目的·探究影响结直肠癌（colorectal cancer，CRC）患者无进展生存时间（progression-free survival，PFS）的风险因素，建立相应的预后预测模型。方法·采用回顾性队列研究，纳入上海交通大学医学院附属同仁医院的533例经手术切除并病理确诊为结直肠腺癌的患者，按照7∶3的比例随机拆分为训练集（373例）和验证集（160例）。采用单因素和多因素Cox比例风险回归模型分析纳入的临床资料，分析CRC患者术后PFS的独立影响因素，并建立关于结直肠癌的临床预后预测模型。使用一致性指数（concordance index，C-index）、受试者操作特征曲线（receiver operator characteristic curve，ROC曲线）下面积（area under the curve，AUC）、校准曲线、生存曲线评估预测模型的区分度和校准度。进一步通过多因素Cox回归分析确定不同年龄、性别以及美国癌症联合委员会（American Joint Committee on Cancer，AJCC）癌症分期人群预后的独立影响因素。结果·多因素Cox回归分析发现，年龄、吸烟史、肝脏疾病、糖类抗原724（carbohydrate antigen 724，CA724）、AJCC分期是PFS的独立影响因素。在训练集中，该PFS模型的C-index为0.69，3年和5年的AUC分别为0.744和0.713。在验证集中，该PFS模型的C-index为0.64，3年和5年的AUC分别为0.706和0.683。校准曲线图可见训练集和验证集的PFS预测校准曲线均趋近标准曲线。生存曲线提示低风险组患者的进展率显著低于高风险组。分层分析结果表明：对年龄≥65岁患者，年龄、肝脏疾病、AJCC临床分期是术后PFS的独立影响因素；对年龄<65岁的患者，吸烟史、CA724、AJCC临床分期是术后PFS的独立影响因素。对男性患者，年龄、吸烟史、CA724、AJCC临床分期是术后PFS的独立影响因素；对女性患者，肝脏疾病、CA724、AJCC临床分期是术后PFS的独立影响因素。对AJCC分期Ⅰ~Ⅱ期的患者，年龄和吸烟史是术后PFS的独立影响因素；对AJCC分期Ⅲ~Ⅳ期的患者，年龄、肝脏疾病和CA724是术后PFS的独立影响因素。结论·针对CRC患者建立的PFS预后模型具有较好区分能力，为临床医师提供了有效的风险评估工具。

Objective ·To explore the risk factors affecting progression-free survival (PFS) in colorectal cancer (CRC) patients and establish a corresponding prognostic prediction model. Methods ·A retrospective cohort study was used for analysis, including 533 patients with surgically resected and pathologically confirmed colorectal adenocarcinoma at Tongren Hospital, Shanghai Jiao Tong University School of Medicine, who were randomly divided into a training set (373 cases) and a validation set (160 cases) in a 7:3 ratio. The included clinical data were analyzed using univariate and multivariate Cox proportional hazards models to explore independent factors affecting postoperative PFS in patients with CRC and to establish a clinical prognostic prediction model based on these factors. The discrimination and calibration of the prediction model were evaluated by using concordance index (C-index), area under the receiver operating characteristic (ROC) curve (AUC), calibration curve, and survival curve. The independent effects of age, gender, and American Joint Committee on Cancer (AJCC) cancer stage on prognosis were assessed using multivariate Cox regression analysis. Results ·Multivariate Cox regression analysis revealed that age, smoking history, liver disease, carbohydrate antigen 724 (CA724), and AJCC stage were independent factors influencing PFS. In the training set, the C-index of the PFS model was 0.69, with AUCs of 0.744 and 0.713 at 3 and 5 years, respectively. In the validation set, the C-index of the PFS model was 0.64, with AUCs of 0.706 and 0.683 at 3 and 5 years, respectively. The calibration curves showed that the prediction of PFS for the training and validation sets were close to the standard curve. The survival curves suggested that the progression rate of patients in the low-risk group was significantly lower than that in the high-risk group. Stratified analysis revealed that among patients aged ≥65 years, age, liver disease, and AJCC clinical stage were independent factors affecting postoperative PFS. Among patients aged <65 years, smoking history, CA724, and AJCC clinical stage were independent factors affecting postoperative PFS. For male patients, age, smoking history, CA724, and AJCC clinical stage were independent factors affecting postoperative PFS, while for female patients, liver disease, CA724, and AJCC clinical staging were independent predictors of postoperative PFS. Among patients with AJCC stage Ⅰ‒Ⅱ, age and smoking history were independent factors affecting postoperative PFS, whereas in those with AJCC stage Ⅲ‒⁠Ⅳ, age, liver disease, and CA724 were independent factors affecting postoperative PFS. Conclusion ·The PFS prognostic model established in this study for CRC patients has good discriminative ability and provides clinicians with an effective risk assessment tool.