Construction and validation of a nomogram for predicting overall survival of patients with stage III/IV early-onset colorectal cancer

Wanbin Yin; Wenju Pei; Tao Yu; Qi Zhang; Shiyao Zhang; Maorun Zhang; Gang Liu

doi:10.3389/fonc.2024.1332499

Construction and validation of a nomogram for predicting overall survival of patients with stage III/IV early-onset colorectal cancer

Front Oncol. 2024 Apr 10:14:1332499. doi: 10.3389/fonc.2024.1332499. eCollection 2024.

Authors

Wanbin Yin^#^{1

2}, Wenju Pei^#^{1

2}, Tao Yu³, Qi Zhang¹, Shiyao Zhang¹, Maorun Zhang¹, Gang Liu¹

Affiliations

¹ Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China.
² Department of Anorectal Surgery, Affiliated Hospital of Jining Medical University, Jining, China.
³ Department of Oncology, Tianjin Medical University General Hospital, Tianjin, China.

^# Contributed equally.

Abstract

Purpose: This study aimed to identify prognostic factors and develop a nomogram for predicting overall survival (OS) in stage III/IV early-onset colorectal cancer (EO-CRC).

Methods: Stage III/IV EO-CRC patients were identified from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2015. The datasets were randomly divided (2:1) into training and validation sets. A nomogram predicting OS was developed based on the prognostic factors identified by Cox regression analysis in the training cohort. Moreover, the predictive performance of the nomogram was assessed using the receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA). Subsequently, the internal validation was performed using the validation cohort. Finally, a risk stratification system was established based on the constructed nomogram.

Results: Of the 10,387 patients diagnosed with stage III/IV EO-CRC between 2010 and 2015 in the SEER database, 8,130 patients were included. In the training cohort (n=3,071), sex, marital status, race/ethnicity, primary site, histologic subtypes, grade, T stage, and N stage were identified as independent prognostic variables for OS. The 1-, 3-, and 5-year area under the curve (AUC) values of the nomogram were robust in both the training (0.751, 0.739, and 0.723) and validation cohorts (0.748, 0.733, and 0.720). ROC, calibration plots, and DCA indicated good predictive performance of the nomogram in both the training and validation sets. Furthermore, patients were categorized into low-, middle-, and high-risk groups based on the nomogram risk score. Kaplan-Meier curve showed significant survival differences between the three groups.

Conclusion: We developed a prognostic nomogram and risk stratification system for stage III/IV EO-CRC, which may facilitate clinical decision-making and individual prognosis prediction.

Keywords: colorectal cancer; early-onset; nomogram; overall survivals; prognostic factors.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was sponsored by Tianjin Health Research Project (TJSJMYXYC-D2-027).