Development and validation of a clinical survival model for young-onset colorectal cancer with synchronous liver-only metastases: a SEER population-based study and external validation

Tao Li; Yahang Liang; Daqiang Wang; Zhen Zhou; Haoran Shi; Mingming Li; Hualin Liao; Taiyuan Li; Xiong Lei

doi:10.3389/fonc.2023.1161742

Development and validation of a clinical survival model for young-onset colorectal cancer with synchronous liver-only metastases: a SEER population-based study and external validation

Front Oncol. 2023 Apr 18:13:1161742. doi: 10.3389/fonc.2023.1161742. eCollection 2023.

Authors

Tao Li^{1

2}, Yahang Liang^{1

2}, Daqiang Wang^{1

2}, Zhen Zhou^{1

2}, Haoran Shi^{1

2}, Mingming Li^{1

2}, Hualin Liao^{1

2}, Taiyuan Li^{1

2}, Xiong Lei^{1

2}

Affiliations

¹ Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
² Gastrointestinal Surgical Institute, Nanchang University, Nanchang, Jiangxi, China.

Abstract

Background: The morbidity and mortality of young-onset colorectal cancer (YO-CRC) patients have been increasing in recent years. Moreover, YO-CRC patients with synchronous liver-only metastases (YO-CRCSLM) have various survival outcomes. Therefore, the purpose of this study was to construct and validate a prognostic nomogram for patients with YO-CRCSLM.

Methods: The YO-CRCSLM patients were rigorously screened from the Surveillance, Epidemiology, and End Results (SEER) database in January 2010 and December 2018 and then assigned to a training and validation cohort randomly (1488 and 639 patients, respectively). Moreover, the 122 YO-CRCSLM patients who were enrolled in The First Affiliated Hospital of Nanchang University were served as a testing cohort. The variables were selected using the multivariable Cox model based on the training cohort and then developed a nomogram. The validation and testing cohort were used to validate the model's predictive accuracy. The calibration plots were used to determine the Nomogram's discriminative capabilities and precision, and the decision analysis (DCA) was performed to evaluate the Nomogram's net benefit. Finally, the Kaplan-Meier survival analyses were performed for the stratified patients based on total nomogram scores classified by the X-tile software.

Results: The Nomogram was constructed including ten variables: marital status, primary site, grade, metastatic lymph nodes ratio (LNR), T stage, N stage, carcinoembryonic antigen (CEA), Surgery, and chemotherapy. The Nomogram performed admirably in the validation and testing group according to the calibration curves. The DCA analyses showed good clinical utility values. Low-risk patients (score<234) had significantly better survival outcomes than middle-risk (234-318) and high-risk (>318) patients (P < 0.001).

Conclusion: A nomogram predicting the survival outcomes for patients with YO-CRCSLM was developed. In addition to facilitating personalized survival prediction, this nomogram may assist in developing clinical treatment strategies for patients with YO-CRCSLM who are undergoing treatment.

Keywords: SEER; YO-CRCSLM; nomogram; survival; survival model.

Grants and funding

This work was supported by National Natural Science Foundation of China (grant no. 81860519; 82160561), key project of Natural Science Foundation of Jiangxi, China (grant no. 20192ACBL21043).