Performance of a Nomogram Based on the Integration of Inflammation Markers with Tumor Staging in Prognosis Prediction of Stage III Colorectal Cancer
Authors Wang L, Xiao J, Li MZ, Teng WH, Jia J, Lin L, Liu S, Ye X, Zang WD, Chen Y
Received 28 May 2020
Accepted for publication 24 July 2020
Published 7 August 2020 Volume 2020:12 Pages 7077—7085
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Eileen O'Reilly
Lin Wang,1,* Jun Xiao,2,* Min-Zhe Li,3 Wen-Hao Teng,2 Jing Jia,1 Lu Lin,1 Sheng Liu,2 Xing-ming Ye,1 Wei-Dong Zang,2 Ying Chen1
1Central Laboratory, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou 350000, People’s Republic of China; 2Department of Gastrointestinal Surgery, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou 350000, People’s Republic of China; 3General Surgery Department, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100000, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Wei-Dong Zang
Department of Gastrointestinal Surgery, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou 350000, People’s Republic of China
Central Laboratory, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou 350000, People’s Republic of China
Introduction: The aim of the present study was to evaluate a nomogram model for predicting the 5-year overall survival (OS) in lymph node-metastatic colorectal cancer (CRC) patients by combining inflammation markers with some traditional prognostic factors.
Methods: A total of 399 patients with stage III (pTXN1-3M0) CRC operated from January 2007 to December 2012 were enrolled in this retrospective study. All patients underwent D2 lymphadenectomy in the hospital. A prognostic nomogram based on the integration of traditional prognostic factors and NLR (neutrophil-to-lymphocyte ratio) and PLR (platelet-to-lymphocyte ratio) was established and compared with the nomogram based on the traditional prognostic factors alone. ROC curves were further applied to verify the predictive accuracy of the established model.
Results: Both NLR (P=0.00) and PLR (P=0.01) predicted the 5-year OS. In multivariate analysis, age, T3 category, T4 category, N2 category, N3 category, Pgp (P-glycoprotein), NLR and PLR are proven to be independent (all P≤ 0.05). The established nomogram showed better predictive power than that of traditional profile (c-index: 0.66 versus 0.63) in both training and validation cohorts. External assessment by ROC curve analysis demonstrated that the established model had a good prediction accuracy of 5-year OS in stage III CRC patients, with area under curve values of 0.657 and 0.629 in training and validating sets, respectively.
Conclusion: A nomogram based on the integration of traditional prognostic factors and inflammatory markers (NLR and PLR) could provide more precise long-term prognosis information for lymph node-metastatic CRC patients than the model based on traditional profile alone. This model might be useful for clinical application in personalized evaluation.
Keywords: nomogram, TNM staging system, lymph node metastasis, colorectal cancer, prognosis
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