Individualized conditional survival nomograms for stage I–III early onset colorectal cancer patients

Abstract

Objective Conditional survival accounts for the time already survived after surgery and provides additional survival information. The aim was to assess conditional survival in stages I–III early onset colorectal cancer patients and to create nomograms predicting the conditional overall survival and cancer-specific survival after surgery. Methods A total of 7058 patients who underwent surgical resection of early onset colorectal cancer were identified from surveillance, epidemiology and end results database. The formula used for conditional survival calculation was conditional survival(x|y) = S(x + y)/S(x), where S(x) represents the survival at x years. Conditional survival nomograms were then developed to predict the 5-year conditional overall survival and cancer-specific survival. Results The 5-year overall survival and cancer-specific survival after surgery increases gradually with additional survival time. Race, tumour site, grade, histology, T stage, N stage, lymph node ratio, preoperative carcinoma embryonic antigen level and perineural invasion status were independent predictors of cancer-specific survival, while age and sex were another two independent risk factors for overall survival. The nomograms based on these factors were successfully developed to predict 5-year overall survival and cancer-specific survival given 1–4 years already survived. Conclusion The probability of achieving postoperative 5-year overall survival and cancer-specific survival for early onset colorectal cancer increases gradually with additional time survived. The developed nomograms are fairly valuable and informative in facilitating clinical treatment and follow-up schemes.

Construction and validation of a nomogram for predicting overall survival of patients with stage III/IV early−onset colorectal cancer

“…However, a few studies have presented contrasting views. A survival nomogram for stage I–III EO-CRC patients revealed that patients with older age had a worse survival than those with younger age ( 14 ). In contrast, another nomogram for combined lymphatic metastases in EO-CRC patients demonstrated that patients with younger age had a worse survival than those with older age ( 21 ).…”

“…Similar to T stage, a higher N stage means a worse prognosis ( 14 , 20 , 24 ). In contrast, our study suggested another paradoxical finding.…”

“…Our results also support this view. Generally speaking, a higher T stage means a worse prognosis (13,14,21). Surprisingly, our study indicated that, compared to T1 patients, those with T2 (adjusted hazard ratio [aHR], 0.28; 95% confidence interval [CI], 0.21-0.36), T3 (aHR, 0.52; 95% CI, 0.45-0.61) and > T4 (aHR, 1.07; 95% CI, 0.91-1.26) had better OS independent of other variables.…”

“…However, some problems remain. First, flow chat was not available in two studies ( 13 , 14 ). Second, three nomograms ( 15 – 17 ) were associated with too many prognosis factors (≥ 12), which reduced its practicability.…”

“…For example, it was paradoxical that patients with grade I had a worse prognosis than those with grade II (15,16,18). Similar to the "grade paradox", there were also "race/ethnicity paradox" (13,14,19,20), "T stage paradox" (16, 18,19), "histologic subtypes paradox" (21), and "primary site paradox" (15,18,21,22). Thus, more high-quality research is urgently needed.…”