Author(s): Kong X.; Li J.; Cai Y.; Hu Y.; Yang Q.; Ding K.; Tian Y.; Chi S.; Tong D.; Poston G.; Yuan Y.
Source: BMC Cancer; Jan 2018; vol. 18 (no. 1)
Publication Date: Jan 2018
Publication Type(s): Article
Available at BMC Cancer – from BioMed Central
Available at BMC Cancer – from SpringerLink – Medicine
Available at BMC Cancer – from Europe PubMed Central – Open Access
Abstract:Background: To revise the American Joint Committee on Cancer TNM staging system for colorectal cancer (CRC) based on a nomogram analysis of Surveillance, Epidemiology, and End Results (SEER) database, and to prove the rationality of enhancing T stage’s weighting in our previously proposed T-plus staging system. Methods: Total 115,377 non-metastatic CRC patients from SEER were randomly grouped as training and testing set by ratio 1:1. The Nomo-staging system was established via three nomograms based on 1-year, 2-year and 3-year disease specific survival (DSS) Logistic regression analysis of the training set. The predictive value of Nomo-staging system for the testing set was evaluated by concordance index (c-index), likelihood ratio (L.R.) and Akaike information criteria (AIC) for 1-year, 2-year, 3-year overall survival (OS) and DSS. Kaplan-Meier survival curve was used to valuate discrimination and gradient monotonicity. And an external validation was performed on database from the Second Affiliated Hospital of Zhejiang University (SAHZU). Results: Patients with T1-2N1 and T1N2a were classified into stage II while T4N0 patients were classified into stage III in Nomo-staging system. Kaplan-Meier survival curves of OS and DSS in testing set showed Nomo-staging system performed better in discrimination and gradient monotonicity, and the external validation in SAHZU database also showed distinctly better discrimination. The Nomo-staging system showed higher value in L.R. and c-index, and lower value in AIC when predicting OS and DSS in testing set. Conclusion: The Nomo-staging system showed better performance in prognosis prediction and the weight of lymph nodes status in prognosis prediction should be cautiously reconsidered.
Copyright © 2018 The Author(s).