Liang L, Li XS, Huang ZJ, Hu ZH, Xu QJ, Yuan YL, Zhang W, Lei HK. Development and validation of a nomogram prediction model for overall survival in patients with rectal cancer. World J Gastrointest Oncol 2025; 17(2): 100908 [DOI: 10.4251/wjgo.v17.i2.100908]
Corresponding Author of This Article
Hai-Ke Lei, Associate Professor, Chongqing Cancer Multi-omics Big Data Application Engineering Research Center, Chongqing University Cancer Hospital, No. 181 Hanyu Road, Shapingba District, Chongqing 400030, China. tohaike@163.com
Research Domain of This Article
Medical Informatics
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Ling Liang, Ze-Jun Huang, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing 400030, China
Xiao-Sheng Li, Qian-Jie Xu, Yu-Liang Yuan, Wei Zhang, Hai-Ke Lei, Chongqing Cancer Multi-omics Big Data Application Engineering Research Center, Chongqing University Cancer Hospital, Chongqing 400030, China
Zu-Hai Hu, Department of Health Statistics, School of Public Health, Chongqing Medical University, Chongqing 400016, China
Co-first authors: Ling Liang and Xiao-Sheng Li.
Co-corresponding authors: Wei Zhang and Hai-Ke Lei.
Author contributions: Liang L and Li XS conceived and designed the study; Hu ZH performed the analysis and interpretation of the statistics; Liang L and Huang ZJ wrote the initial drafts of the paper; Xu QJ handled the data collection and statistical analysis; Zhang W and Lei HK revised the article and approved publishing the final version. All the authors contributed equally to the manuscript and read and approved the final version of the manuscript. Liang L and Li XS contributed equally to this work as co-first authors. Prof. Zhang W, who is affiliated with the Department of Gastroenterology, identified a pressing need for a more scientifically rigorous, comprehensive, and practical model that integrates clinically relevant indicators to aid in decision-making processes. Prof. Lei HK primarily oversees the follow-up care of cancer patients. Consequently, Prof. Zhang W and Prof. Lei HK collaborated to design the study, revise the manuscript, and approve the final version for publication. They are jointly designated as co-corresponding authors.
Institutional review board statement: This study adhered to the guiding principles of the Helsinki Declaration and received approval from the Ethics Committee of Chongqing University Cancer Hospital (CZLS2023337-A).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hai-Ke Lei, Associate Professor, Chongqing Cancer Multi-omics Big Data Application Engineering Research Center, Chongqing University Cancer Hospital, No. 181 Hanyu Road, Shapingba District, Chongqing 400030, China. tohaike@163.com
Received: August 30, 2024 Revised: October 30, 2024 Accepted: November 14, 2024 Published online: February 15, 2025 Processing time: 141 Days and 8 Hours
Abstract
BACKGROUND
Rectal cancer is prevalent and associated with substantial morbidity and mortality.
AIM
To develop a nomogram prediction model for overall survival (OS) in patients with rectal cancer by leveraging a comprehensive analysis of demographic, clinicopathological, haematological, and follow-up data to identify independent prognostic factors.
METHODS
We conducted a prospective cohort study in China involving rectal cancer patients and applied Cox regression and least absolute shrinkage and selection operator regression to assess the significance of various variables as independent prognostic factors for OS. The identified factors were integrated into a nomogram model, which was evaluated for predictive accuracy via the C-index, area under the curve (AUC), calibration curve, and decision curve analysis (DCA).
RESULTS
Multivariate analysis revealed independent predictors of OS, including the Karnofsky performance status, age, sex, TNM stage, chemotherapy, surgery, targeted therapy, β2-microglobulin, lactate dehydrogenase, and the neutrophil-to-lymphocyte ratio. The nomogram demonstrated a C-index of 0.80 for the training and validation cohorts, with AUC values indicating high predictive accuracy for 1-year, 3-year, and 5-year OS. The calibration curves confirmed the model's excellent agreement with the observed survival rates, and DCA revealed the superior clinical utility of the nomogram over the TNM staging system.
CONCLUSION
In this study, a novel prognostic model that accurately predicts the OS of rectal cancer patients was developed. The model exhibited excellent discriminatory and calibration capabilities, thus offering a reliable tool for health care professionals to estimate patient survival.
Core Tip: This study developed and validated a novel prognostic nomogram for rectal cancer, incorporating demographic, clinicopathological, haematological, and follow-up data. The prognostic factors include Karnofsky performance status, age, sex, TNM stage, chemotherapy, surgery, targeted therapy, β2-microglobulin, lactate dehydrogenase (LDH), and neutrophil-to-lymphocyte ratio. Compared to the TNM staging system, the nomogram demonstrated high accuracy in predicting 1-year, 3-year, and 5-year overall survival (C-index 0.80), with excellent generalizability and clinical utility. It provides a reliable tool for personalized interventions. However, further research is needed to explore the role of β2-microglobulin and LDH in the progression of rectal cancer and to validate the model.
