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. 2024 May 16:14:1397468.
doi: 10.3389/fonc.2024.1397468. eCollection 2024.

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

Hao Zeng #  1 , Xuejing Zhong #  2 , Wenxin Liu  3 , Baofeng Liang  1 , Xueyi Xue  1 , Nong Yu  1 , Dongbo Xu  1 , Xiaojie Wang  4 , Shuangming Lin  1
Affiliations

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

Hao Zeng et al. Front Oncol. .

Abstract

Purpose: The aim to assess treatment failure in patients with stage III colon cancer who underwent radical surgery and was analyzed using the nomogram.

Methods: Clinical factors and survival outcomes for stage III colon cancer patients registered in the SEER database from 2018 to 2019 were analyzed, with patients split into training and testing cohorts (7:3 ratio). A total of 360 patients from the First Affiliated Hospital of Longyan served as an external validation cohort. Independent predictors of treatment failure were identified using logistic regression analyses. The nomograms was evaluated by concordance index (C-index), calibration curves, and the area under the curve (AUC), decision curve analysis (DCA) and clinical impact curves (CIC) assessed the clinical utility of nomograms versus TNM staging.

Results: The study included 4,115 patients with stage III colon cancer. Multivariate logistic analysis age, tumor site, pT stage, pN stage, chemotherapy, pretreatment CEA levels, number of harvested lymph nodes, perineural invasion and marital status were identified as independent risk factors for treatment failure. The C-indices for the training and testing sets were 0.853 and 0.841. Validation by ROC and calibration curves confirmed the stability and reliability of the model. DCA showed that the net clinical effect of the histogram was superior to that of the TNM staging system, while CIC highlighted the potentially large clinical impact of the model.

Conclusions: The developed Nomogram provides a powerful and accurate tool for clinicians to assess the risk of treatment failure after radical surgery in patients with stage III colon cancer.

Keywords: Surveillance, Epidemiology, and End Results (SEER); TNM staging systems; nomogram; stage III colon cancer; treatment failure.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of patient cohort definition.
Figure 2
Figure 2
Nomogram for treatment failure of stage III colon cancer patients in training cohort, testing cohort and validation cohort. (A) Nomogram in training cohort. (B) Nomogram in testing cohort. (C) Nomogram in validation cohort. To estimate the risk of treatment failure, the point of each variable was calculated by drawing a straight line from the patient variable value to the axis marked “points.” The total points are converted to the “Risk” on the lowest axis.
Figure 3
Figure 3
Calibration curves of nomograms for treatment failure. (A) Calibration curve in the training cohort. (B) Calibration curve in the testing cohort (C) Calibration curve in the validation cohort. (D) ROC curve in the training cohort. (E) ROC curve in the testing cohort. (F) ROC curve in the validation cohort.
Figure 4
Figure 4
The decision curve analysis (DCA) curves and clinical impact curve (CIC) curves of nomogram for treatment failure, the nomograms (red line) had a better clinical net value than the TNM staging system (green line). (A) DCA curve in the training cohort. (B) DCA curve in the testing cohort. (C) DCA curve in the validation cohort. (D) CIC curve in the training cohort. (E) CIC curve in the testing cohort. (F) CIC curve in the validation cohort.
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