Abstract
BackgroundConsidering that the knowledge of adenocarcinoma in villous adenoma of the colorectum is limited to several case reports, we designed a study to investigate independent prognostic factors and developed nomograms for predicting the survival of patients.MethodsUnivariate and multivariate Cox regression analyses were used to evaluate prognostic factors. A nomogram predicting cancer-specific survival (CSS) was performed; internally and externally validated; evaluated by receiver operating characteristic (ROC) curve, C-index, and decision curve analyses; and compared to the 7th TNM stage.ResultsPatients with adenocarcinoma in villous adenoma of the colorectum had a 1-year overall survival (OS) rate of 88.3% (95% CI: 87.1–89.5%), a 3-year OS rate of 75.1% (95% CI: 73.3–77%) and a 5-year OS rate of 64.5% (95% CI: 62–67.1%). Nomograms for 1-, 3- and 5-year CSS predictions were constructed and performed better with a higher C-index than the 7th TNM staging (internal: 0.716 vs 0.663; P < 0.001; external: 0.713 vs 0.647; P < 0.001). Additionally, the nomogram showed good agreement between internal and external validation. According to DCA analysis, compared to the 7th TNM stage, the nomogram showed a greater benefit across the period of follow-up regardless of the internal cohort or external cohort.ConclusionAge, race, T stage, pathologic grade, N stage, tumor size and M stage were prognostic factors for both OS and CSS. The constructed nomograms were more effective and accurate for predicting the 1-, 3- and 5-year CSS of patients with adenocarcinoma in villous adenoma than 7th TNM staging.
Highlights
Considering that the knowledge of adenocarcinoma in villous adenoma of the colorectum is limited to several case reports, we designed a study to investigate independent prognostic factors and developed nomograms for predicting the survival of patients
Mounting evidence has suggested that villous adenoma is correlated with adenocarcinoma, current knowledge of the survival rate of patients with adenocarcinoma in villous adenoma is limited to a small series of studies [7,8,9,10,11]
The six variables of age, grade, tumor size, T stage, N stage and metastasis had statistical significance in the cases of death attributed to adenocarcinoma and other causes, while no significant differences were observed for race, sex or tumor number
Summary
Considering that the knowledge of adenocarcinoma in villous adenoma of the colorectum is limited to several case reports, we designed a study to investigate independent prognostic factors and developed nomograms for predicting the survival of patients. According to previous studies, compared with other adenomas, adenomas with villous features have been considered a risk factor associated with an increased probability of developing into a more advanced neoplasia or dysplasia lesion [4]. Mounting evidence has suggested that villous adenoma is correlated with adenocarcinoma, current knowledge of the survival rate of patients with adenocarcinoma in villous adenoma is limited to a small series of studies [7,8,9,10,11].
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