Cancer Management and Research (Aug 2020)

Performance of a Nomogram Based on the Integration of Inflammation Markers with Tumor Staging in Prognosis Prediction of Stage III Colorectal Cancer

  • Wang L,
  • Xiao J,
  • Li MZ,
  • Teng WH,
  • Jia J,
  • Lin L,
  • Liu S,
  • Ye X,
  • Zang WD,
  • Chen Y

Journal volume & issue
Vol. Volume 12
pp. 7077 – 7085

Abstract

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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 workCorrespondence: Wei-Dong ZangDepartment of Gastrointestinal Surgery, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou 350000, People’s Republic of ChinaEmail [email protected] ChenCentral Laboratory, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou 350000, People’s Republic of ChinaEmail [email protected]: 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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