Chok AY, Zhao Y, Chen HLR, Tan IEH, Chew DHW, Zhao Y, Au MKH, Tan EJKW. Elderly patients over 80 years undergoing colorectal cancer resection: Development and validation of a predictive nomogram for survival. World J Gastrointest Surg 2023; 15(5): 892-905 [PMID: 37342856 DOI: 10.4240/wjgs.v15.i5.892]
Corresponding Author of This Article
Aik Yong Chok, FRCS (Ed), MBBS, MMed, Surgeon, Department of Colorectal Surgery, Singapore General Hospital, Academia, 20 College Road, Singapore 169608, Singapore. chokaikyong@gmail.com
Research Domain of This Article
Surgery
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/
World J Gastrointest Surg. May 27, 2023; 15(5): 892-905 Published online May 27, 2023. doi: 10.4240/wjgs.v15.i5.892
Elderly patients over 80 years undergoing colorectal cancer resection: Development and validation of a predictive nomogram for survival
Aik Yong Chok, Yun Zhao, Hui Lionel Raphael Chen, Ivan En-Howe Tan, Desmond Han Wen Chew, Yue Zhao, Marianne Kit Har Au, Emile John Kwong Wei Tan
Aik Yong Chok, Yun Zhao, Hui Lionel Raphael Chen, Yue Zhao, Emile John Kwong Wei Tan, Department of Colorectal Surgery, Singapore General Hospital, Singapore 169608, Singapore
Yun Zhao, Ivan En-Howe Tan, Desmond Han Wen Chew, Group Finance Analytics, Singapore Health Services, Singapore 168582, Singapore
Marianne Kit Har Au, Group Finance, Singapore Health Services, Singapore 168582, Singapore
Marianne Kit Har Au, Singhealth Community Hospitals, Singapore 168582, Singapore
Author contributions: Chok AY designed the study and interpreted the data; Zhao Y performed the analysis and visualization; Chen HLR and Zhao Y performed the literature review; Tan IEH, Chew DHW, Au MKH collected the clinical data; Chok AY, Zhao Y, Chen HLR, and Zhao Y drafted the manuscript; Chok AY, Zhao Y and Tan EJKW edited the manuscript; Chok AY and Tan EJKW provided critical revision for final approval; all authors have read and approved the final version of the manuscript.
Institutional review board statement: This study was approved by Singapore Health Services (SingHealth) Institutional Review Board (IRB Ref. 2022/2438). All methods were carried out in accordance with relevant guidelines and regulations (Declaration of Helsinki).
Informed consent statement: Due to the study’s retrospective design using de-identified data, written informed consent collection was waived by SingHealth Centralised Institutional Review Board.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data are not publicly available due to privacy and ethical restrictions.
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: Aik Yong Chok, FRCS (Ed), MBBS, MMed, Surgeon, Department of Colorectal Surgery, Singapore General Hospital, Academia, 20 College Road, Singapore 169608, Singapore. chokaikyong@gmail.com
Received: December 3, 2022 Peer-review started: December 3, 2022 First decision: February 1, 2023 Revised: February 27, 2023 Accepted: March 27, 2023 Article in press: March 27, 2023 Published online: May 27, 2023
ARTICLE HIGHLIGHTS
Research background
Colorectal surgery is associated with a decreased probability of survival in elderly cancer patients. Several factors can affect the postoperative survival of elderly colorectal cancer (CRC) patients.
Research motivation
A precise predictive tool is required to enhance the decision-making process for elderly CRC patients undergoing colorectal resection.
Research objectives
To construct and validate a nomogram to predict the overall survival of elderly CRC patients over 80 years undergoing colorectal surgery.
Research methods
This retrospective study included 295 elderly CRC patients over 80 years undergoing colorectal resection. Variables were selected using regression methods, and a nomogram for 1- and 3-year overall survival was constructed from 60% of the cohort and validated on the remaining 40%. The performance of the nomogram was evaluated using various metrics, and the risk group was stratified based on the risk points of the nomogram.
Research results
The nomogram, which comprised age, comorbidities, body mass index, serum albumin level, distant metastasis, emergency surgery, postoperative pneumonia, and postoperative myocardial infarction, demonstrated excellent discriminative ability and consistency between predictions and actual observations. The risk group was stratified based on the nomogram's risk points, and a significant difference in overall survival was observed between low- and high-risk groups.
Research conclusions
This novel nomogram provides a valuable tool for informed decision-making in elderly CRC patients undergoing colorectal resection.
Research perspectives
We developed a nomogram using demographic and clinical variables to estimate the survival of elderly CRC patients undergoing colorectal surgery. This nomogram may guide treatment decisions, facilitate patient counseling, and enhance surgical outcomes.
