Nomogram model for predicting cancer-specific mortality in patients with early-onset colorectal cancer: a competing risk analysis insight from the SEER database and an external validation cohort

Xinao Fu; Yang Chen; Zongqi Fan; Weisi Wang; Ziying Wang; Haoting Yin; Jushang Li; Shigang Guo

doi:10.21037/tcr-23-2023

Nomogram model for predicting cancer-specific mortality in patients with early-onset colorectal cancer: a competing risk analysis insight from the SEER database and an external validation cohort

Transl Cancer Res. 2024 Apr 30;13(4):1665-1684. doi: 10.21037/tcr-23-2023. Epub 2024 Apr 22.

Authors

Xinao Fu¹, Yang Chen¹, Zongqi Fan², Weisi Wang³, Ziying Wang³, Haoting Yin¹, Jushang Li¹, Shigang Guo¹

Affiliations

¹ Department of Gastrointestinal Surgery, Chaoyang Central Hospital, China Medical University, Chaoyang, China.
² Department of Gastrointestinal Surgery, Chaoyang Central Hospital Postgraduate Training Base, Jinzhou Medical University, Chaoyang, China.
³ Department of Gastrointestinal Surgery, Chaoyang Central Hospital, Chengde Medical University, Chengde, China.

Abstract

Background: Early-onset colorectal cancer (EOCRC) is increasing in incidence and poses a growing threat. Urgent research is needed, especially in survival analysis, to enhance comprehension and treatment strategies. This study aimed to explore the risk factors associated with cancer-specific mortality (CSM) and other-cause mortality (OCM) in patients with EOCRC. Additionally, the study aimed to develop a nomogram predicting CSM using a competitive risk model and validate its accuracy through the use of training, using internal and external cohorts.

Methods: Data from EOCRC patients were collected from the Surveillance, Epidemiology, and End Results (SEER) database (2008-2017). EOCRC patients who were treated at a tertiary hospital in northeast China between 2014 and 2020 were also included in the study. The SEER data were divided into the training and validation sets at a 7:3 ratio. A univariate Cox regression model was employed to identify prognostic factors. Subsequently, multivariate Cox regression models were applied to ascertain the presence of independent risk factors. A nomogram was generated to visualize the results, which were evaluated using the concordance index (C-index), area under the curve (AUC), and calibration curves. The clinical utility was assessed via decision curve analysis (DCA).

Results: Multivariable Cox regression analysis demonstrated that factors such as race, tumor differentiation, levels of carcinoembryonic antigen (CEA), marital status, histological type, American Joint Committee on Cancer (AJCC) stage, and surgical status were independent risk factors for CSM in EOCRC patients. In addition, age, gender, chemotherapy details, CEA levels, marital status, and AJCC stage were established as independent risk factors for OCM in individuals diagnosed with EOCRC. A nomogram was developed using the identified independent risk factors, demonstrating excellent performance with a C-index of 0.806, 0.801, and 0.810 for the training, internal validation, and external validation cohorts, respectively. The calibration curves and AUC further confirmed the accuracy and discriminative ability of the nomogram. Furthermore, the DCA results indicated that the model had good clinical value.

Conclusions: In this study, a competing risk model for CSM was developed in EOCRC patients. The model demonstrates a high level of predictive accuracy, providing valuable insights into the treatment decision-making process.

Keywords: Early-onset colorectal cancer (EOCRC); Surveillance, Epidemiology, and End Results database (SEER database); cancer-specific mortality (CSM); competing risk model; external validation.