Published online Mar 6, 2021. doi: 10.12998/wjcc.v9.i7.1563
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
Nomograms for prognosis prediction in colorectal cancer patients are few, and prognostic indicators differ with age.
To construct a new nomogram survival prediction tool for middle-aged and elderly patients with stage III rectal adenocarcinoma.
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.
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.
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.
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.