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. 2025 Mar 18;40(1):72.
doi: 10.1007/s00384-025-04856-3.

Development and validation of cancer-specific survival prediction nomogram for patients with T4 stage colon cancer after surgical resection: a population-based study

Yuncan Xing #  1 , Sirui Zhu #  1 , Liang Zhou #  1 , Jiawei Tu  1 , Zheng Wang  2
Affiliations

Development and validation of cancer-specific survival prediction nomogram for patients with T4 stage colon cancer after surgical resection: a population-based study

Yuncan Xing et al. Int J Colorectal Dis. .

Abstract

Purpose: The increasing incidence of colorectal cancer has coincided with a rise in T4 stage colon cancer (CC), yet research on its prognosis remains limited. This study aimed to identify risk factors and develop a nomogram to predict cancer-specific survival (CSS), optimizing treatment strategies for different subgroups.

Methods: Using data from the from the Surveillance, Epidemiology, and End Results (SEER) database, we identified risk factors in T4 stage CC patients and created a nomogram to predict CSS. Patients were divided into low- and high-risk groups, and the nomogram was validated. Propensity score matching was used to evaluate the benefits of various therapies across subgroups.

Results: Independent risk factors, including T stage, N stage, tumor grade, age, and therapy sequence, were identified through Cox regression analyses and incorporated into the nomogram. The nomogram outperformed the American Joint Committee on Cancer (AJCC) 7th staging system, with a Concordance-index of 0.77 in both training and validation sets. The receiver operating characteristic curves showed area under the curve values of 0.81, 0.77, and 0.75 for 1-, 3-, and 5-year CSS, respectively. Calibration plots confirmed strong alignment between predicted and actual outcomes, and decision curve analysis highlighted the nomogram's superior clinical utility. Chemotherapy significantly improved CSS, while radiation did not. Adjuvant therapy was particularly beneficial in high-risk groups.

Conclusion: This study offered a thorough prognostic analysis of T4 stage colon cancer patients and developed nomograms for predicting CSS. Subgroup analyses highlight the potential benefits of various treatment options.

Keywords: Adjuvant therapy; Colon cancer; Nomogram; Surveillance, Epidemiology, and End Results; T4 stage.

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Conflict of interest statement

Declarations. Ethical approval: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The selection of patient in the study. SEER, Surveillance, Epidemiology, and End Results
Fig. 2
Fig. 2
A nomogram to predict CSS in T4 stage CC patients. CSS, cancer-specific survival; CC, colon cancer
Fig. 3
Fig. 3
The Kaplan–Meier survival curves of CSS between the high-risk group and the low-risk group in all (A), left-side colon (B), right-side colon (C) and transverse colon (D) tumor sites. CSS, cancer-specific survival; HR, hazard ratio; CI, confidence interval
Fig. 4
Fig. 4
The Kaplan–Meier survival curves of CSS under radiation therapy in all (A), left-side colon (B), right-side colon (C) and transverse colon (D) tumor sites. CSS, cancer-specific survival; HR, hazard ratio; CI, confidence interval
Fig. 5
Fig. 5
The Kaplan–Meier survival curves of CSS under chemotherapy in all (A), left-side colon (B), right-side colon (C) and transverse colon (D) tumor sites. CSS, cancer-specific survival; HR, hazard ratio; CI, confidence interval
Fig. 6
Fig. 6
The Kaplan–Meier survival curves of CSS between adjuvant therapy and neoadjuvant therapy in all (A), left-side colon (B), right-side colon (C) and transverse colon (D) tumor sites. CSS, cancer-specific survival; HR, hazard ratio; CI, confidence interval
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References

    1. Bray F, Laversanne M, Sung H et al (2024) Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 74:229–263 - DOI - PubMed
    1. Patel SG, Dominitz JA (2024) Screening for colorectal cancer. Ann Intern Med 177:Itc49-itc64 - DOI - PubMed
    1. Chen M, Chen T (2023) Individualized conditional survival nomograms for stage I-III early onset colorectal cancer patients. Jpn J Clin Oncol 53:115–121 - DOI - PubMed
    1. Zheng X, Cen W, Zhu J et al (2023) Prognostic value of tumor deposits in stage III colorectal cancer patients with different N stages: a population-based, retrospective cohort study. Ann Surg Oncol 30:8067–8073 - DOI - PubMed
    1. Bastiaenen VP, Aalbers AGJ, Arjona-Sánchez A et al (2021) Risk of metachronous peritoneal metastases in patients with pT4a versus pT4b colon cancer: an international multicentre cohort study. Eur J Surg Oncol 47:2405–2413 - DOI - PubMed

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