Purpose

Risk assessment of disease recurrence in pT1 colorectal cancer is crucial in order to select the appropriate treatment strategy. The study aimed to develop a prediction model, based on histopathological data, for the probability of disease recurrence and residual disease in patients with pT1 colorectal cancer.

Methods

The model dataset consisted of 558 patients with pT1 CRC who had undergone endoscopic resection only (n = 339) or endoscopic resection followed by subsequent bowel resection (n = 219). Tissue blocks and slides were retrieved from Pathology Departments from all regions in Denmark. All original slides were evaluated by one experienced gastrointestinal pathologist (TPK). New sections were cut and stained for haematoxylin and eosin (HE) and immunohistochemical markers. Missing values were multiple imputed. A logistic regression model with backward elimination was used to construct the prediction model.

Results

The final prediction model for disease recurrence demonstrated good performance with AUC of 0.75 [95% CI 0.72–0.78], HL chi-squared test of 0.59 and scaled Brier score of 10%. The final prediction model for residual disease demonstrated medium performance with an AUC of 0.68 [0.63–0.72].

Conclusion

We developed a prediction model for the probability of disease recurrence in pT1 CRC with good performance and calibration based on histopathological data. Together with lymphatic and venous invasion, an involved resection margin (0 mm) as opposed to a margin of ≤ 1 mm was an independent risk factor for both disease recurrence and residual disease.

中文翻译：

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pT1 结直肠癌初次内镜切除术后疾病复发或残留疾病的预测——丹麦一项大型全国性研究的结果

目的

为了选择合适的治疗策略，pT1 结直肠癌疾病复发的风险评估至关重要。该研究旨在基于组织病理学数据开发一个预测模型，用于预测 pT1 结直肠癌患者疾病复发和残留疾病的可能性。

方法

模型数据集由 558 名 pT1 CRC 患者组成，他们仅接受内镜切除术 ( n  = 339) 或内镜切除后再行肠切除 ( n  = 219)。组织块和载玻片取自丹麦所有地区的病理科。所有原始载玻片均由一位经验丰富的胃肠道病理学家 (TPK) 进行评估。切割新切片并进行苏木精和曙红 (HE) 以及免疫组织化学标记物染色。缺失值经过多重估算。使用向后消除的逻辑回归模型来构建预测模型。

结果

疾病复发的最终预测模型表现良好，AUC 为 0.75 [95% CI 0.72–0.78]，HL 卡方检验为 0.59，缩放 Brier 评分为 10%。残留病灶的最终预测模型表现出中等性能，AUC 为 0.68 [0.63–0.72]。

结论

我们开发了一种 pT1 CRC 疾病复发概率的预测模型，具有良好的性能和基于组织病理学数据的校准。与淋巴和静脉侵犯一起，受累切除边缘 (0 mm) 相对于 ≤ 1 mm 的边缘是疾病复发和残留疾病的独立危险因素。