医学
结直肠癌
肿瘤科
内科学
病理分期
阶段(地层学)
危险系数
队列
卡培他滨
病态的
淋巴结
辅助治疗
比例危险模型
癌症
置信区间
生物
古生物学
作者
Andreas Kleppe,Ole-Johan Skrede,Sepp de Raedt,Tarjei S. Hveem,Hanne A. Askautrud,Jørn Evert Jacobsen,David N. Church,Arild Nesbakken,Neil A. Shepherd,Marco Gerlinger,Rachel Kerr,Knut Liestøl,David Kerr,Håvard E. Danielsen
出处
期刊:Lancet Oncology
[Elsevier]
日期:2022-09-01
卷期号:23 (9): 1221-1232
被引量:41
标识
DOI:10.1016/s1470-2045(22)00391-6
摘要
Background The DoMore-v1-CRC marker was recently developed using deep learning and conventional haematoxylin and eosin-stained tissue sections, and was observed to outperform established molecular and morphological markers of patient outcome after primary colorectal cancer resection. The aim of the present study was to develop a clinical decision support system based on DoMore-v1-CRC and pathological staging markers to facilitate individualised selection of adjuvant treatment. Methods We estimated cancer-specific survival in subgroups formed by pathological tumour stage (pT<4 or pT4), pathological nodal stage (pN0, pN1, or pN2), number of lymph nodes sampled (≤12 or >12) if not pN2, and DoMore-v1-CRC classification (good, uncertain, or poor prognosis) in 997 patients with stage II or III colorectal cancer considered to have no residual tumour (R0) from two community-based cohorts in Norway and the UK, and used these data to define three risk groups. An external cohort of 1075 patients with stage II or III R0 colorectal cancer from the QUASAR 2 trial was used for validation; these patients were treated with single-agent capecitabine. The proposed risk stratification system was evaluated using Cox regression analysis. We similarly evaluated a risk stratification system intended to reflect current guidelines and clinical practice. The primary outcome was cancer-specific survival. Findings The new risk stratification system provided a hazard ratio of 10·71 (95% CI 6·39–17·93; p<0·0001) for high-risk versus low-risk patients and 3·06 (1·73–5·42; p=0·0001) for intermediate versus low risk in the primary analysis of the validation cohort. Estimated 3-year cancer-specific survival was 97·2% (95% CI 95·1–98·4; n=445 [41%]) for the low-risk group, 94·8% (91·7–96·7; n=339 [32%]) for the intermediate-risk group, and 77·6% (72·1–82·1; n=291 [27%]) for the high-risk group. The guideline-based risk grouping was observed to be less prognostic and informative (the low-risk group comprised only 142 [13%] of the 1075 patients). Interpretation Integrating DoMore-v1-CRC and pathological staging markers provided a clinical decision support system that risk stratifies more accurately than its constituent elements, and identifies substantially more patients with stage II and III colorectal cancer with similarly good prognosis as the low-risk group in current guidelines. Avoiding adjuvant chemotherapy in these patients might be safe, and could reduce morbidity, mortality, and treatment costs. Funding The Research Council of Norway.
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