Contemporary Validation of a Nomogram Predicting Colon Cancer Recurrence, Revealing All-Stage Improved Outcomes

Abstract Background The Memorial Sloan Kettering Cancer Center (MSK) colon cancer recurrence nomogram is a risk calculator that provides patients and clinicians with individualized prediction of recurrence following curative resection of colon cancer. Although validated on multiple separate cohorts, the nomogram requires periodic updating as patient care changes over time. The aim of this study was to evaluate the nomogram’s accuracy in a contemporary cohort and modify the tool to reflect improvements in outcome related to advances in colon cancer therapy. Methods A contemporary patient cohort was compiled, including consecutive colon cancer patients undergoing curative resection for stage I–III colon adenocarcinoma at MSK from 2007 to 2014. The nomogram’s predictive accuracy was assessed by concordance index and calibration plots of predicted vs actual freedom from recurrence at 5 years after surgery. Results Data from a total of 999 eligible patients with complete records were used for validation. Median follow-up among survivors was 37 months. The concordance index was 0.756 (95% confidence interval = 0.707 to 0.805), indicating continued discriminating power, but the calibration plot revealed that the nomogram overestimated recurrence risk. Recalibration of the nomogram by estimating a new baseline freedom-from-recurrence function restored the nomogram’s accuracy. Conclusion The updated nomogram retains the original nomogram’s variables but includes a lower baseline estimation of recurrence risk, reflecting improvements in outcomes for all stages of colon cancer, likely resulting from advances in imaging and integration of multiple treatment modalities.

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Individualized Prediction of Colon Cancer Recurrence Using a Nomogram

Journal of Clinical Oncology ◽

10.1200/jco.2007.14.1291 ◽

2008 ◽

Vol 26 (3) ◽

pp. 380-385 ◽

Cited By ~ 149

Author(s):

Martin R. Weiser ◽

Ron G. Landmann ◽

Michael W. Kattan ◽

Mithat Gonen ◽

Jinru Shia ◽

...

Keyword(s):

Colon Cancer ◽

Treatment Planning ◽

Cox Regression ◽

Multivariable Analysis ◽

Cancer Recurrence ◽

Significant Heterogeneity ◽

Continuous Variables ◽

Concordance Index ◽

Curative Surgery ◽

Colon Cancer Recurrence

PurposeEstimates of recurrence after curative colon cancer surgery are integral to patient care, forming the basis of cancer staging and treatment planning. The categoric staging system of the American Joint Committee on Cancer (AJCC) is commonly used to convey risk by grouping patients based on anatomic elements. Although easy to implement, there remains significant heterogeneity within each stage grouping. In the era of multimodality treatment, a more refined tool is needed to predict recurrence.MethodsAn institutional database of 1,320 patients with nonmetastatic colon cancer was used to develop a nomogram to estimate recurrence after curative surgery. Prognostic factors were assessed with multivariable analysis using Cox regression, whereas nonlinear continuous variables were modeled with cubic splines. The model was internally validated with bootstrapping, and performance was assessed by concordance index and a calibration curve.ResultsThe colon cancer recurrence nomogram predicted relapse with a concordance index of 0.77, improving on the stratification provided by either the AJCC fifth or sixth staging scheme. Factors in the model included patient age, tumor location, preoperative carcinoembryonic antigen, T stage, numbers of positive and negative lymph nodes, lymphovascular invasion, perineural invasion, and use of postoperative chemotherapy.ConclusionUsing common clinicopathologic factors, the recurrence nomogram is better able to account for tumor and patient heterogeneity, thereby providing a more individualized outcome prognostication than that afforded by the AJCC categoric system. By identifying both the high- and low-risk patients within any particular stage, the nomogram is expected to aid in treatment planning and future trial design.

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Glycemic load raises colon cancer recurrence risk

Springer Healthcare News ◽

10.1007/s40014-012-1470-8 ◽

2012 ◽

Vol 1 (1) ◽

Keyword(s):

Colon Cancer ◽

Glycemic Load ◽

Cancer Recurrence ◽

Recurrence Risk ◽

Colon Cancer Recurrence

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Validation of the 12-Gene Colon Cancer Recurrence Score as a Predictor of Recurrence Risk in Stage II and III Rectal Cancer Patients

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/dju269 ◽

2014 ◽

Vol 106 (11) ◽

Cited By ~ 10

Author(s):

Marlies S. Reimers ◽

Peter J. K. Kuppen ◽

Mark Lee ◽

Margarita Lopatin ◽

Haluk Tezcan ◽

...

Keyword(s):

Rectal Cancer ◽

Colon Cancer ◽

Cancer Patients ◽

Cancer Recurrence ◽

Recurrence Score ◽

Recurrence Risk ◽

Stage Ii ◽

Colon Cancer Recurrence

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Development and external validation of a nomogram predicting overall survival after curative resection of colon cancer

Journal of International Medical Research ◽

10.1177/03000605211015023 ◽

2021 ◽

Vol 49 (5) ◽

pp. 030006052110150

Author(s):

Shuanhu Wang ◽

Yakui Liu ◽

Yi Shi ◽

Jiajia Guan ◽

Mulin Liu ◽

...

Keyword(s):

Colon Cancer ◽

Overall Survival ◽

Curative Resection ◽

Predictive Accuracy ◽

External Validation ◽

Tnm Staging ◽

Cox Proportional Hazards ◽

Calibration Plot ◽

Metastatic Colon Cancer ◽

Validation Set

Objective To develop and externally validate a prognostic nomogram to predict overall survival (OS) in patients with resectable colon cancer. Methods Data for 50,996 patients diagnosed with non-metastatic colon cancer were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. Patients were assigned randomly to the training set (n = 34,168) or validation set (n = 16,828). Independent prognostic factors were identified by multivariate Cox proportional hazards regression analysis and used to construct the nomogram. Harrell’s C-index and calibration plots were calculated using the SEER validation set. Additional external validation was performed using a Chinese dataset (n = 342). Results Harrell’s C-index of the nomogram for OS in the SEER validation set was 0.71, which was superior to that using the 7th edition of the American Joint Committee on Cancer TNM staging (0.59). Calibration plots showed consistency between actual observations and predicted 1-, 3-, and 5-year survival. Harrell’s C-index (0.72) and calibration plot showed excellent predictive accuracy in the external validation set. Conclusions We developed a nomogram to predict OS after curative resection for colon cancer. Validation using the SEER and external datasets revealed good discrimination and calibration. This nomogram may help predict individual survival in patients with colon cancer.

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Clinical Calculator Based on Molecular and Clinicopathologic Characteristics Predicts Recurrence Following Resection of Stage I-III Colon Cancer

Journal of Clinical Oncology ◽

10.1200/jco.20.02553 ◽

2021 ◽

pp. JCO.20.02553

Author(s):

Martin R. Weiser ◽

Meier Hsu ◽

Philip S. Bauer ◽

William C. Chapman ◽

Iván A. González ◽

...

Keyword(s):

Colon Cancer ◽

Predictive Accuracy ◽

External Validation ◽

Tumor Infiltrating Lymphocytes ◽

Stage I ◽

Cancer Center ◽

Third Generation ◽

Concordance Index ◽

Pathologic Features ◽

Infiltrating Lymphocytes

PURPOSE Clinical calculators and nomograms have been endorsed by the American Joint Committee on Cancer (AJCC), as they provide the most individualized and accurate estimate of patient outcome. Using molecular and clinicopathologic variables, a third-generation clinical calculator was built to predict recurrence following resection of stage I-III colon cancer. METHODS Prospectively collected data from 1,095 patients who underwent colectomy between 2007 and 2014 at Memorial Sloan Kettering Cancer Center were used to develop a clinical calculator. Discrimination was measured with concordance index, and variability in individual predictions was assessed with calibration curves. The clinical calculator was externally validated with a patient cohort from Washington University's Siteman Cancer Center in St Louis. RESULTS The clinical calculator incorporated six variables: microsatellite genomic phenotype; AJCC T category; number of tumor-involved lymph nodes; presence of high-risk pathologic features such as venous, lymphatic, or perineural invasion; presence of tumor-infiltrating lymphocytes; and use of adjuvant chemotherapy. The concordance index was 0.792 (95% CI, 0.749 to 0.837) for the clinical calculator, compared with 0.708 (95% CI, 0.671 to 0.745) and 0.757 (0.715 to 0.799) for the staging schemes of the AJCC manual's 5th and 8th editions, respectively. External validation confirmed robust performance, with a concordance index of 0.738 (95% CI, 0.703 to 0.811) and calibration plots of predicted probability and observed events approaching a 45° diagonal. CONCLUSION This third-generation clinical calculator for predicting cancer recurrence following curative colectomy successfully incorporates microsatellite genomic phenotype and the presence of tumor-infiltrating lymphocytes, resulting in improved discrimination and predictive accuracy. This exemplifies an evolution of a clinical calculator to maintain relevance by incorporating emerging variables as they become validated and accepted in the oncologic community.

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