Individualized prediction of colon cancer recurrence using a nomogram Journal Article


Authors: Weiser, M. R.; Landmann, R. G.; Kattan, M. W.; Gonen, M.; Shia, J.; Chou, J.; Paty, P. B.; Guillem, J. G.; Temple, L. K.; Schrag, D.; Saltz, L. B.; Wong, W. D.
Article Title: Individualized prediction of colon cancer recurrence using a nomogram
Abstract: Purpose: Estimates of recurrence after curative colon cancer surgery are integral to patient care, forming the basis of cancer staging and treatment planning. The categoric staging system of the American Joint Committee on Cancer (AJCC) is commonly used to convey risk by grouping patients based on anatomic elements. Although easy to implement, there remains significant heterogeneity within each stage grouping. In the era of multimodality treatment, a more refined tool is needed to predict recurrence. Methods: An institutional database of 1,320 patients with nonmetastatic colon cancer was used to develop a nomogram to estimate recurrence after curative surgery. Prognostic factors were assessed with multivariable analysis using Cox regression, whereas nonlinear continuous variables were modeled with cubic splines. The model was internally validated with bootstrapping, and performance was assessed by concordance index and a calibration curve. Results: The colon cancer recurrence nomogram predicted relapse with a concordance index of 0.77, improving on the stratification provided by either the AJCC fifth or sixth staging scheme. Factors in the model included patient age, tumor location, preoperative carcinoembryonic antigen, T stage, numbers of positive and negative lymph nodes, lymphovascular invasion, perineural invasion, and use of postoperative chemotherapy. Conclusion: Using common clinicopathologic factors, the recurrence nomogram is better able to account for tumor and patient heterogeneity, thereby providing a more individualized outcome prognostication than that afforded by the AJCC categoric system. By identifying both the high- and low-risk patients within any particular stage, the nomogram is expected to aid in treatment planning and future trial design. © 2008 by American Society of Clinical Oncology.
Keywords: controlled study; treatment outcome; cancer surgery; major clinical study; cancer recurrence; treatment planning; cancer staging; antineoplastic agent; neoplasm staging; lymph node excision; medical decision making; demography; tumor localization; neoplasm recurrence, local; carcinoembryonic antigen; colonic neoplasms; cancer invasion; patient care; nomograms; colon cancer; cystectomy; predictive value of tests; nomogram
Journal Title: Journal of Clinical Oncology
Volume: 26
Issue: 3
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2008-01-20
Start Page: 380
End Page: 385
Language: English
DOI: 10.1200/jco.2007.14.1291
PUBMED: 18202413
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 25" - "Export Date: 17 November 2011" - "CODEN: JCOND" - "Source: Scopus"
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MSK Authors
  1. Joanne Fu-Lou Chou
    157 Chou
  2. Leonard B Saltz
    599 Saltz
  3. Philip B Paty
    373 Paty
  4. Mithat Gonen
    716 Gonen
  5. Jose Guillem
    373 Guillem
  6. Deborah Schrag
    137 Schrag
  7. Jinru Shia
    465 Shia
  8. Martin R Weiser
    346 Weiser
  9. Larissa Temple
    179 Temple
  10. Douglas W Wong
    173 Wong
  11. Michael W Kattan
    218 Kattan