Prognostic value of a nomogram model for postoperative liver metastasis of colon cancer

De-Xin Cheng; Kang-Di Xu; Han-Bo Liu; Yi Liu

doi:10.4240/wjgs.v16.i4.1055

Prognostic value of a nomogram model for postoperative liver metastasis of colon cancer

World J Gastrointest Surg. 2024 Apr 27;16(4):1055-1065. doi: 10.4240/wjgs.v16.i4.1055.

Authors

De-Xin Cheng¹, Kang-Di Xu², Han-Bo Liu¹, Yi Liu³

Affiliations

¹ Cancer Center, Department of Interventional Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou 310014, Zhejiang Province, China.
² General Surgery, Cancer Center, Department of Vascular Surgery, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou 310014, Zhejiang Province, China.
³ General Surgery, Cancer Center, Department of Vascular Surgery, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou 310014, Zhejiang Province, China. liuyi4917@126.com.

Abstract

Background: Colon cancer is one of the most common malignant tumors of the digestive system. Liver metastasis after colon cancer surgery is the primary cause of death in patients with colon cancer.

Aim: To construct a novel nomogram model including various factors to predict liver metastasis after colon cancer surgery.

Methods: We retrospectively analyzed 242 patients with colon cancer who were admitted and underwent radical resection for colon cancer in Zhejiang Provincial People's Hospital from December 2019 to December 2022. Patients were divided into liver metastasis and non-liver metastasis groups. Sex, age, and other general and clinicopathological data (preoperative blood routine and biochemical test indexes) were compared. The risk factors for liver metastasis were analyzed using single-factor and multifactorial logistic regression. A predictive model was then constructed and evaluated for efficacy.

Results: Systemic inflammatory index (SII), C-reactive protein/albumin ratio (CAR), red blood cell distribution width (RDW), alanine aminotransferase, preoperative carcinoembryonic antigen level, and lymphatic metastasis were different between groups (P < 0.05). SII, CAR, and RDW were risk factors for liver metastasis after colon cancer surgery (P < 0.05). The area under the curve was 0.93 for the column-line diagram prediction model constructed based on these risk factors to distinguish whether liver metastasis occurred postoperatively. The actual curve of the column-line diagram predicting the risk of postoperative liver metastasis was close to the ideal curve, with good agreement. The prediction model curves in the decision curve analysis showed higher net benefits for a larger threshold range than those in extreme cases, indicating that the model is safer.

Conclusion: Liver metastases after colorectal cancer surgery could be well predicted by a nomogram based on the SII, CAR, and RDW.

Keywords: C-reactive protein/albumin ratio; Colon cancer; Erythrocyte distribution width; Liver metastasis; Novel nomogram model; Systemic immunoinflammatory index.