Influencing factors and predictive model of the early postoperative recurrence of colorectal cancer with obstruction

Abstract

BACKGROUND

In cases of colorectal cancer (CRC) with obstruction, patients experience local tissue edema due to intestinal obstruction. This condition stimulates the accumulation of inflammatory factors, activates cancer cells, and increases the risk of tumor recurrence. At present, analyses and evaluation tools for factors influencing early postoperative recurrence in patients with CRC and obstruction are limited.

AIM

To explore the influencing factors and construct a predictive model of the early postoperative recurrence of CRC with obstruction.

METHODS

Data from 181 patients with CRC and obstruction who underwent surgery in the Department of Gastrointestinal Surgery, Suzhou Ninth Hospital Affiliated to Soochow University, between January 2017 and May 2023 were retrospectively collected. Patients with CRC and obstruction were divided into a recurrence group and a non-recurrence group based on whether recurrence occurred during the 2-year follow-up after surgery. Datasets from the two groups were compared. Subsequently, multiple logistic regression was employed to analyze the influencing factors of the early postoperative recurrence of CRC with obstruction. The nomogram prediction model was drawn using R software, and its performance was evaluated by the goodness of fit test and receiver operating characteristic (ROC) curve analysis. The clinical benefit rate of the model was evaluated by decision curves.

RESULTS

Among the 181 patients with CRC and obstruction, 52 (28.73%) experienced tumor recurrence within 2 years after surgery. Significant differences were observed in preoperative carcinoembryonic antigen (CEA), preoperative systemic immune-inflammation index (SII), tumor, node, and metastasis (TNM) stage, differentiation degree, nerve infiltration, and Ki-67 expression between the recurrence and non-recurrence groups (P < 0.05). Multivariate logistic regression analysis showed that high preoperative CEA (OR = 2.094, P = 0.008), high preoperative SII (OR = 2.795, P < 0.001), TNM stage III (OR = 1.644, P = 0.027), poor differentiation (OR = 1.861, P = 0.035), and high Ki-67 expression (OR = 2.467, P = 0.001) were all influencing factors for early postoperative recurrence of CRC with obstruction. The area under the ROC curve of the nomograph model constructed based on this was 0.890, the goodness of fit deviation test was conducted (χ² = 3.903, P = 0.866), and the decision curve display model demonstrated practical value in clinical practice.

CONCLUSION

The early recurrence rate of CRC with obstruction is high. CEA, SII, TNM staging, differentiation degree, and Ki-67 expression are factors related to early postoperative recurrence. A nomogram prediction model incorporating these factors can effectively evaluate the risk of early postoperative recurrence in patients with CRC.

Keywords: Colorectal cancer; Obstruction; Early recurrence; Influencing factors; Prediction model

Core Tip: Colorectal cancer (CRC) with intestinal obstruction is at risk of recurrence following surgery. This study analyzed factors influencing early postoperative recurrence of CRC with obstruction and constructed a nomogram prediction model. This model provides significant guidance for the clinical evaluation of the early postoperative recurrence risk in patients with CRC and intestinal obstruction and focuses on targeted measures to reduce the early recurrence risk.