Abstract
ObjectivesTo develop and validate predictive nomograms of cancer specific survival (CSS) and overall survival (OS) for synchronous colon cancer with liver metastasis (SCLM) patients.MethodsPatients with pathologically diagnosed colon cancer with liver metastasis were retrieved from the SEER database between 2010 and 2015. Only SCLM patients were included. Univariate and multivariate cox regression analyses were conducted to identify the potential predictors of patients’ survival outcomes. The selected variables were integrated to create predictive nomograms via R tools. Furthermore, the concordance index Harrell’s C statistic (C-index) was calculated to describe the discrimination of nomograms. Calibration (1000 bootstrap resamples) curves were plotted to compare the predictions of nomograms with the observed outcomes. Decision curve analysis (DCA) and clinical impact curves were performed to evaluate the clinical effects of nomograms.ResultsA total of 22,378 SCLM patients were included. The median time of OS and CSS was 13 and 17 months, respectively. The 1-, 2-, and 3-year rate of OS was 50.6, 28.1, and 14.8%, respectively. While the 1-, 2-, and 3-year rate of CSS was 58.7, 36.8, and 22.5%, respectively. SCLM patients with increased age, left primary tumor location, AJCC IVb stage, and no chemotherapy were associated with an obviously reduced OS and CSS. Variables including age, histological grade, T/N/M stage, tumor size, bone/lung metastasis, CEA, surgery of primary site, and chemotherapy were closely related to the prognoses of SCLM patients. Nomograms of OS and CSS were built and displayed online for convenient utilization. The C-index of OS and CSS monograms were 0.74 and 0.73, respectively, indicating relatively good discrimination of the nomograms. The calibration curves suggested a good agreement between the actual observation and the nomogram prediction. DCAs and clinical impact curves reflected favorable potential clinical effects of predictive nomograms.ConclusionChemotherapy, surgery of primary site, and age were important independent risk factors for the CSS and OS of SCLM patients. We built and validated two reliable nomograms of OS and CSS to predict the prognoses of SCLM patients, which can be accessed online at (https://predictive-tool.shinyapps.io/CSS-DynNomapp/; https://predictive-tool.shinyapps.io/OS-DynNomapp/).
Highlights
PATIENTS AND METHODSColorectal cancer (CRC) is a commonly diagnosed malignant digestive tract cancer both in men and women worldwide
A total of 179,426 patients diagnosed with colon cancer were extracted from the SEER database
The results revealed that age, histological grade, T/N/M stage, tumor size, bone/lung metastasis, CEA, surgery of primary site, and chemotherapy were independent risk factors for the cancer-specific survival (CSS) and overall survival (OS) of Synchronous colon cancer with liver metastasis (SCLM) patients
Summary
Colorectal cancer (CRC) is a commonly diagnosed malignant digestive tract cancer both in men and women worldwide. CRC is responsible for 10% of cancer-specific deaths in the United States, ranking as the second leading cause [1]. Despite the difference in primary site and histology subtypes, generally, the most frequently metastatic organ of CRC is the liver, followed by the lungs, bone, and the brain [3]. Liver metastases were observed in more than 25% of CRC patients when initially diagnosed. Liver metastases occurred in up to 25% of patients after the resection of a primary tumor. A total of 50% of CRC patients may develop liver metastases during the whole disease course [4, 5]
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