J Cancer 2020; 11(21):6213-6225. doi:10.7150/jca.46155 This issue

Research Paper

Nomograms predicting Overall Survival and Cancer-specific Survival for Synchronous Colorectal Liver-limited Metastasis

Yuqiang Li1,2*, Wenxue Liu3,4, Lilan Zhao5, Cenap Güngör2, Yang Xu2, Xiangping Song1, Dan Wang1,2, Zhongyi Zhou1, Yuan Zhou1, Chenglong Li1, Qian Pei1, Fengbo Tan1✉, Haiping Pei1✉

1. Department of Gastrointestinal Surgery, Xiangya Hospital, Central South University, Changsha, China.
2. Department of General Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
3. Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China.
4. Department of Rheumatology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
5. Department of Thoracic surgery, Fujian Provincial Hospital, Fuzhou, China.
*This author contributed mainly to this article as a first author.

This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/). See http://ivyspring.com/terms for full terms and conditions.
Li Y, Liu W, Zhao L, Güngör C, Xu Y, Song X, Wang D, Zhou Z, Zhou Y, Li C, Pei Q, Tan F, Pei H. Nomograms predicting Overall Survival and Cancer-specific Survival for Synchronous Colorectal Liver-limited Metastasis. J Cancer 2020; 11(21):6213-6225. doi:10.7150/jca.46155. Available from https://www.jcancer.org/v11p6213.htm

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Graphic abstract

Background: Colorectal cancer (CRC) ranks as the third most frequent cancer type and the second leading cause of cancer-related death worldwide. The liver is the most common metastatic site of CRC with 20%-34% of patients suffering synchronous liver metastasis. Patients with colorectal liver-limited metastasis account for one-third of deaths from colorectal cancer. Moreover, some evidence indicated that CRC patients with synchronous liver disease encounter a worse prognosis and more disseminated disease state comparing with metastatic liver disease that develops metachronously.

Methods: Data in this retrospective analysis were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Nomograms were constructed with basis from a multivariate Cox regression analysis. The prognostic nomograms were validated by C-index, time-dependent receiver operating characteristic (ROC) curve, decision curve analysis (DCA) and calibration curves.

Results: A total of 9,958 CRC patients with synchronous liver-limited metastasis were extracted from the SEER database during 2010-2016. Both overall survival (OS) and cancer-specific survival (CSS) were significantly correlated with age, marital status, race, tumor location, pathological grade, histologic type, T stage, N stage, surgery for primary tumor, surgery for liver metastasis, chemotherapy and CEA. All of the significant variables were used to create the nomograms predicting OS and CSS. C-index values, time-dependent ROC curves, DCA curves and calibration curves, proved the superiority of the nomograms.

Conclusions: Our research investigated a national cohort of almost 10,000 patients to create and verify nomograms based on pathological, therapeutic and demographic features to predict OS and CSS for synchronous colorectal liver-limited metastasis (SCLLM). The nomograms may act as an excellent tool to integrate clinical characteristics to guide the therapeutic choice for SCLLM patients.

Keywords: Nomogram, colorectal cancer, liver metastasis, overall survival, cancer-specific survival