Abstract
Background
A nomogram that integrates risk models and clinical characteristics can accurately predict the prognosis of individual patients. We aimed to identify the prognostic factors and establish nomograms for predicting overall survival (OS) and cause-specific survival (CSS) in patients with multi-organ metastatic colorectal cancer (CRC).
Methods
Demographic and clinical information on multi-organ metastases from 2010 to 2019 were extracted from the Surveillance, Epidemiology, and End Results (SEER) Program. Univariate and multivariate Cox analyses were used to identify independent prognostic factors that were used to develop nomograms to predict CSS and OS, and to assess the concordance index (C-index), area under the curve (AUC), and calibration curve.
Results
The patients were randomly assigned to the training and validation groups at a 7:3 ratio. A Cox proportional hazards model was conducted for CRC patients to identify independent prognostic factors, including age, sex, tumor size, metastases, degree of differentiation, stage T, stage N, primary and metastasis surgery. The competing risk models employed by Fine and Gray were used to identify the risk factors for CRC. Death from other causes was treated as a competing event, and Cox models were used to identify the factors for death to identify the independent factors of CSS. By incorporating the corresponding independent prognostic factors, we established prognostic nomograms for OS and CSS. Finally, we used the C-index, ROC curve, and calibration plots to assess the utility of the nomogram.
Conclusions
Using the SEER database, we constructed a predictive model for CRC patients with multi-organ metastases. Nomograms provide clinicians with 1-, 3-, and 5-year OS and CSS predictions for CRC, allowing them to formulate appropriate treatment plans.
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Data availability
The data that support the findings of this study are openly available in the SEER database (www.seer.cancer.gov).
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Study conception and design: XT and NH. Drafting of manuscript: NH, JJ, SH. Acquisition of data and critical revision: HR, XY, YY, YZ. Revision of manuscript, and final approval of manuscript: XT, GX.
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Dr. Nan Hu, Dr. Jiao Jiang, Dr. Shu Huan, Dr. Huiting Rao, Dr. Xin Yang, Dr. Yi Yuan, Dr. Yanlang Zhang, Dr. Guodong Xia, Dr. Xiaowei Tang all have no conflicts of interest or financial ties to disclose.
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Tang, X., Hu, N., Huang, S. et al. Prognostic nomogram for colorectal cancer patients with multi-organ metastases: a Surveillance, Epidemiology, and End Results program database analysis. J Cancer Res Clin Oncol 149, 12131–12143 (2023). https://doi.org/10.1007/s00432-023-05070-w
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DOI: https://doi.org/10.1007/s00432-023-05070-w