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:
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.
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
Research background

Patients with colorectal cancer have fewer nomograms for prognosis prediction, and prognostic indicators change with age. Middle-aged and elderly people frequently develop rectal adenocarcinoma, and clinical patients are mainly stage III patients.

Research motivation

Providing a prognostically essential tool for the target population can help physicians make correct clinical decisions regarding related treatments and benefit physicians and patients.

Research objectives

To construct a prognostic nomogram for in the target population, a prognostic tool that can predict OS and CSS in this population. This prognostic tool should have good predictive power and clinical utility.

Research methods

First, patients in the Surveillance, Epidemiology, and End Results Program database were screened according to the inclusion and exclusion criteria; second, the prognostic factors of OS and CSS in the target population were determined by univariate analysis and multivariate analysis; third, a predictor-based clinical survival prediction model was constructed; and fourth, the predictive power and clinical efficacy of the nomogram were verified.

Research results

The 95%CI was 0.719 (0.690-0.749) and 0.733 (0.702-0.74) in the OS and CSS nomogram prediction model training groups, respectively, compared with 0.739 (0.696-0.782) and 0.750 (0.701-0.800) in the validation group. In the validation, the area under the receiver operating characteristic curve (AUC) for the OS and CSS nomograms for the three-year survival rate was 0.762 and 0.770, respectively, while the AUC for the five-year survival rate was 0.722 and 0.744, respectively. Predictive models can distinguish all-cause mortality from cancer-specific mortality in patients with different risk grades. Time-dependent AUC and decision curve analysis showed that the nomogram had excellent clinical prediction and decision-making capabilities, significantly better than the tumor-node-metastases staging system.

Research conclusions

Lymph node-positive rate is more important for the prognosis of the target population than the number of positive lymph nodes and number of examined lymph nodes. The nomogram survival prediction model we constructed is helpful in assessing the clinical prognosis of this population and providing guidance for the optimization of clinical treatment plans.

Research perspectives

The nomograms constructed can be used for individualized survival prediction in the target population. It is a convenient tool for general practitioners and surgeons as it can help to evaluate the patient's status more accurately and provide help for the relevant treatment of the target population in clinical practice.