A postsurgical prognostic nomogram for patients with lymph node positive rectosigmoid junction adenocarcinoma
Wu Yanlong1, Wu Yunxiao2, Wang Yibing3
1Department of Medical Records, The Second Affiliated Hospital of Nanchang University, Nanchang, China.
BMC Gastroenterology
|May 18, 2023
Summary
This study developed a nomogram for predicting survival in patients with positive lymph nodes in rectosigmoid junction cancer (PLN-RSJCs). The new model offers improved accuracy over the AJCC staging system for clinical decision-making.
Area of Science:
- Oncology
- Surgical Oncology
- Cancer Prognostics
Background:
- The definition of the rectosigmoid junction (RSJ) remains debated.
- Current treatment and prognosis for rectosigmoid junction cancer (RSJC) with positive lymph nodes (PLN-RSJCs) rely on the American Joint Committee on Cancer (AJCC) staging system.
- There is a need for more intuitive and accurate predictive models for PLN-RSJCs.
Purpose of the Study:
- To develop and validate a nomogram model for predicting overall survival (OS) in patients with PLN-RSJCs.
- To provide clinicians with a tool to aid in the treatment and follow-up of PLN-RSJC patients.
- To compare the accuracy of the developed nomogram with the existing AJCC staging system.
Main Methods:
- Utilized the Surveillance, Epidemiology, and End Results (SEER) database to extract data from 3384 PLN-RSJC patients.
- Randomly divided patients into development (n=2344) and validation (n=1004) cohorts.
- Employed univariate and multivariate COX regression, concordance index (C-index), ROC curves, calibration plots, and decision curve analysis (DCA) for model development and validation.
Main Results:
- Identified age, marital status, chemotherapy, AJCC stage, TNM stage, tumor size, and regional lymph nodes as independent risk factors for OS.
- The nomogram demonstrated superior accuracy (C-index: 0.751 in development, 0.750 in validation) compared to the AJCC 7th staging system (C-index: 0.681).
- The nomogram showed good calibration and predictive performance across 1-, 3-, and 5-year OS, with favorable clinical applicability via DCA.
Conclusions:
- An accurate and validated nomogram model for predicting overall survival in PLN-RSJCs has been established.
- This nomogram serves as a valuable tool to assist clinicians in managing and monitoring patients with PLN-RSJCs.
- The developed model offers improved prognostic prediction compared to the current AJCC staging system.
