Abstract
BackgroundTo use competing analyses to estimate the prognostic value of KRAS mutation status in colorectal cancer (CRC) patients and to build nomogram for CRC patients who had KRAS testing.MethodThe cohort was selected from the Surveillance, Epidemiology, and End Results database. Cumulative incidence function model and multivariate Fine-Gray regression for proportional hazards modeling of the subdistribution hazard (SH) model were used to estimate the prognosis. An SH model based nomogram was built after a variable selection process. The validation of the nomogram was conducted by discrimination and calibration with 1,000 bootstraps.ResultsWe included 8,983 CRC patients who had KRAS testing. SH model found that KRAS mutant patients had worse CSS than KRAS wild type patients in overall cohort (HR = 1.10 (95% CI [1.04–1.17]), p < 0.05), and in subgroups that comprised stage III CRC (HR = 1.28 (95% CI [1.09–1.49]), p < 0.05) and stage IV CRC (HR = 1.14 (95% CI [1.06–1.23]), p < 0.05), left side colon cancer (HR = 1.28 (95% CI [1.15–1.42]), p < 0.05) and rectal cancer (HR = 1.23 (95% CI [1.07–1.43]), p < 0.05). We built the SH model based nomogram, which showed good accuracy by internal validation of discrimination and calibration. Calibration curves represented good agreement between the nomogram predicted CRC caused death and actual observed CRC caused death. The time dependent area under the curve of receiver operating characteristic curves (AUC) was over 0.75 for the nomogram.ConclusionThis is the first population based competing risk study on the association between KRAS mutation status and the CRC prognosis. The mutation of KRAS indicated a poor prognosis of CRC patients. The current competing risk nomogram would help physicians to predict cancer specific death of CRC patients who had KRAS testing.
Highlights
Colorectal cancer (CRC) is the second and third most common cancer of women and men worldwide, respectively (Bray et al, 2018)
Significant differences were found between KRAS MT and KRAS wild type (WT) patients among variables of age, race, location, surgery, tumor stage, grade, positive regional nodes amount, and chemotherapy experience (p < 0.05)
In KRAS MT patients, the death rate caused by cancer and other reasons were 49.89% and 13.69%, respectively
Summary
Colorectal cancer (CRC) is the second and third most common cancer of women and men worldwide, respectively (Bray et al, 2018). Prognostic value of KRAS mutation status in colorectal cancer patients: a population-based competing risk analysis. CRC is a heterogeneous disease with various genetic events (Inamura, 2018; Punt, Koopman & Vermeulen, 2017). To use competing analyses to estimate the prognostic value of KRAS mutation status in colorectal cancer (CRC) patients and to build nomogram for CRC patients who had KRAS testing. We built the SH model based nomogram, which showed good accuracy by internal validation of discrimination and calibration. Conclusion: This is the first population based competing risk study on the association between KRAS mutation status and the CRC prognosis. The current competing risk nomogram would help physicians to predict cancer specific death of CRC patients who had KRAS testing
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