Survival nomograms for colorectal carcinoma patients with lung metastasis and lung-only metastasis, based on the SEER database and a single-center external validation cohort

Abstract

Background: We analysed the survival of colorectal cancer (CRC) patients with lung metastasis and lung-only metastasis and determined the risk factors for lung metastasis in CRC patients.

Methods: Data from colorectal cancer patients with lung metastasis diagnosed from 2010 to 2015 were obtained from the SEER database. Survival was analysed using the Kaplan-Meier method and log-rank test, the Cox proportional hazards regression model, and a competing risk model. The predictive ability of the nomgram was assessed by the concordance index (C-index) and calibration curves. The data from the SEER database for the period 2016-2019 was used as an external validation set. The characteristics of 70 CRC patients treated at Shanghai East Hospital between 2016 and 2019 were retrospectively analysed and data from China was chosen as an external validation set.

Results: The median survival time for colorectal cancer patients with lung metastasis was 12 months, while this value was 24 months in patients with lung-only metastasis. Among all CRC patients with lung metastasis, age, grade, T stage, N stage, presence of liver, brain or bone metastasis, anatomic site and surgery were related to overall survival (OS). In CRC patients with lung-only metastasis, age, T stage, marital status, chemotherapy and surgery were independent prognostic factors affecting OS. Two nomograms predicting OS were established, with great discrimination (C-index between 0.67 and 0.81) and excellent calibration. Factors including age, race, sex, tumour grade, T stage, N stage, presence of liver, brain or bone metastasis, marital status, insurance status and anatomic location were related to the occurrence of lung metastasis in CRC patients.

Conclusion: We developed two reliable clinical prediction models among CRC patients to predict the OS rates in patients with lung metastasis and lung metastasis only.

Keywords: Colorectal carcinoma; Lung metastasis; Nomogram; Prognosis; SEER database.

Fig. 1

The flow diagram of the selection process for the study

Fig. 2

Overall Kaplan-Meier survival curves for CRC patients with lung metastasis and lung-only metastasis

Fig. 3

1 Overall Kaplan-Meier survival curves for CRC patients with lung metastasis in training cohort according to A Age, B Bone metastasis, C Liver metastasis, D Brain metastasis, E Marital status, F Chemotherapy, G Insurance status, H Grade. 2 Overall Kaplan-Meier survival curves for CRC patients with lung metastasis in training cohort according to I T stage, J N stage, K Race, L Radiotherapy, M Site, N Surgery

Fig. 4

1 Overall Kaplan-Meier survival curves for CRC patients with lung-only metastasis in training cohort according to A Age, B Gender, C Marital status, D Race, E Chemotherapy, F Radiotherapy, G Insurance status, H Surgery. 2 Overall Kaplan-Meier survival curves for CRC patients with lung-only metastasis in training cohort according to I Grade, J T stage, K Site, L N stage

Fig. 5

A nomogram for prediction of 1- and 3-year OS rates of CRC patients with lung metastasis (A); Calibration curve of the nomogram predicting 1- and 3-year OS rates of CRC patients with lung metastasis in training cohort (B); Calibration curve of the nomogram predicting 1- and 3-year OS rates of CRC patients with lung metastasis in the validation cohort (C)

Fig. 6

A nomogram for prediction of 1- and 3-year OS rates of CRC patients with lung-only metastasis (A); Calibration curve of the nomogram predicting 1- and 3-year OS rates of CRC patients with lung-only metastasis in training cohort (B); Calibration curve of the nomogram predicting 1- and 3-year OS rates of CRC patients with lung-only metastasis in the validation cohort (C)

Fig. 7

Calibration curve of the nomogram predicting 3-year OS rates of patients with lung metastasis in colorectal cancer in our hospital