Predicting treatment failure in stage III colon cancer patients after radical surgery

Area of Science:

• Oncology
• Surgical Oncology
• Cancer Prognostics

Background:

• Stage III colon cancer requires precise prognostic tools for effective treatment planning.
• Identifying patients at high risk of treatment failure post-surgery is crucial for optimizing outcomes.

Purpose of the Study:

• To develop and validate a nomogram for predicting treatment failure in stage III colon cancer patients undergoing radical surgery.
• To compare the clinical utility of the nomogram against the established TNM staging system.

Main Methods:

• Analysis of clinical factors and survival outcomes in 4,115 stage III colon cancer patients from the SEER database (2018-2019).
• Development of a nomogram using logistic regression, validated with internal (7:3 split) and external cohorts.
• Evaluation of nomogram performance using concordance index (C-index), ROC curves, calibration plots, decision curve analysis (DCA), and clinical impact curves (CIC).

Main Results:

• Age, tumor site, pT/pN stage, chemotherapy, CEA levels, lymph node count, perineural invasion, and marital status were identified as independent predictors of treatment failure.
• The nomogram achieved high predictive accuracy with C-indices of 0.853 (training) and 0.841 (testing).
• Decision curve analysis demonstrated the nomogram's superior clinical utility compared to TNM staging.

Conclusions:

• The developed nomogram is a reliable and accurate tool for assessing treatment failure risk in stage III colon cancer patients post-radical surgery.
• The nomogram offers enhanced clinical decision-making support beyond traditional staging methods.