Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 6, 2021; 9(7): 1563-1579
Published online Mar 6, 2021. doi: 10.12998/wjcc.v9.i7.1563
Construction of a clinical survival prognostic model for middle-aged and elderly patients with stage III rectal adenocarcinoma
Hao Liu, Yu Li, Yi-Dan Qu, Jun-Jiang Zhao, Zi-Wen Zheng, Xue-Long Jiao, Jian Zhang
Hao Liu, Yu Li, Jun-Jiang Zhao, Zi-Wen Zheng, Xue-Long Jiao, Jian Zhang, Department of Colonrectal Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
Yi-Dan Qu, Rheumatology and Immunology Department, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
Author contributions: Liu H, Jiao XL, and Zhang J participated in the design of the study, acquisition of data, and article revisions; Liu H, Li Y, Qu YD, Zhao JJ, Zheng ZW, and Zhang J analyzed the data and drafted the article. All authors have approved the final version of the article.
Supported by The National Natural Science Foundation of China, No. 81770631.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Affiliated Hospital of Qingdao University.
Informed consent statement: As this study is based on a publicly available database without identifying patient information, informed consent was not needed.
Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.
Data sharing statement: No additional data are available.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jian Zhang, PhD, Chief Doctor, Postdoc, Professor, Surgeon, Department of Colonrectal Surgery, The Affiliated Hospital of Qingdao University, No. 19 Jiangsu Road, Shinan District, Qingdao 266000, Shandong Province, China. zhangjian@qduhospital.cn
Received: August 16, 2020
Peer-review started: August 16, 2020
First decision: November 3, 2020
Revised: November 10, 2020
Accepted: December 16, 2020
Article in press: December 16, 2020
Published online: March 6, 2021
Processing time: 197 Days and 0.2 Hours
Abstract
BACKGROUND

Nomograms for prognosis prediction in colorectal cancer patients are few, and prognostic indicators differ with age.

AIM

To construct a new nomogram survival prediction tool for middle-aged and elderly patients with stage III rectal adenocarcinoma.

METHODS

A total of 2773 eligible patients were divided into the training cohort (70%) and the validation cohort (30%). Optimal cutoff values were calculated using the X-tile software for continuous variables. Univariate and multivariate Cox proportional hazards regression analyses were used to determine overall survival (OS) and cancer-specific survival (CSS)-related prognostic factors. Two nomograms were successfully constructed. The discriminant and predictive ability and clinical usefulness of the model were also assessed by multiple methods of analysis.

RESULTS

The 95%CI in the training group was 0.719 (0.690-0.749) and 0.733 (0.702-0.74), while that in the validation group was 0.739 (0.696-0.782) and 0.750 (0.701-0.800) for the OS and CSS nomogram prediction models, respectively. In the validation group, the AUC of the three-year survival rate was 0.762 and 0.770, while the AUC of the five-year survival rate was 0.722 and 0.744 for the OS and CSS nomograms, respectively. The nomogram distinguishes all-cause mortality from cancer-specific mortality in patients with different risk grades. The time-dependent AUC and decision curve analysis showed that the nomogram had good clinical predictive ability and decision efficacy and was significantly better than the tumor-node-metastases staging system.

CONCLUSION

The survival prediction model constructed in this study is helpful in evaluating the prognosis of patients and can aid physicians in clinical diagnosis and treatment.

Keywords: Rectal adenocarcinoma; Lymph node positive rate; Nomogram; Prognostic model; Predictive model; Survival time

Core Tip: This investigation was based on a large-scale population study of middle-aged and elderly patients with stage III rectal adenocarcinoma. In this study, we analyzed the clinical data of thousands of patients with stage III rectal adenocarcinoma aged 45 years or older and determined the relevant prognostic factors and the degree of impact. New cutoff values were identified and used to construct nomograms. The nomograms showed excellent clinical predictive ability and decision power. The nomograms constructed in this study have clinical utility.