Development of a prognostic nomogram for colorectal cancer with peritoneal metastasis: a SEER database analysis

Colorectal cancer (CRC) is one of the most common malignant tumors worldwide. Advanced CRC patients often develop peritoneal metastasis (PM), which severely impairs prognosis. However, there is a lack of accurate prognostic prediction tools to guide clinical decision-making. This study aimed to develop and validate a nomogram for short-term prognostic assessment in CRC patients with PM using the Surveillance, Epidemiology, and End Results (SEER) database.

We retrospectively analyzed 2,425 eligible CRC patients with PM identified from the SEER database between 2018 and 2022. Patients were randomly assigned to a training cohort and an internal validation cohort at a ratio of 7:3. In addition, 58 patients from the Affiliated People's Hospital of Jiangsu University (2011-2024) were included as an external validation cohort. The primary endpoint was cancer-specific survival (CSS). Univariate and multivariate Cox proportional hazards regression analyses combined with Kaplan-Meier (KM) survival curves were performed to identify independent prognostic factors and construct a nomogram for predicting 6-month and 1-year CSS. Model performance was evaluated using the concordance index (C-index), time-dependent receiver operating characteristic curves, the area under the curve (AUC), and calibration plots.

Age, primary tumor location, N stage, carcinoembryonic antigen (CEA) level, surgical history, chemotherapy history, and number of lymph nodes examined were identified as independent prognostic factors. The nomogram's C-index was 0.76 [95% confidence interval (CI): 0.74-0.77] in the training cohort and 0.73 (95% CI: 0.70-0.76) in the internal validation cohort. The AUC values for predicting 6-month and 1-year CSS were 0.84 and 0.80 in the training cohort, and 0.82 and 0.77 in the internal validation cohort, respectively. Calibration curves showed good agreement between predicted and actual CSS.

We developed a nomogram for short-term prognostic assessment in CRC patients with PM using routinely available clinicopathological variables. The model showed acceptable discrimination and calibration in the SEER-derived cohorts, and external calibration showed generally acceptable agreement in the preliminary external validation cohort. Further validation in larger multicenter cohorts is needed.