Abstract
Oxidative stress plays an important role in the development of colorectal cancer (CRC). This study is aimed at developing and validating a novel scoring system, based on oxidative stress indexes, for prognostic prediction in CRC patients. A retrospective analysis of 1422 CRC patients who underwent surgical resection between January 2013 and December 2017 was performed. These patients were randomly assigned to the training set (n = 1022) or the validation set (n = 400). Cox regression model was used to analyze the laboratory parameters. The CRC-Integrated Oxidative Stress Score (CIOSS) was developed from albumin (ALB), direct bilirubin (DBIL), and blood urea nitrogen (BUN), which were significantly associated with survival in CRC patients. Furthermore, a survival nomogram was generated by combining the CIOSS with other beneficial clinical characteristics. The CIOSS generated was as follows: 0.074 × albumin (g/L), −0.094 × bilirubin (μmol/L), and -0.099 × blood urea nitrogen (mmol/L), based on the multivariable Cox regression analysis. Using 50% (0.1025) and 85% (0.481) of CIOSS as cutoff values, three prognostically distinct groups were formed. Patients with high CIOSS experienced worse overall survival (OS) (hazard ratio [HR] = 4.33; 95% confidence interval [CI], 2.80-6.68; P < 0.001) and worse disease-free survival (DFS) (HR = 3.02; 95% CI, 1.96-4.64; P < 0.001) compared to those with low CIOSS. This predictive nomogram had good calibration and discrimination. ROC analyses showed that the CIOSS possessed excellent performance (AUC = 0.818) in predicting DFS. The AUC of the OS nomogram based on CIOSS, TNM stage, T stage, and chemotherapy was 0.812, while that of the DFS nomogram based on CIOSS, T stage, and TNM stage was 0.855. Decision curve analysis showed that these two prediction models were clinically useful. CIOSS is a CRC-specific prognostic index based on the combination of available oxidative stress indexes. High CIOSS is a powerful indicator of poor prognosis. The CIOSS also showed better predictive performance compared to TNM stage in CRC patients.
Highlights
Colorectal cancer (CRC) is the third most common cancer, accounting for 9.7% of all cancers except melanoma skin cancer
In establishing a predictive model of CRC comprehensive oxidative stress score (CIOSS), we found that patients with high CRC-Integrated Oxidative Stress Score (CIOSS) had worse overall survival (OS) (HR = 4:33; 95% CI, 2.80-6.68; P < 0:001) and worse disease-free survival (DFS) (HR = 3:02; 95% CI, 1.96-4.64; P < 0:001) compared with CRC patients with low CIOSS
Li et al established nomogram prediction for progression based on inflammatory biomarkers to predict the prognosis of CRC patients, and the results showed that the inflammatory factors
Summary
Colorectal cancer (CRC) is the third most common cancer, accounting for 9.7% of all cancers except melanoma skin cancer. It is the second and third most common cancer in women and men, respectively, accounting for 10% of all new cancer cases each year [1]. The “rise” of CRC in developed countries can be attributed to an ageing population, unfavorable modern dietary habits, and an increase in risk factors such as smoking, inadequate physical activity, and Oxidative Medicine and Cellular Longevity obesity [2]. Despite significant advances in treatment strategies, the mortality rate from CRC remains high; from 1990 to 2013, the death rate from CRC increased by 57%. The long-term prognosis of CRC patients is still not optimistic, warranting a reasonable and effective prediction model for the long-term prognostic assessment of CRC patients
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