Clinical calculator based on molecular and clinicopathologic characteristics predicts recurrence following resection of stage I-III colon cancer Journal Article


Authors: Weiser, M. R.; Hsu, M.; Bauer, P. S.; Chapman, W. C. Jr; González, I. A.; Chatterjee, D.; Lingam, D.; Mutch, M. G.; Keshinro, A.; Shia, J.; Vakiani, E.; Konishi, T.; Shimada, Y.; Stadler, Z.; Segal, N. H.; Cercek, A.; Saltz, L.; Yaeger, R.; Varghese, A.; Widmar, M.; Wei, I. H.; Pappou, E. P.; Smith, J. J.; Nash, G.; Paty, P.; Garcia-Aguilar, J.; Gonen, M.
Article Title: Clinical calculator based on molecular and clinicopathologic characteristics predicts recurrence following resection of stage I-III colon cancer
Abstract: PURPOSE: Clinical calculators and nomograms have been endorsed by the American Joint Committee on Cancer (AJCC), as they provide the most individualized and accurate estimate of patient outcome. Using molecular and clinicopathologic variables, a third-generation clinical calculator was built to predict recurrence following resection of stage I-III colon cancer. METHODS: Prospectively collected data from 1,095 patients who underwent colectomy between 2007 and 2014 at Memorial Sloan Kettering Cancer Center were used to develop a clinical calculator. Discrimination was measured with concordance index, and variability in individual predictions was assessed with calibration curves. The clinical calculator was externally validated with a patient cohort from Washington University's Siteman Cancer Center in St Louis. RESULTS: The clinical calculator incorporated six variables: microsatellite genomic phenotype; AJCC T category; number of tumor-involved lymph nodes; presence of high-risk pathologic features such as venous, lymphatic, or perineural invasion; presence of tumor-infiltrating lymphocytes; and use of adjuvant chemotherapy. The concordance index was 0.792 (95% CI, 0.749 to 0.837) for the clinical calculator, compared with 0.708 (95% CI, 0.671 to 0.745) and 0.757 (0.715 to 0.799) for the staging schemes of the AJCC manual's 5th and 8th editions, respectively. External validation confirmed robust performance, with a concordance index of 0.738 (95% CI, 0.703 to 0.811) and calibration plots of predicted probability and observed events approaching a 45° diagonal. CONCLUSION: This third-generation clinical calculator for predicting cancer recurrence following curative colectomy successfully incorporates microsatellite genomic phenotype and the presence of tumor-infiltrating lymphocytes, resulting in improved discrimination and predictive accuracy. This exemplifies an evolution of a clinical calculator to maintain relevance by incorporating emerging variables as they become validated and accepted in the oncologic community.
Journal Title: Journal of Clinical Oncology
Volume: 39
Issue: 8
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2021-03-10
Start Page: 911
End Page: 919
Language: English
DOI: 10.1200/jco.20.02553
PUBMED: 33439688
PROVIDER: scopus
PMCID: PMC8189618
DOI/URL:
Notes: Article -- Export Date: 1 April 2021 -- Source: Scopus
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MSK Authors
  1. Meier Hsu
    169 Hsu
  2. Leonard B Saltz
    791 Saltz
  3. Philip B Paty
    499 Paty
  4. Neil Howard Segal
    210 Segal
  5. Mithat Gonen
    1030 Gonen
  6. Anna Mary Varghese
    145 Varghese
  7. Zsofia Kinga Stadler
    391 Stadler
  8. Jinru Shia
    720 Shia
  9. Martin R Weiser
    538 Weiser
  10. Rona Denit Yaeger
    316 Yaeger
  11. Garrett Nash
    263 Nash
  12. Efsevia Vakiani
    265 Vakiani
  13. Jesse Joshua Smith
    221 Smith
  14. Maria   Widmar
    76 Widmar
  15. Emmanouil Pappou
    91 Pappou
  16. Iris Hsin - chu Wei
    66 Wei