Nomogram for prediction of peritoneal metastasis risk in colorectal cancer

Xian-Qing Song; Zhi-Xian Liu; Qing-Yuan Kong; Zhen-Hua He; Sen Zhang

doi:10.3389/fonc.2022.928894

Nomogram for prediction of peritoneal metastasis risk in colorectal cancer

Front Oncol. 2022 Nov 7:12:928894. doi: 10.3389/fonc.2022.928894. eCollection 2022.

Authors

Xian-Qing Song¹, Zhi-Xian Liu², Qing-Yuan Kong³, Zhen-Hua He⁴, Sen Zhang⁵

Affiliations

¹ General Surgery Department, Ningbo Fourth Hospital, Ningbo, Zhejiang, China.
² Proctology Department, Beilun People's Hospital of Ningbo, Ningbo, Zhejiang, China.
³ General Surgery Department, Baoan People's Hospital of Shenzhen, Shenzhen, Guangdong, China.
⁴ General Surgery Department, Hezhou People's Hospital, Hezhou, Guangxi, China.
⁵ Department of Colorectal Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.

Abstract

Objective: Peritoneal metastasis is difficult to diagnose using traditional imaging techniques. The main aim of the current study was to develop and validate a nomogram for effectively predicting the risk of peritoneal metastasis in colorectal cancer (PMCC).

Methods: A retrospective case-control study was conducted using clinical data from 1284 patients with colorectal cancer who underwent surgery at the First Affiliated Hospital of Guangxi Medical University from January 2010 to December 2015. Least absolute shrinkage and selection operator (LASSO) regression was applied to optimize feature selection of the PMCC risk prediction model and multivariate logistic regression analysis conducted to determine independent risk factors. Using the combined features selected in the LASSO regression model, we constructed a nomogram model and evaluated its predictive value via receiver operating characteristic (ROC) curve analysis. The bootstrap method was employed for repeated sampling for internal verification and the discrimination ability of the prediction models evaluated based on the C-index. The consistency between the predicted and actual results was assessed with the aid of calibration curves.

Results: Overall, 96 cases of PMCC were confirmed via postoperative pathological diagnosis. Logistic regression analysis showed that age, tumor location, perimeter ratio, tumor size, pathological type, tumor invasion depth, CEA level, and gross tumor type were independent risk factors for PMCC. A nomogram composed of these eight factors was subsequently constructed. The calibration curve revealed good consistency between the predicted and actual probability, with a C-index of 0.882. The area under the curve (AUC) of the nomogram prediction model was 0.882 and its 95% confidence interval (CI) was 0.845-0.919. Internal validation yielded a C-index of 0.868.

Conclusion: We have successfully constructed a highly sensitive nomogram that should facilitate early diagnosis of PMCC, providing a robust platform for further optimization of clinical management strategies.

Keywords: LASSO; colorectal cancer; logistic regression analysis; nomogram; peritoneal metastasis.