Development and validation of a prognostic nomogram for colorectal cancer after radical resection based on individual patient data from three large-scale phase III trials

Michitaka Honda, Koji Oba, Takashi Akiyoshi, Hiromichi Maeda, Kosuke Kashiwabara, Mitsuro Kanda, Shuhei Mayanagi, Toru Aoyama, Chikuma Hamada, Sotaro Sadahiro, Yosuke Fukunaga, Masashi Ueno, Junichi Sakamoto, Shigetoyo Saji, Takaki Yoshikawa

Research output: Contribution to journalArticle

Abstract

Background: Few prediction models have so far been developed and assessed for the prognosis of patients who undergo curative resection for colorectal cancer (CRC). Materials and Methods: We prepared a clinical dataset including 5,530 patients who participated in three major randomized controlled trials as a training dataset and 2,263 consecutive patients who were treated at a cancer-specialized hospital as a validation dataset. All subjects underwent radical resection for CRC which was histologically diagnosed to be adenocarcinoma. The main outcomes that were predicted were the overall survival (OS) and disease free survival (DFS). The identification of the variables in this nomogram was based on a Cox regression analysis and the model performance was evaluated by Harrell's c-index. The calibration plot and its slope were also studied. For the external validation assessment, risk group stratification was employed. Results: The multivariate Cox model identified variables; sex, age, pathological T and N factor, tumor location, size, lymphnode dissection, postoperative complications and adjuvant chemotherapy. The c-index was 0.72 (95% confidence interval [CI] 0.66- 0.77) for the OS and 0.74 (95% CI 0.69-0.78) for the DFS. The proposed stratification in the risk groups demonstrated a significant distinction between the Kaplan-Meier curves for OS and DFS in the external validation dataset. Conclusions: We established a clinically reliable nomogram to predict the OS and DFS in patients with CRC using large scale and reliable independent patient data from phase III randomized controlled trials. The external validity was also confirmed on the practical dataset.

Original languageEnglish
Pages (from-to)99150-99160
Number of pages11
JournalOncotarget
Volume8
Issue number58
DOIs
Publication statusPublished - 2017 Jan 1

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Nomograms
Colorectal Neoplasms
Disease-Free Survival
Survival
Randomized Controlled Trials
Confidence Intervals
Cancer Care Facilities
Kaplan-Meier Estimate
Adjuvant Chemotherapy
Proportional Hazards Models
Calibration
Dissection
Adenocarcinoma
Regression Analysis
Datasets
Neoplasms

Keywords

  • Colorectal cancer
  • Disease free survival
  • Overall survival
  • Prediction model
  • Prognostic nomogram

ASJC Scopus subject areas

  • Oncology

Cite this

Development and validation of a prognostic nomogram for colorectal cancer after radical resection based on individual patient data from three large-scale phase III trials. / Honda, Michitaka; Oba, Koji; Akiyoshi, Takashi; Maeda, Hiromichi; Kashiwabara, Kosuke; Kanda, Mitsuro; Mayanagi, Shuhei; Aoyama, Toru; Hamada, Chikuma; Sadahiro, Sotaro; Fukunaga, Yosuke; Ueno, Masashi; Sakamoto, Junichi; Saji, Shigetoyo; Yoshikawa, Takaki.

In: Oncotarget, Vol. 8, No. 58, 01.01.2017, p. 99150-99160.

Research output: Contribution to journalArticle

Honda, M, Oba, K, Akiyoshi, T, Maeda, H, Kashiwabara, K, Kanda, M, Mayanagi, S, Aoyama, T, Hamada, C, Sadahiro, S, Fukunaga, Y, Ueno, M, Sakamoto, J, Saji, S & Yoshikawa, T 2017, 'Development and validation of a prognostic nomogram for colorectal cancer after radical resection based on individual patient data from three large-scale phase III trials', Oncotarget, vol. 8, no. 58, pp. 99150-99160. https://doi.org/10.18632/oncotarget.21845
Honda, Michitaka ; Oba, Koji ; Akiyoshi, Takashi ; Maeda, Hiromichi ; Kashiwabara, Kosuke ; Kanda, Mitsuro ; Mayanagi, Shuhei ; Aoyama, Toru ; Hamada, Chikuma ; Sadahiro, Sotaro ; Fukunaga, Yosuke ; Ueno, Masashi ; Sakamoto, Junichi ; Saji, Shigetoyo ; Yoshikawa, Takaki. / Development and validation of a prognostic nomogram for colorectal cancer after radical resection based on individual patient data from three large-scale phase III trials. In: Oncotarget. 2017 ; Vol. 8, No. 58. pp. 99150-99160.
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abstract = "Background: Few prediction models have so far been developed and assessed for the prognosis of patients who undergo curative resection for colorectal cancer (CRC). Materials and Methods: We prepared a clinical dataset including 5,530 patients who participated in three major randomized controlled trials as a training dataset and 2,263 consecutive patients who were treated at a cancer-specialized hospital as a validation dataset. All subjects underwent radical resection for CRC which was histologically diagnosed to be adenocarcinoma. The main outcomes that were predicted were the overall survival (OS) and disease free survival (DFS). The identification of the variables in this nomogram was based on a Cox regression analysis and the model performance was evaluated by Harrell's c-index. The calibration plot and its slope were also studied. For the external validation assessment, risk group stratification was employed. Results: The multivariate Cox model identified variables; sex, age, pathological T and N factor, tumor location, size, lymphnode dissection, postoperative complications and adjuvant chemotherapy. The c-index was 0.72 (95{\%} confidence interval [CI] 0.66- 0.77) for the OS and 0.74 (95{\%} CI 0.69-0.78) for the DFS. The proposed stratification in the risk groups demonstrated a significant distinction between the Kaplan-Meier curves for OS and DFS in the external validation dataset. Conclusions: We established a clinically reliable nomogram to predict the OS and DFS in patients with CRC using large scale and reliable independent patient data from phase III randomized controlled trials. The external validity was also confirmed on the practical dataset.",
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T1 - Development and validation of a prognostic nomogram for colorectal cancer after radical resection based on individual patient data from three large-scale phase III trials

AU - Honda, Michitaka

AU - Oba, Koji

AU - Akiyoshi, Takashi

AU - Maeda, Hiromichi

AU - Kashiwabara, Kosuke

AU - Kanda, Mitsuro

AU - Mayanagi, Shuhei

AU - Aoyama, Toru

AU - Hamada, Chikuma

AU - Sadahiro, Sotaro

AU - Fukunaga, Yosuke

AU - Ueno, Masashi

AU - Sakamoto, Junichi

AU - Saji, Shigetoyo

AU - Yoshikawa, Takaki

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Background: Few prediction models have so far been developed and assessed for the prognosis of patients who undergo curative resection for colorectal cancer (CRC). Materials and Methods: We prepared a clinical dataset including 5,530 patients who participated in three major randomized controlled trials as a training dataset and 2,263 consecutive patients who were treated at a cancer-specialized hospital as a validation dataset. All subjects underwent radical resection for CRC which was histologically diagnosed to be adenocarcinoma. The main outcomes that were predicted were the overall survival (OS) and disease free survival (DFS). The identification of the variables in this nomogram was based on a Cox regression analysis and the model performance was evaluated by Harrell's c-index. The calibration plot and its slope were also studied. For the external validation assessment, risk group stratification was employed. Results: The multivariate Cox model identified variables; sex, age, pathological T and N factor, tumor location, size, lymphnode dissection, postoperative complications and adjuvant chemotherapy. The c-index was 0.72 (95% confidence interval [CI] 0.66- 0.77) for the OS and 0.74 (95% CI 0.69-0.78) for the DFS. The proposed stratification in the risk groups demonstrated a significant distinction between the Kaplan-Meier curves for OS and DFS in the external validation dataset. Conclusions: We established a clinically reliable nomogram to predict the OS and DFS in patients with CRC using large scale and reliable independent patient data from phase III randomized controlled trials. The external validity was also confirmed on the practical dataset.

AB - Background: Few prediction models have so far been developed and assessed for the prognosis of patients who undergo curative resection for colorectal cancer (CRC). Materials and Methods: We prepared a clinical dataset including 5,530 patients who participated in three major randomized controlled trials as a training dataset and 2,263 consecutive patients who were treated at a cancer-specialized hospital as a validation dataset. All subjects underwent radical resection for CRC which was histologically diagnosed to be adenocarcinoma. The main outcomes that were predicted were the overall survival (OS) and disease free survival (DFS). The identification of the variables in this nomogram was based on a Cox regression analysis and the model performance was evaluated by Harrell's c-index. The calibration plot and its slope were also studied. For the external validation assessment, risk group stratification was employed. Results: The multivariate Cox model identified variables; sex, age, pathological T and N factor, tumor location, size, lymphnode dissection, postoperative complications and adjuvant chemotherapy. The c-index was 0.72 (95% confidence interval [CI] 0.66- 0.77) for the OS and 0.74 (95% CI 0.69-0.78) for the DFS. The proposed stratification in the risk groups demonstrated a significant distinction between the Kaplan-Meier curves for OS and DFS in the external validation dataset. Conclusions: We established a clinically reliable nomogram to predict the OS and DFS in patients with CRC using large scale and reliable independent patient data from phase III randomized controlled trials. The external validity was also confirmed on the practical dataset.

KW - Colorectal cancer

KW - Disease free survival

KW - Overall survival

KW - Prediction model

KW - Prognostic nomogram

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