Nomogram to Predict the Overall Survival of Colorectal Cancer Patients: A Multicenter National Study

Nasrin Borumandnia, Hassan Doosti, Amirhossein Jalali, Soheila Khodakarim, Jamshid Yazdani Charati, Mohamad Amin Pourhoseingholi, Atefeh Talebi, Shahram Agah, Nasrin Borumandnia, Hassan Doosti, Amirhossein Jalali, Soheila Khodakarim, Jamshid Yazdani Charati, Mohamad Amin Pourhoseingholi, Atefeh Talebi, Shahram Agah

Abstract

Background: Colorectal cancer (CRC) is the third foremost cause of cancer-related death and the fourth most commonly diagnosed cancer globally. The study aimed to evaluate the survival predictors using the Cox Proportional Hazards (CPH) and established a novel nomogram to predict the Overall Survival (OS) of the CRC patients.

Materials and methods: A historical cohort study, included 1868 patients with CRC, was performed using medical records gathered from Iran's three tertiary colorectal referral centers from 2006 to 2019. Two datasets were considered as train set and one set as the test set. First, the most significant prognostic risk factors on survival were selected using univariable CPH. Then, independent prognostic factors were identified to construct a nomogram using the multivariable CPH regression model. The nomogram performance was assessed by the concordance index (C-index) and the time-dependent area under the ROC curve.

Results: The age of patients, body mass index (BMI), family history, tumor grading, tumor stage, primary site, diabetes history, T stage, N stage, and type of treatment were considered as significant predictors of CRC patients in univariable CPH model (p < 0.2). The multivariable CPH model revealed that BMI, family history, grade and tumor stage were significant (p < 0.05). The C-index in the train data was 0.692 (95% CI, 0.650-0.734), as well as 0.627 (0.670, 0.686) in the test data.

Conclusion: We improved a novel nomogram diagram according to factors for predicting OS in CRC patients, which could assist clinical decision-making and prognosis predictions in patients with CRC.

Keywords: colorectal cancer; cox proportional hazards; nomogram; overall survival; risk factors.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of the patient selection process.
Figure 2
Figure 2
Dynamic nomogram for the Cox proportional hazards model, fitted to the Colorectal cancer patient’s data, on web page (Dynamic Nomogram (shinyapps.io), https://nbshiny.shinyapps.io/DynNomColorectal/). The Kaplan-Meier plots display survival curve correspond to 55 years old male, BMI > 25, have a family history, cancer in the right colon, T2 T-stage, N1 N-stage, stage III, receive all treatments, and well-differentiated grade (in black color) vs. a patient with the same characteristics and poorly differentiated grade (in blue color), shown in the left side of the picture (upper). The patients’ corresponding predicted survival probability and 95% confidence intervals at a specific time is given in the ‘Predicted survival’ tab, shown on the left side of the picture (lower). The predicted value with corresponding confidence interval and the formatted model output summary are presented in the ‘Numerical Summary’ and ‘Model Summary’ tabs, respectively.
Figure 3
Figure 3
Time-dependent AUC values for internal nomogram validation.

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