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