Development and Validation of the Individualized Prognostic Nomograms in Patients With Right- and Left-Sided Colon Cancer

Zai Luo; Zhongmao Fu; Tengfei Li; Yuan Zhang; Jianming Zhang; Yan Yang; Zhengfeng Yang; Qi Li; Zhengjun Qiu; Chen Huang

doi:10.3389/fonc.2021.709835

Development and Validation of the Individualized Prognostic Nomograms in Patients With Right- and Left-Sided Colon Cancer

Front Oncol. 2021 Nov 1:11:709835. doi: 10.3389/fonc.2021.709835. eCollection 2021.

Authors

Zai Luo¹, Zhongmao Fu¹, Tengfei Li¹, Yuan Zhang¹, Jianming Zhang¹, Yan Yang¹, Zhengfeng Yang², Qi Li³, Zhengjun Qiu¹, Chen Huang¹

Affiliations

¹ Department of Gastrointestinal Surgery, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
² Institute of Translational Medicine, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
³ Department of Medical Oncology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.

Abstract

Background: The overall survival (OS) of patients diagnosed with colon cancer (CC) varied greatly, so did the patients with the same tumor stage. We aimed to design a nomogram that is capable of predicting OS in resected left-sided colon cancers (LSCC) and right-sided colon cancers (RSCC), and thus to stratify patients into different risk groups, respectively.

Methods: Records from a retrospective cohort of 577 patients with complete information were used to construct the nomogram. Univariate and multivariate analyses screened risk factors associated with overall survival. The performance of the nomogram was evaluated with concordance index (c-index), calibration plots, and decision curve analyses for discrimination, accuracy, calibration ability, and clinical net benefits, respectively, which was further compared with the American Joint Committee on Cancer (AJCC) 8th tumor-node-metastasis (TNM) classification. Risk stratification based on nomogram scores was performed with recursive partitioning analysis.

Results: The LSCC nomogram incorporated carbohydrate antigen 12-5 (CA12-5), age and log odds of positive lymph nodes (LODDS), and RSCC nomogram enrolled tumor stroma percentage (TSP), age and LODDS. Compared with the TNM classification, the LSCC and RSCC nomograms both had a statistically higher C-index (0.837, 95% CI: 0.827-0.846 and 0.780, 95% CI 0.773-0.787, respectively) and more clinical net benefits, respectively. Calibration plots revealed no deviations from reference lines. All results were reproducible in the validation cohort.

Conclusions: An original predictive nomogram was constructed and validated for OS in patients with CC after surgery, which had facilitated physicians to appraise the individual survival of postoperative patients accurately and to identify high-risk patients who were in need of more aggressive treatment and follow-up strategies.

Keywords: colon cancer; location; nomogram; prognosis; tumor-stroma percentage.