Risk factors, prognostic factors and nomograms for distant metastasis in colorectal neuroendocrine neoplasms: a SEER-based study

Abstract

Background: Distant metastasis is uncommon in colorectal neuroendocrine neoplasms (CRNENs). However, the prognosis of patients with distant metastasis is often poor, so it is crucial to detect distant metastasis in time. This article aims to study the risk factors and prognostic factors for the development of distant metastasis in patients with CRNENs and to construct two related nomograms.

Methods: Patient data were obtained through the Surveillance, Epidemiology, and End Results (SEER) database, and the inclusion population was identified according to inclusion and exclusion criteria. Logistic regression analysis was used to determine risk factors for distant metastasis in patients with CRNENs. Cox regression analysis was utilized to identify prognostic factors in patients with CRNENs with distant metastasis. Two nomograms were created and the predictive performance of the nomogram was evaluated using receiver operating characteristic (ROC) curves, the calibration curve, and decision curve analysis (DCA) curves.

Results: We included 9,142 patients with CRNENs and 859 patients with distant metastasis. Age, race, marital status, primary site, histological grade, T stage, N stage, and tumor size were independent risk factors. Age, primary site, histological grade, N stage, tumor size, dissected lymph nodes, and surgery were independent prognostic factors. The constructed nomogram can predict the occurrence and prognosis of distant metastasis in patients with CRNENs.

Conclusions: The nomogram developed in this paper may contribute to the diagnosis and prognosis of distant metastasis in patients with CRNENs and may help clinicians make better clinical decisions.

Keywords: Colorectal neuroendocrine neoplasms (CRNENs); Surveillance, Epidemiology, and End Results (SEER); distant metastasis; nomogram.

Figure 1

Patient enrollment flowchart. AJCC_T, American Joint Committee on Cancer_Tumor; NENs, neuroendocrine neoplasms; SEER, Surveillance, Epidemiology, and End Results.

Figure 2

Kaplan-Meier analysis of OS for distant and non-distant metastasis. OS, overall survival.

Figure 3

A diagnostic nomogram predicting risk of distant metastasis in patients with CRNENs. CRNENs, colorectal neuroendocrine neoplasms.

Figure 4

ROC, calibration curves, and DCA of the nomogram for the risk of CRNENs with distant metastasis. ROC of the training (A), validation (B), and testing (C) sets; calibration curve of the training (D), validation (E), and testing (F) sets; DCA curve of the training (G), validation (H), and testing (I) sets. AUC, area under the ROC curve; DCA, decision curve analysis; ROC, receiver operating characteristic.

Figure 5

Comparison of AUC between nomogram and all independent factors, including age, race, marriage, primary site, grade, T stage, N stage, and tumor size in the training set (A), validation set (B), and testing set (C). AUC, area under the ROC curve; ROC, receiver operating characteristic.

Figure 6

Nomogram for 1-, 3-, and 5-year OS in patients with CRNENs with distant metastasis. CRNENs, colorectal neuroendocrine neoplasms; OS, overall survival.

Figure 7

The ROC of 1-, 3-, and 5-year of the training (A), validation (B), and testing (C) sets. AUC, area under the ROC curve; ROC, receiver operating characteristic.

Figure 8

Calibration curve of the nomogram. (A-C) For 1-, 3-, and 5-year OS in the training set; (D-F) for 1-, 3-, and 5-year OS in the validation set; (G-I) for 1-, 3-, and 5-year OS in the testing set. OS, overall survival.

Figure 9

The DCA curves at 1 (A), 3 (B), and 5 years (C) in the training set, 1 (D), 3 (E), and 5 years (F) in the validation set, and 1 (G), 3 (H), and 5 years (I) in the testing set were used to evaluate the reliability of the prognostic nomogram. DCA, decision curve analysis.

Figure 10

The AUCs were compared for the prognostic nomogram in the training, validation, and testing sets with all independent variables, including age, primary site, grade, N stage, tumor size, dissected lymph nodes, and surgery at 1 (A,D,G), 3 (B,E,H), and 5 years (C,F,I). AUC, area under the ROC curve; ROC, receiver operating characteristic.

Figure 11

Survival outcomes in the training set (A), validation set (B), and testing set (C) for the high-risk and low-risk groups (according to the prognostic nomogram).