Abstract
Liver metastasis in colorectal cancer (CRC) is common and has an unfavorable prognosis. This study aimed to establish a functional nomogram model to predict overall survival (OS) and cancer-specific survival (CSS) in patients with colorectal cancer liver metastasis (CRCLM). A total of 9,736 patients with CRCLM from 2010 to 2016 were randomly assigned to training, internal validation, and external validation cohorts. Univariate and multivariate Cox analyses were performed to identify independent clinicopathologic predictive factors, and a nomogram was constructed to predict CSS and OS. Multivariate analysis demonstrated age, tumor location, differentiation, gender, TNM stage, chemotherapy, number of sampled lymph nodes, number of positive lymph nodes, tumor size, and metastatic surgery as independent predictors for CRCLM. A nomogram incorporating the 10 predictors was constructed. The nomogram showed favorable sensitivity at predicting 1-, 3-, and 5-year OS, with area under the receiver operating characteristic curve (AUROC) values of 0.816, 0.782, and 0.787 in the training cohort; 0.827, 0.769, and 0.774 in the internal validation cohort; and 0.819, 0.745, and 0.767 in the external validation cohort, respectively. For CSS, the values were 0.825, 0.771, and 0.772 in the training cohort; 0.828, 0.753, and 0.758 in the internal validation cohort; and 0.828, 0.737, and 0.772 in the external validation cohort, respectively. Calibration curves and ROC curves revealed that using our models to predict the OS and CSS would add more benefit than other single methods. In summary, the novel nomogram based on significant clinicopathological characteristics can be conveniently used to facilitate the postoperative individualized prediction of OS and CSS in CRCLM patients.
Highlights
Colorectal cancer (CRC) is the third most common cause of cancer-related death worldwide, with an estimated 145,600 new cases diagnosed in 2019; population-based studies have shown that about 30%–55% of CRC patients develop liver metastasis during their course of the disease [1, 2]
We found that primary tumor site is closely related to prognosis of patients with colorectal cancer liver metastases (CRCLM)
A study determining the influence on CRCLM after portal vein embolization and right hepatic resection and evaluating progression-free survival and prognostic factors for overall survival (OS) found that the location of the primary colorectal cancer was a statistically significant predictor, and right-sided colorectal cancers had a significantly shorter progression-free survival than left-sided colorectal cancers
Summary
Colorectal cancer (CRC) is the third most common cause of cancer-related death worldwide, with an estimated 145,600 new cases diagnosed in 2019; population-based studies have shown that about 30%–55% of CRC patients develop liver metastasis during their course of the disease [1, 2]. Previous studies have reported that important predictors of survival in CRCLM patients include multiple liver metastases, positive primary nodules, degree of primary tumor differentiation, extrahepatic spread, tumor size, CEA, positive surgical margin, venous infiltration, and tumor emergence [5, 6]. Intrahepatic lymphatic invasion, especially combined with vascular invasion, is an important adverse prognostic factor for OS in patients with single CRCLM after hepatectomy. These previous studies did not further evaluate these prognostic risk factors in a comprehensive and systematic manner and study their combinations with the aim of establishing a corresponding prediction model that could accurately predict the prognosis of patients with colorectal cancer
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