Development and Validation of a Novel Prognostic Nomogram Combined With Desmoplastic Reaction for Synchronous Colorectal Peritoneal Metastasis

Xiusen Qin; Mingpeng Zhao; Weihao Deng; Yan Huang; Zhiqiang Cheng; Jacqueline Pui Wah Chung; Xufei Chen; Keli Yang; David Yiu Leung Chan; Hui Wang

doi:10.3389/fonc.2022.826830

Development and Validation of a Novel Prognostic Nomogram Combined With Desmoplastic Reaction for Synchronous Colorectal Peritoneal Metastasis

Front Oncol. 2022 Mar 11:12:826830. doi: 10.3389/fonc.2022.826830. eCollection 2022.

Authors

Xiusen Qin^{1

2}, Mingpeng Zhao³, Weihao Deng⁴, Yan Huang⁴, Zhiqiang Cheng⁴, Jacqueline Pui Wah Chung³, Xufei Chen⁵, Keli Yang^{1

2}, David Yiu Leung Chan³, Hui Wang^{1

2}

Affiliations

¹ Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
² Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Supported by the National Key Clinical Discipline, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
³ Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China.
⁴ Department of Pathology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
⁵ Department of Obstetrics and Gynaecology, Songshan Lake Central Hospital, Affiliated Dongguan Shilong People's Hospital of Southern Medical University, Dongguan, China.

Abstract

Purpose: The prognostic value of desmoplastic reaction (DR) has not been investigated in colorectal cancer (CRC) patients with synchronous peritoneal metastasis (SPM). The present study aimed to identify whether DR can predict overall survival (OS) and develop a novel prognostic nomogram.

Methods: CRC patients with SPM were enrolled from a single center between July 2007 and July 2019. DR patterns in primary tumors were classified as mature, intermediate, or immature according to the existence and absence of keloid-like collagen or myxoid stroma. Cox regression analysis was used to identify independent factors associated with OS and a nomogram was developed subsequently.

Results: One hundred ninety-eight and 99 patients were randomly allocated into the training and validation groups. The median OS in the training group was 36, 25, and 12 months in mature, intermediate, and immature DR categories, respectively. Age, T stage, extraperitoneal metastasis, differentiation, cytoreductive surgery (CRS), hyperthermic intraperitoneal chemotherapy (HIPEC), and DR categorization were independent variables for OS, based on which the nomogram was developed. The C-index of the nomogram in the training and validation groups was 0.773 (95% CI 0.734-0.812) and 0.767 (95% CI 0.708-0.826). The calibration plots showed satisfactory agreement between the actual outcome and nomogram-predicted OS probabilities in the training and validation cohorts.

Conclusions: DR classification in the primary tumor is a potential prognostic index for CRC patients with SPM. The novel prognostic nomogram combined with DR classification has good discrimination and accuracy in predicting the OS for CRC patients with SPM.

Keywords: cancer-associated fibroblasts; colorectal cancer; desmoplastic reaction; prognosis; synchronous peritoneal metastasis.