Development and validation of nomograms for prediction of overall survival and cancer-specific survival of patients with Stage IV colorectal cancer

Zhang, Jieyun; Gong, Zhe; Gong, Yitao

doi:10.1093/jjco/hyz035

Cited by 25 publications

(18 citation statements)

References 19 publications

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“…19 Additional individualized treatment after surgical resection may offer improved At present, the individual survival of patients with CRC is usually predicted via the TNM staging system, which has limitations in its precision. In recent years, various prognostic models have been described, [20][21][22][23][24][25] but an ideal survival prediction model developed for stage II-III CRC has not yet been created. Thus, intensive study regarding the prediction of individual survival for postoperative patients with CRC is urgently needed.…”

Section: Discussionmentioning

confidence: 99%

Nomogram for predicting overall survival in stage II‐III colorectal cancer

et al. 2020

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Purpose The overall survival (OS) of patients diagnosed with stage II‐III colorectal cancer (CRC) can vary greatly, even between patients with the same tumor stage. We aimed to design a nomogram to predict OS in resected, stage II‐III CRC and stratify patients with CRC into different risk groups. Patients and Methods Based on data from 873 patients with CRC, we used univariate Cox regression analysis to select the significant prognostic features, which were subjected to the least absolute shrinkage and selection operator (LASSO) regression algorithm for feature selection. Cross‐validation was used to confirm suitable tuning parameters (λ) for LASSO logistic regression. Then, the nomogram was used to estimate 3‐ and 5‐year OS based on the multivariable Cox regression model. The survival curves of the two groups were produced using the Kaplan‐Meier method. Risk group stratification was performed to assess the predictive capacity of the nomogram. Results Preoperative mean platelet volume, preoperative platelet distribution width, monocytes, and postoperative adjuvant chemotherapy were identified as independent prognostic factors by LASSO regression and integrated for the construction of the nomogram. The nomogram provided good discrimination, with C‐indices of 0.67 and 0.69 for the training and validation sets, respectively. Calibration plots illustrated excellent agreement between the nomogram predictions and actual observations for 3‐ and 5‐year OS. Moreover, a significant difference in OS was shown between patients stratified into different risk groups (P < .001). Conclusion We constructed and validated an original predictive nomogram for OS in patients with CRC after surgery, facilitating physicians to appraise the individual survival of postoperative patients accurately and identify high‐risk patients who need more aggressive treatment and follow‐up strategies.

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Section: Discussionmentioning

confidence: 99%

Nomogram for predicting overall survival in stage II‐III colorectal cancer

et al. 2020

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“…More importantly, we created and verified the first survival nomogram devoted to accurately predict OS in patients with EOCRC. In addition, our survival nomogram exhibited good predictive ability for OS in EOCRC patients (C-index of 0.829, 0.841 and 0.796 in the SEER training, SEER validation and RHWU validation sets, respectively), which was much higher than predictive value (C-index less than 0.75) of the nomogram for OS in traditional CRC patients [25][26][27][28].…”

Section: Discussionmentioning

confidence: 99%

Personalizing prognostic prediction in early-onset Colorectal Cancer

Liu

et al. 2020

J. Cancer

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Accurately estimating prognosis based on clinicopathologic variables could improve risk stratification for patients with early-onset colorectal cancer (EOCRC). Our primary goal was to create and validate a survival nomogram with adequate performance for predicting overall survival (OS) in patients with EOCRC. Least absolute shrinkage and selection operator (LASSO) Cox regression analysis was applied to identify clinical features statistically related to OS. Then we established and internally validated a survival nomogram based on surveillance, epidemiology and end results (SEER) database (N=23813). A cohort of 77 patients with EOCRC from Renmin Hospital of Wuhan University (RHWU) was employed to detect the external validity of the survival nomogram. Moreover, we compared the predictive accuracy of survival nomogram with TNM stage, and also compared the OS between endoscopy and surgery groups before and after propensity score matching (PSM) among EOCRC patients with early stage (Tis-T1N0M0). We selected seven informative indexes (N stage, M stage, perineural invasion, chemotherapy, surgery primary site, summary stage and tumor grade) for the construction of the survival nomogram. Then the survival nomogram exhibited good discrimination with C-index of 0.829, 0.841 and 0.796 in the SEER training, SEER validation and RHWU validation sets, respectively. Calibration curves showed good concordance between the survival nomogram predictions and actual outcomes for 1-year, 3-year and 5-year OS. Furthermore, the survival nomogram was superior to risk stratification by TNM stage in predicting OS among patients with EOCRC. Early-stage patients treated with endoscopy showed similar survival to those with surgery before and after PSM. We proposed a survival nomogram based on the extensively used parameters to precisely predict OS in EOCRC patients. This survival nomogram will contribute to aid oncologists better risk stratification and prognostication for patients with EOCRC.

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“…Nomograms are widely used as graphical prediction models, by which survival predictive points can be calculated based on the predictors [ 15 ]. Several prognostic nomograms for stage IV CRC have been constructed in recent years [ 16 – 18 ]. Based on 1133 stage IV CRC patients who received curative resection, nomograms to predict disease-free survival (DFS) and overall survival (OS) were constructed [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, neither serum CEA level nor the performance of adjuvant treatment (radiation and chemotherapy) were included as predictors, which are widely considered independent prognostic factors for CRC patients [ 13 ]. Another SEER-based study enrolled 2996 CRC patients with stage IV disease, and a predictive nomogram was constructed [ 18 ]. External validation was performed based on a Chinese cohort with high discrimination (C-index of OS: 0.657; 95% CI 0.544–0.770), which indicated good transportability of the nomogram [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

Nomogram for predicting overall survival in colorectal cancer with distant metastasis

Liu

et al. 2021

BMC Gastroenterol

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Background Colorectal cancer (CRC) is a major cancer burden, and prognosis is determined by many demographic and clinicopathologic factors. The present study aimed to construct a prognostic nomogram for colorectal cancer patients with distant metastasis. Methods Colorectal cancer patients with distant metastasis diagnosed between 2010 and 2016 were selected from the Surveillance, Epidemiology, and End Results database. Cox proportional hazards regression was used to identify independent prognostic factors. A nomogram was constructed to predict survival, and validation was performed. Results A total of 7099 stage IV colorectal cancer patients were enrolled in the construction cohort. The median overall survival was 20.0 (95% CI 19.3–20.7) months. Age at diagnosis, marital status, race, primary tumour site, tumour grade, CEA level, T stage, N stage, presence of bone, brain, liver and lung metastasis, surgery for primary site and performance of chemotherapy were independent prognostic factors. The nomogram was constructed and the calibration curve showed satisfactory agreement. The C-index was 0.742 (95% CI 0.726–0.758). In the validation cohort (7098 patients), the nomogram showed satisfactory discrimination and calibration with a C-index of 0.746 (95% CI 0.730–0.762). Conclusion A series of factors associated with the survival of CRC patients with distant metastasis were found. Based on the identified factors, a nomogram was generated to predict the survival of stage IV colorectal cancer patients. The predictive model showed satisfactory discrimination and calibration, which can provide a reference for survival estimation and individualized treatment decisions.

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Development and validation of nomograms for prediction of overall survival and cancer-specific survival of patients with Stage IV colorectal cancer

Abstract: We built nomograms for the prediction of OS and CCSS of patients with Stage IV colorectal cancer. Performance of the model was excellent.

Cited by 25 publications

References 19 publications

Nomogram for predicting overall survival in stage II‐III colorectal cancer

Nomogram for predicting overall survival in stage II‐III colorectal cancer

Personalizing prognostic prediction in early-onset Colorectal Cancer

Nomogram for predicting overall survival in colorectal cancer with distant metastasis

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