Abstract
BackgroundThe existing literature does not provide a prediction model for mortality of all colorectal cancer patients using contemporary national hospital data. We developed and validated such a model to predict colorectal cancer death within 90, 180 and 365 days after diagnosis.MethodsCohort study using linked national cancer and death records. The development population included 27,480 patients diagnosed in England in 2015. The test populations were diagnosed in England in 2016 (n = 26,411) and Wales in 2015–2016 (n = 3814). Predictors were age, gender, socioeconomic status, referral source, performance status, tumour site, TNM stage and treatment intent. Cox regression models were assessed using Brier scores, c-indices and calibration plots.ResultsIn the development population, 7.4, 11.7 and 17.9% of patients died from colorectal cancer within 90, 180 and 365 days after diagnosis. T4 versus T1 tumour stage had the largest adjusted association with the outcome (HR 4.67; 95% CI: 3.59–6.09). C-indices were 0.873–0.890 (England) and 0.856–0.873 (Wales) in the test populations, indicating excellent separation of predicted risks by outcome status. Models were generally well calibrated.ConclusionsThe model was valid for predicting short-term colorectal cancer mortality. It can provide personalised information to support clinical practice and research.
Highlights
The existing literature does not provide a prediction model for mortality of all colorectal cancer patients using contemporary national hospital data
In the population used to develop the prediction model, the percentages of patients who died from colorectal cancer were 7.4%, 11.7% (180 days), and 17.9% (365 days)
These percentages were similar in the England test population but slightly greater in the Wales test population (Table 1)
Summary
The existing literature does not provide a prediction model for mortality of all colorectal cancer patients using contemporary national hospital data. We developed and validated such a model to predict colorectal cancer death within 90, 180, and 365 days after diagnosis. Results: In the development population, 7.4%, 11.7%, and 17.9% of patients died from colorectal cancer within 90, 180, and 365 days after diagnosis. C-indices were 0.873–0.890 (England) and 0.856–0.873 (Wales) in the test populations, indicating excellent separation of predicted risks by outcome status. Prediction models have been used to examine prognosis in clinical trials,[6] to control for confounding in observational studies,[7] and to assess the added prognostic value of biomarkers.[8] In clinical practice, they may be used to inform treatment decisions and to communicate prognosis to patients, in line with the aims of personalised medicine and shared decision-making.[9]
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