Liu Cheng, Qiu Huaide, Wang Junqiang, Yang Min, Wang Zhixiang
Department of Rehabilitation Medicine, Yixing No.2 People's Hospital (Yixing Prevention and Treatment Hospital for Occupational Diseases), Yixing, Jiangsu, China.
School of Rehabilitation Science, Nanjing Normal University of Special Education, Nanjing, China.
Front Oncol. 2025 Apr 17;15:1541561. doi: 10.3389/fonc.2025.1541561. eCollection 2025.
This study aimed to identify the determinants of postoperative overall survival in Asian patients with colon cancer and to establish a prognostic nomogram model.
The study included colon cancer cases diagnosed between 2010 and 2015, sourced from the SEER database as well as an external cohort from Yixing No.2 People's Hospital. Records with incomplete data on predetermined variables were excluded. The SEER dataset of eligible Asian postoperative colon cancer cases was split into a training set and a validation set with a 7:3 ratio. Prognostic factors affecting overall survival were identified using univariate and multivariate Cox regression analyses on the training set. A prognostic nomogram was developed with the R software package, and its predictive accuracy was evaluated in training, validation and external cohorts using ROC curves and calibration plots. Concordance index (C-index) and area under curves (AUCs) were also calculated, while decision curve analysis (DCA) was performed to examine the clinical utility.
Based on the criteria, 8738 cases from the SEER database were deemed suitable for analysis, and were divided into a training set (6118 cases) and a validation set (2620 cases) with a 7:3 ratio. An external cohort consisting of 73 cases with colon cancer was collected for external validation. The Cox regression analysis revealed that factors such as age, gender, marital status, histological type, grade classification, AJCC_T stage, AJCC_N stage, AJCC_M stage, CEA levels, and chemotherapy significantly influenced OS (P<0.05). These factors were incorporated into the nomogram, which demonstrated a C-index of 0.775 (95% CI: 0.766-0.784) for predicting OS in the training set, a C-index of 0.774 (95% CI: 0.760-0.787) in the validation set, and a C-index of 0.763 (95% CI: 0.698-0.828) in the external cohort. The nomogram was validated with good accuracy and clinical utility across three datasets.
This study identified several independent prognostic factors influencing the postoperative overall survival of Asian colon cancer patients, including age, gender, marital status, histological type, grade classification, AJCC_T, AJCC_N, and AJCC_M stages, CEA levels, and chemotherapy. The constructed prognostic model showed good discrimination and accuracy, offering clinicians an individualized tool for survival predictions.
本研究旨在确定亚洲结肠癌患者术后总生存的决定因素，并建立一个预后列线图模型。
该研究纳入了2010年至2015年期间诊断的结肠癌病例，数据来源于监测、流行病学和最终结果（SEER）数据库以及宜兴市第二人民医院的一个外部队列。排除预定变量数据不完整的记录。符合条件的亚洲结肠癌术后病例的SEER数据集按7:3的比例分为训练集和验证集。使用单因素和多因素Cox回归分析在训练集上确定影响总生存的预后因素。使用R软件包开发预后列线图，并使用ROC曲线和校准图在训练集、验证集和外部队列中评估其预测准确性。还计算了一致性指数（C指数）和曲线下面积（AUC），同时进行决策曲线分析（DCA）以检验临床实用性。
根据标准，SEER数据库中的8738例病例被认为适合分析，并按7:3的比例分为训练集（6118例）和验证集（2620例）。收集了一个由73例结肠癌病例组成的外部队列进行外部验证。Cox回归分析显示，年龄、性别、婚姻状况、组织学类型、分级分类、美国癌症联合委员会（AJCC）_T分期、AJCC_N分期、AJCC_M分期、癌胚抗原（CEA）水平和化疗等因素对总生存有显著影响（P<0.05）。这些因素被纳入列线图，该列线图在训练集中预测总生存的C指数为0.775（95%置信区间：0.766 - 0.784），在验证集中为0.774（95%置信区间：0.760 - 0.787），在外部队列中为0.763（95%置信区间：0.698 - 0.828）。该列线图在三个数据集中均得到了良好准确性和临床实用性验证。
本研究确定了几个影响亚洲结肠癌患者术后总生存的独立预后因素，包括年龄、性别、婚姻状况、组织学类型、分级分类、AJCC_T、AJCC_N和AJCC_M分期、CEA水平和化疗。构建的预后模型显示出良好的区分度和准确性，为临床医生提供了一个用于生存预测的个体化工具。
