=6.372,P=0.034;死亡:Waldχ^(2)=7.183,P=0.007)、淋巴脉管间隙侵犯(lymphovascular space invasion,LVSI)(复发:Waldχ^(2)=13.396,P<0.001;死亡:Waldχ^(2)=8.449,P=0.004)、雌激素受体(estrogen receptor,ER)表达(复发:Waldχ^(2)=7.679,P=0.006;死亡:Waldχ^(2)=8.532,P=0.003)及P53表达(复发:Waldχ^(2)=7.886,P=0.005;死亡:Waldχ^(2)=7.174,P=0.007)均是患者复发及死亡的影响因素。基于以上6个因素成功构建评估患者预后的简易评分系统,ROC曲线显示评分系统的AUC值大于单一预测因子。X-title软件确定了评分系统的截值点并自动将患者分为低风险组(0~1分)、中风险组(2~3分)及高风险组(4~6分),3组患者之间总体预后水平差异有统计学意义(P<0.001)。结论:本研究构建的简易评分系统对Ⅰ期子宫内膜癌患者预后评估有一定价值。
