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Analysis of prognostic factors in different grades of histologic differentiation in colorectal cancer patients receiving preoperative neoadjuvant chemotherapy and establishment of prognostic nomograms for moderately differentiated grade

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Objective

The aim of this study is to analyze the differences in independent prognostic factors of cancer-specific survival (CSS) and overall survival (OS) in patients with different grades of histologic differentiation of colorectal cancer (CRC) who received preoperative neoadjuvant chemotherapy (NAC) and to establish a nomogram for predicting postoperative survival based on moderately differentiated CRC.

Methods

We analyzed CRC patients from the SEER database who received NAC before operation between 2010 and 2015. The Kaplan-Meier curves were drawn to describe the differences in CSS and OS of CRC patients with different histologic grades of differentiation. Cox regression analysis was used to determine the independent prognostic factors. Nomograms were established to predict CSS and OS at 3 and 5 years by integrating independent prognostic factors. The calibration curve, receiver operating characteristic (ROC) curve, and C-index were used to verify nomograms.

Results

A total of 6481 patients with CRC who received preoperative NAC were included in this study. Patients with different grades of histologic differentiation had significant differences in CSS and OS (P < 0.001), and the independent prognostic factors of different grades of histologic differentiation showed heterogeneity. In patients with moderately differentiated grade CRC, the independent prognostic factors for CSS and OS were age, race, marital status, serum carcinoembryonic antigen (CEA) level before treatment, site of primary tumor, histologic type, pT stage, pN stage, liver metastasis, and lung metastasis. Nomograms were established based on the independent prognostic factors of moderately differentiated grade CRC, and its calibration curves, area under the curve (AUC), and C-index showed good prediction accuracy.

Conclusions

The independent prognostic factors of CSS and OS are different in patients with different grades of histologic differentiation of CRC who received NAC before the operation. Nomograms can be used to predict the survival of patients with moderately differentiated grade CRC who received preoperative NAC and to assist clinicians in making clinical decisions.

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Data availability

Publicly available datasets were analyzed in this study. This data can be found here: Surveillance, Epidemiology, and End Results (SEER) database (https://seer.cancer.gov/).

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Author information

Author notes

  1. Xiagang Luo, Yimin E and Jie Wu contributed equally to this work and should be considered as co-first authors.

Authors and Affiliations

  1. Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, 121 Jiang jia Yuan Road, Nanjing, 210011, China

    Xiagang Luo, Yimin E & Jianping Zhang

  2. Medical Center for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China

    Jie Wu

  3. Department of General Surgery, Sir Run Run Hospital Nanjing Medical University, Nanjing, China

    Chen Lu

Authors
  1. Xiagang Luo
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  4. Chen Lu
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  5. Jianping Zhang
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Contributions

(I) Conception and design: Jianping Zhang, Xiagang Luo, Yimin E; (II) Administrative support: Jianping Zhang; (III) Provision of study materials or patients: Xiagang Luo, Yimin E, Jie Wu; (IV) Collection and assembly of data: Xiagang Luo, Yimin E; (V) Data analysis and interpretation: Xiagang Luo, Yimin E, Chen Lu; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Xiagang Luo, Yimin E, Jie Wu contributed equally to this work.

Corresponding author

Correspondence to Jianping Zhang.

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The SEER database is an open public database, and the release of data from the SEER database does not require informed patient consent.

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The authors declare no competing interests.

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Luo, X., E, Y., Wu, J. et al. Analysis of prognostic factors in different grades of histologic differentiation in colorectal cancer patients receiving preoperative neoadjuvant chemotherapy and establishment of prognostic nomograms for moderately differentiated grade. Int J Colorectal Dis 38, 237 (2023). https://doi.org/10.1007/s00384-023-04539-x

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  • DOI: https://doi.org/10.1007/s00384-023-04539-x

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