International Journal of Colorectal Disease

, Volume 34, Issue 7, pp 1189–1201 | Cite as

The incidence, associated factors, and predictive nomogram for early death in stage IV colorectal cancer

  • Xin Wang
  • Min Mao
  • Guijun Xu
  • Feng Lin
  • Peng Sun
  • Vladimir P. Baklaushev
  • Vladimir P. Chekhonin
  • Karl Peltzer
  • Jin ZhangEmail author
  • Chao ZhangEmail author
Original Article



The purpose of the present study was to investigate the incidence and associated factors for early death in stage IV colorectal cancer (CRC) and to construct the predictive nomogram.


Patients with stage IV CRC, who had been diagnosed between 2010 and 2014 in the Surveillance, Epidemiology, and End Results datasets, were eligible for this retrospective cohort study. The univariable and multivariable logistic regression models were conducted to determine the associated factors for early death (survival time ≤ 3 months). The predictive nomogram was constructed and the internal validation was performed.


Ten thousand two hundred sixty-three out of 36,461 (28.1%) eligible patients resulted in all causes of early death (25.8% for cancer-specific early death and 2.3% for non-cancer early death). Advanced age, marital status, right colon, poor differentiation, higher N stage, and bone metastasis were positively associated with all causes of early death, cancer-specific early death, and non-cancer early death, while higher T stage, positive carcinoembryonic antigen, and distant metastases (bone, lung, liver, and brain) were only positively associated with all causes of early death and cancer-specific early death. The calibration curve for all causes of early death, cancer-specific early death, and non-cancer early death showed the prediction curve closely approximated at the 45° line and the areas under the curve were 75.7% (95% CI, 74.9–76.4%), 75.9% (95% CI, 75.1–76.6%), and 76.9% (95% CI, 76.3–77.6%), respectively.


The nomogram was calibrated to predict all causes of early death development, cancer-specific early death development, and non-cancer early death development. These findings can be utilized in early screening and to tailor targeted treatment regimens for stage IV CRC patients.


Colorectal cancer Stage IV SEER Early death Nomogram 



Natural Science Foundation of China (81702161, 81801781, and 81802508); Natural Science Foundation of the Tianjin Science and Technology Committee of China (17JCQNJC11000); Natural Science Foundation of Tianjin Medical University (2016KYZQ10); Doctor Start-up Grant of Tianjin Medical University Cancer Institute and Hospital (B1711); Top talent training program of the first affiliated hospital of PLA Army Medical University (SWH2018BJKJ-12).

Compliance with ethical standards

The present study was complied with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F (2015) Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 136(5):E359–E386CrossRefGoogle Scholar
  2. 2.
    Van Cutsem E, Oliveira J (2009) Advanced colorectal cancer: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol 20(Suppl):461–463Google Scholar
  3. 3.
    Lee YC, Lee YL, Chuang JP, Lee JC (2013) Differences in survival between colon and rectal cancer from SEER data. PLoS One 8(11):e78709CrossRefGoogle Scholar
  4. 4.
    Kawamura H, Yamaguchi T, Yano Y, Hozumi T, Takaki Y, Matsumoto H, Nakano D, Takahashi K (2018) Characteristics and prognostic factors of bone metastasis in patients with colorectal cancer. Dis Colon Rectum 61(6):673–678Google Scholar
  5. 5.
    Rutter CM, Johnson EA, Feuer EJ, Knudsen AB, Kuntz KM, Schrag D (2013) Secular trends in colon and rectal cancer relative survival. J Natl Cancer Inst 105(23):1806–1813CrossRefGoogle Scholar
  6. 6.
    Edge SB, Compton CC (2010) The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 17(6): 1471–1474Google Scholar
  7. 7.
    Brenner H, Kloor M, Pox CP (2014) Colorectal cancer. Lancet 383(9927):1490–1502CrossRefGoogle Scholar
  8. 8.
    Del CHL, Virgili MA, Szafranska J, Martin-Richard M, Paez LD, Sebio GA et al (2018) Brain metastases in colorectal cancer: prognostic factors and survival analysis. Int J Color Dis 33(11):1517–1523CrossRefGoogle Scholar
  9. 9.
    Jochems A, El-Naqa I, Kessler M, Mayo CS, Jolly S, Matuszak M et al (2018) A prediction model for early death in non-small cell lung cancer patients following curative-intent chemoradiotherapy. Acta Oncol 57(2):226–230CrossRefGoogle Scholar
  10. 10.
    Inoue T, Tamiya M, Tamiya A, Nakahama K, Taniguchi Y, Shiroyama T, Isa SI, Nishino K, Kumagai T, Kunimasa K, Kimura M, Suzuki H, Hirashima T, Atagi S, Imamura F (2018) Analysis of early death in Japanese patients with advanced non-small-cell lung cancer treated with nivolumab. Clin Lung Cancer 19(2):e171–e176CrossRefGoogle Scholar
  11. 11.
    Luo D, Liu Q, Yu W, Ma Y, Zhu J, Lian P, Cai S, Li Q, Li X (2018) Prognostic value of distant metastasis sites and surgery in stage IV colorectal cancer: a population-based study. Int J Color Dis [Epub ahead of print], 33, 1241, 1249Google Scholar
  12. 12.
    Kruser TJ, Chao ST, Elson P, Barnett GH, Vogelbaum MA, Angelov L, Weil RJ, Pelley R, Suh JH (2008) Multidisciplinary management of colorectal brain metastases: a retrospective study. Cancer 113(1):158–165CrossRefGoogle Scholar
  13. 13.
    Shervani S, Lu G, Sager K, Wajima T, Wong L (2018) Prognostic factors and hazard ratios in colorectal cancer patients over 80 years of age: a retrospective, 20-year, single institution review. J Gastrointest Oncol 9(2):254–262CrossRefGoogle Scholar
  14. 14.
    Baghestani AR, Daneshvar T, Pourhoseingholi MA, Asadzade H (2014) Survival of colorectal cancer patients in the presence of competing-risk. Asian Pac J Cancer Prev 15(15):6253–6255CrossRefGoogle Scholar
  15. 15.
    Lionti S, Reggiani BL, Bettelli S, Spallanzani A, Gelsomino F, Barresi V (2018) Histopathological variables in liver metastases of patients with stage IV colorectal cancer: potential prognostic relevance of poorly differentiated clusters. Hum Pathol:78115–78124Google Scholar
  16. 16.
    Wang R, Wang MJ, Ping J (2015) Clinicopathological features and survival outcomes of colorectal cancer in young versus elderly: a population-based cohort study of SEER 9 registries data (1988-2011). Medicine (Baltimore) 94(35):e1402CrossRefGoogle Scholar
  17. 17.
    O’Connell JB, Maggard MA, Liu JH, Etzioni DA, Livingston EH, Ko CY (2004) Do young colon cancer patients have worse outcomes? World J Surg 28(6):558–562CrossRefGoogle Scholar
  18. 18.
    Troncone E, Marafini I, Stolfi C, Monteleone G (2018) Transforming growth factor-beta1/Smad7 in intestinal immunity, inflammation, and cancer. Front Immunol 91407:9Google Scholar
  19. 19.
    Janakiram NB, Rao CV (2014) The role of inflammation in colon cancer. Adv Exp Med Biol:81625–81652Google Scholar
  20. 20.
    O’Connell JB, Maggard MA, Livingston EH, Yo CK (2004) Colorectal cancer in the young. Am J Surg 187(3):343–348CrossRefGoogle Scholar
  21. 21.
    Wang Y, Yang L, Zhou M, Shen L, Zhang J, Deng W et al (2018) Disparities in survival for right-sided vs. left-sided colon cancers in young patients: a study based on the Surveillance, Epidemiology, and End Results database (1990-2014). Cancer Manag Res:101735–101747Google Scholar
  22. 22.
    Meguid RA, Slidell MB, Wolfgang CL, Chang DC, Ahuja N (2008) Is there a difference in survival between right- versus left-sided colon cancers? Ann Surg Oncol 15(9):2388–2394CrossRefGoogle Scholar
  23. 23.
    Benedix F, Kube R, Meyer F, Schmidt U, Gastinger I, Lippert H (2010) Comparison of 17,641 patients with right- and left-sided colon cancer: differences in epidemiology, perioperative course, histology, and survival. Dis Colon Rectum 53(1):57–64CrossRefGoogle Scholar
  24. 24.
    Petrelli F, Tomasello G, Borgonovo K, Ghidini M, Turati L, Dallera P, et al. (2016) Prognostic survival associated with left-sided vs right-sided colon cancer: a systematic review and meta-analysis. JAMA OncolGoogle Scholar
  25. 25.
    Yahagi M, Okabayashi K, Hasegawa H, Tsuruta M, Kitagawa Y (2016) The worse prognosis of right-sided compared with left-sided colon cancers: a systematic review and meta-analysis. J Gastrointest Surg 20(3):648–655CrossRefGoogle Scholar
  26. 26.
    Arnold D, Lueza B, Douillard JY, Peeters M, Lenz HJ, Venook A, Heinemann V, van Cutsem E, Pignon JP, Tabernero J, Cervantes A, Ciardiello F (2017) Prognostic and predictive value of primary tumour side in patients with RAS wild-type metastatic colorectal cancer treated with chemotherapy and EGFR directed antibodies in six randomized trials. Ann Oncol 28(8):1713–1729CrossRefGoogle Scholar
  27. 27.
    Guan NC, Termorshuizen F, Laan W, Smeets HM, Zainal NZ, Kahn RS, de Wit NJ, Boks MPM (2013) Cancer mortality in patients with psychiatric diagnoses: a higher hazard of cancer death does not lead to a higher cumulative risk of dying from cancer. Soc Psychiatry Psychiatr Epidemiol 48(8):1289–1295CrossRefGoogle Scholar
  28. 28.
    Mazzotti F, Cucchetti A, Claassen Y, Bos A, Bastiaannet E, Ercolani G, et al. (2019) Years of life lost for older patients after colorectal cancer diagnosis. World J SurgGoogle Scholar
  29. 29.
    Ruo L, Gougoutas C, Paty PB, Guillem JG, Cohen AM, Wong WD (2003) Elective bowel resection for incurable stage IV colorectal cancer: prognostic variables for asymptomatic patients. J Am Coll Surg 196(5):722–728CrossRefGoogle Scholar
  30. 30.
    Vennix S, Pelzers L, Bouvy N, Beets GL, Pierie JP, Wiggers T, et al. (2014) Laparoscopic versus open total mesorectal excision for rectal cancer. Cochrane Database Syst Rev (4): D5200Google Scholar
  31. 31.
    Huang L, Li TJ, Zhang JW, Liu S, Fu BS, Liu W (2014) Neoadjuvant chemotherapy followed by surgery versus surgery alone for colorectal cancer: meta-analysis of randomized controlled trials. Medicine (Baltimore) 93(28):e231CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Xin Wang
    • 1
  • Min Mao
    • 2
  • Guijun Xu
    • 3
  • Feng Lin
    • 3
  • Peng Sun
    • 4
    • 5
  • Vladimir P. Baklaushev
    • 6
  • Vladimir P. Chekhonin
    • 7
  • Karl Peltzer
    • 8
  • Jin Zhang
    • 3
    Email author
  • Chao Zhang
    • 3
    Email author
  1. 1.Department of Epidemiology and Biostatistics, First Affiliated HospitalArmy Medical UniversityChongqingChina
  2. 2.Department of Pathology and Southwest Cancer Center, First Affiliated HospitalArmy Medical UniversityChongqingChina
  3. 3.Department of Bone and Soft Tissue Tumors, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for CancerTianjin Medical University Cancer Institute and HospitalTianjinChina
  4. 4.Department of General SurgeryThe Second Affiliated Hospital of Harbin Medical UniversityHarbinChina
  5. 5.Department of Colorectal Surgery, National Cancer Center, Chinese Academy of Medical SciencesPeking Union Medical CollegeBeijingChina
  6. 6.Federal Research and Clinical Center of Specialized Medical Care and Medical TechnologiesFederal Biomedical Agency of the Russian FederationMoscowRussian Federation
  7. 7.Department of Basic and Applied Neurobiology, Federal Medical Research Center for Psychiatry and NarcologyMoscowRussian Federation
  8. 8.Department of Research and InnovationUniversity of Limpopo, TurfloopMankwengSouth Africa

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