Abstract
BackgroundFew prediction models have so far been developed and assessed for the prognosis of patients who undergo curative resection for colorectal cancer (CRC).Materials and MethodsWe prepared a clinical dataset including 5,530 patients who participated in three major randomized controlled trials as a training dataset and 2,263 consecutive patients who were treated at a cancer-specialized hospital as a validation dataset. All subjects underwent radical resection for CRC which was histologically diagnosed to be adenocarcinoma. The main outcomes that were predicted were the overall survival (OS) and disease free survival (DFS). The identification of the variables in this nomogram was based on a Cox regression analysis and the model performance was evaluated by Harrell's c-index. The calibration plot and its slope were also studied. For the external validation assessment, risk group stratification was employed.ResultsThe multivariate Cox model identified variables; sex, age, pathological T and N factor, tumor location, size, lymphnode dissection, postoperative complications and adjuvant chemotherapy. The c-index was 0.72 (95% confidence interval [CI] 0.66-0.77) for the OS and 0.74 (95% CI 0.69-0.78) for the DFS. The proposed stratification in the risk groups demonstrated a significant distinction between the Kaplan–Meier curves for OS and DFS in the external validation dataset.ConclusionsWe established a clinically reliable nomogram to predict the OS and DFS in patients with CRC using large scale and reliable independent patient data from phase III randomized controlled trials. The external validity was also confirmed on the practical dataset.
Highlights
The c-index was 0.72 (95% confidence interval [CI] 0.660.77) for the overall survival (OS) and 0.74 for the disease free survival (DFS)
The proposed stratification in the risk groups demonstrated a significant distinction between the Kaplan–Meier curves for OS and DFS in the external validation dataset
Surgical resection has been the pivotal treatment for patients with colorectal cancer (CRC), and recent advances in total mesorectal excision and multidisciplinary therapy have improved the oncological outcomes of these patients [1,2,3]
Summary
Surgical resection has been the pivotal treatment for patients with colorectal cancer (CRC), and recent advances in total mesorectal excision and multidisciplinary therapy have improved the oncological outcomes of these patients [1,2,3]. Despite achieving a potentially curative resection and the administration of adjuvant treatment, the recurrence rate remains at 20% to 40% after curative resection in patients with stage II or III CRC. Because recent progress on multimodality treatment could improve the curability of such patients, conducting an intensive follow-up after curative resection for CRC has been reported to improve the survival rate [4]. A system for predicting the prognosis or recurrence patterns on an individual basis is required. Few prediction models have so far been developed and assessed for the prognosis of patients who undergo curative resection for colorectal cancer (CRC)
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