Development of a novel model for predicting survival of patients with spine metastasis from colorectal cancer
To develop a novel nomogram for predicting survival of patients with spine metastasis from colorectal cancer (SMCRC) based on the clinical characteristics and prognostic factors.
Included in this study were 93 SMCRC patients who received treatments in our institute between 2006 and 2017, whose clinical data were analyzed retrospectively by univariate and multivariate analysis to identify independent variables that could predict prognosis. A nomogram for survival prediction was established on the basis of preoperative independent factors, and then subjected to bootstrap re-samples for internal validation. The discrimination was measured by concordance index (C-index). We used ROC analysis with the corresponding AUROC to compare the prediction accuracy of Changzheng Nomogram with three existing prognostic systems (Tomita, Tokuhashi and Bauer).
The high and median degrees of primary tumor differentiation, primary tumor surgery, carcinoembryonic antigen ≤ 5 ng/ml, no visceral metastases and ECOG-PS (0–2) were favorable prognostic factors for CRC metastases in the spine. These five preoperative independent factors were identified and entered into the nomogram with the C-index of 0.786 (0.739–0.833). The calibration curves for probability of 12- and 24-month overall survival (OS) showed good agreement between the predictive risk and the actual risk, and calibration was assessed. Compared with the previous prognostic systems, Changzheng Nomogram reported in this study showed higher accuracy in predicting OS of patients with SMCRC spinal metastases (p < 0.05).
By using this novel predictive model, clinicians could more precisely estimate the survival outcome of individual patients by evaluating clinical characteristics and identify subgroups of patients who are in need of a specific individual treatment strategy.
KeywordsColorectal cancer Spine metastasis Nomogram Prognostic factor
This study was supported by the National Key Research and Development Project of China (2016YFC0902100), National Natural Science Foundation of China (81702888) and Shanghai Youth doctor assistance program (QNYS09).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interests.
- 4.Douillard JY, Siena S, Cassidy J, Tabernero J, Burkes R, Barugel M, Humblet Y, Bodoky G, Cunningham D, Jassem J, Rivera F, Kocakova I, Ruff P, Blasinska-Morawiec M, Smakal M, Canon JL, Rother M, Oliner KS, Wolf M, Gansert J (2010) Randomized, phase III trial of panitumumab with infusional fluorouracil, leucovorin, and oxaliplatin (FOLFOX4) versus FOLFOX4 alone as first-line treatment in patients with previously untreated metastatic colorectal cancer: the PRIME study. J Clin Oncol Off J Am Soc Clin Oncol 28:4697–4705. https://doi.org/10.1200/jco.2009.27.4860 CrossRefGoogle Scholar
- 5.Saltz LB, Clarke S, Diaz-Rubio E, Scheithauer W, Figer A, Wong R, Koski S, Lichinitser M, Yang TS, Rivera F, Couture F, Sirzen F, Cassidy J (2008) Bevacizumab in combination with oxaliplatin-based chemotherapy as first-line therapy in metastatic colorectal cancer: a randomized phase III study. J Clin Oncol Off J Am Soc Clin Oncol 26:2013–2019. https://doi.org/10.1200/jco.2007.14.9930 CrossRefGoogle Scholar
- 6.Van Cutsem E, Kohne CH, Hitre E, Zaluski J, Chang Chien CR, Makhson A, D’Haens G, Pinter T, Lim R, Bodoky G, Roh JK, Folprecht G, Ruff P, Stroh C, Tejpar S, Schlichting M, Nippgen J, Rougier P (2009) Cetuximab and chemotherapy as initial treatment for metastatic colorectal cancer. New Engl J Med 360:1408–1417. https://doi.org/10.1056/NEJMoa0805019 CrossRefGoogle Scholar
- 12.Quraishi NA, Manoharan SR, Arealis G, Khurana A, Elsayed S, Edwards KL, Boszczyk BM (2013) Accuracy of the revised Tokuhashi score in predicting survival in patients with metastatic spinal cord compression (MSCC). Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 22(Suppl 1):S21–S26. https://doi.org/10.1007/s00586-012-2649-5 CrossRefGoogle Scholar
- 13.Karakiewicz PI, Briganti A, Chun FK, Trinh QD, Perrotte P, Ficarra V, Cindolo L, De la Taille A, Tostain J, Mulders PF, Salomon L, Zigeuner R, Prayer-Galetti T, Chautard D, Valeri A, Lechevallier E, Descotes JL, Lang H, Mejean A, Patard JJ (2007) Multi-institutional validation of a new renal cancer-specific survival nomogram. J Clin Oncol Off J Am Soc Clin Oncol 25:1316–1322. https://doi.org/10.1200/jco.2006.06.1218 CrossRefGoogle Scholar
- 14.Wierda WG, O’Brien S, Wang X, Faderl S, Ferrajoli A, Do KA, Cortes J, Thomas D, Garcia-Manero G, Koller C, Beran M, Giles F, Ravandi F, Lerner S, Kantarjian H, Keating M (2007) Prognostic nomogram and index for overall survival in previously untreated patients with chronic lymphocytic leukemia. Blood 109:4679–4685. https://doi.org/10.1182/blood-2005-12-051458 CrossRefGoogle Scholar
- 17.Mariani L, Miceli R, Kattan MW, Brennan MF, Colecchia M, Fiore M, Casali PG, Gronchi A (2005) Validation and adaptation of a nomogram for predicting the survival of patients with extremity soft tissue sarcoma using a three-grade system. Cancer 103:402–408. https://doi.org/10.1002/cncr.20778 CrossRefGoogle Scholar
- 20.Vogelaar I, van Ballegooijen M, Schrag D, Boer R, Winawer SJ, Habbema JD, Zauber AG (2006) How much can current interventions reduce colorectal cancer mortality in the U.S.? Mortality projections for scenarios of risk-factor modification, screening, and treatment. Cancer 107:1624–1633. https://doi.org/10.1002/cncr.22115 CrossRefGoogle Scholar
- 21.Chen W, Zheng R, Zuo T, Zeng H, Zhang S, He J (2016) National cancer incidence and mortality in China, 2012. Chin J Cancer Res Chung-kuo yen cheng yen chiu 28:1–11. https://doi.org/10.3978/j.issn.1000-9604.2016.02.08 Google Scholar
- 23.Santini D, Tampellini M, Vincenzi B, Ibrahim T, Ortega C, Virzi V, Silvestris N, Berardi R, Masini C, Calipari N, Ottaviani D, Catalano V, Badalamenti G, Giannicola R, Fabbri F, Venditti O, Fratto ME, Mazzara C, Latiano TP, Bertolini F, Petrelli F, Ottone A, Caroti C, Salvatore L, Falcone A, Giordani P, Addeo R, Aglietta M, Cascinu S, Barni S, Maiello E, Tonini G (2012) Natural history of bone metastasis in colorectal cancer: final results of a large Italian bone metastases study. Ann Oncol Off J Eur Soc Med Oncol 23:2072–2077. https://doi.org/10.1093/annonc/mdr572 CrossRefGoogle Scholar
- 27.Comito T, Cozzi L, Clerici E, Campisi MC, Liardo RL, Navarria P, Ascolese A, Tozzi A, Iftode C, De Rose F, Villa E, Personeni N, Rimassa L, Santoro A, Fogliata A, Mancosu P, Tomatis S, Scorsetti M (2014) Stereotactic ablative radiotherapy (SABR) in inoperable oligometastatic disease from colorectal cancer: a safe and effective approach. BMC Cancer 14:619. https://doi.org/10.1186/1471-2407-14-619 CrossRefGoogle Scholar
- 28.Giantonio BJ, Catalano PJ, Meropol NJ, O’Dwyer PJ, Mitchell EP, Alberts SR, Schwartz MA, Benson AB 3rd (2007) Bevacizumab in combination with oxaliplatin, fluorouracil, and leucovorin (FOLFOX4) for previously treated metastatic colorectal cancer: results from the Eastern Cooperative Oncology Group Study E3200. J Clin Oncol Off J Am Soc Clin Oncol 25:1539–1544. https://doi.org/10.1200/jco.2006.09.6305 CrossRefGoogle Scholar
- 29.Hurwitz HI, Tebbutt NC, Kabbinavar F, Giantonio BJ, Guan ZZ, Mitchell L, Waterkamp D, Tabernero J (2013) Efficacy and safety of bevacizumab in metastatic colorectal cancer: pooled analysis from seven randomized controlled trials. Oncologist 18:1004–1012. https://doi.org/10.1634/theoncologist.2013-0107 CrossRefGoogle Scholar
- 30.Saltz LB, Cox JV, Blanke C, Rosen LS, Fehrenbacher L, Moore MJ, Maroun JA, Ackland SP, Locker PK, Pirotta N, Elfring GL, Miller LL (2000) Irinotecan plus fluorouracil and leucovorin for metastatic colorectal cancer. Irinotecan Study Group. New Engl J Med 343:905–914. https://doi.org/10.1056/nejm200009283431302 CrossRefGoogle Scholar
- 31.Aranda E, Valladares M, Martinez-Villacampa M, Benavides M, Gomez A, Massutti B, Marcuello E, Constenla M, Camara JC, Carrato A, Duenas R, Reboredo M, Navarro M, Diaz-Rubio E (2009) Randomized study of weekly irinotecan plus high-dose 5-fluorouracil (FUIRI) versus biweekly irinotecan plus 5-fluorouracil/leucovorin (FOLFIRI) as first-line chemotherapy for patients with metastatic colorectal cancer: a Spanish Cooperative Group for the Treatment of Digestive Tumors Study. Ann Oncol Off J Eur Soc Med Oncol 20:251–257. https://doi.org/10.1093/annonc/mdn557 CrossRefGoogle Scholar
- 32.Adachi T, Hinoi T, Egi H, Shimomura M, Ohdan H (2015) Oxaliplatin and molecular-targeted drug therapies improved the overall survival in colorectal cancer patients with synchronous peritoneal carcinomatosis undergoing incomplete cytoreductive surgery. Surg Today 45:986–992. https://doi.org/10.1007/s00595-014-1017-y CrossRefGoogle Scholar
- 34.Nozue M, Oshiro Y, Kurata M, Seino K, Koike N, Kawamoto T, Taniguchi H, Todoroki T, Fukao K (2002) Treatment and prognosis in colorectal cancer patients with bone metastasis. Oncol Rep 9:109–112Google Scholar
- 37.Shibutani M, Maeda K, Nagahara H, Ohtani H, Sakurai K, Toyokawa T, Kubo N, Tanaka H, Muguruma K, Ohira M, Hirakawa K (2014) Significance of CEA and CA19-9 combination as a prognostic indicator and for recurrence monitoring in patients with stage II colorectal cancer. Anticancer Res 34:3753–3758Google Scholar
- 38.Aggarwal C, Meropol NJ, Punt CJ, Iannotti N, Saidman BH, Sabbath KD, Gabrail NY, Picus J, Morse MA, Mitchell E, Miller MC, Cohen SJ (2013) Relationship among circulating tumor cells, CEA and overall survival in patients with metastatic colorectal cancer. Ann Oncol Off J Eur Soc Med Oncol 24:420–428. https://doi.org/10.1093/annonc/mds336 CrossRefGoogle Scholar
- 42.Takagawa R, Fujii S, Ohta M, Nagano Y, Kunisaki C, Yamagishi S, Osada S, Ichikawa Y, Shimada H (2008) Preoperative serum carcinoembryonic antigen level as a predictive factor of recurrence after curative resection of colorectal cancer. Ann Surg Oncol 15:3433–3439. https://doi.org/10.1245/s10434-008-0168-8 CrossRefGoogle Scholar
- 45.Tang Y, Qu J, Wu J, Li S, Zhou Y, Xiao J (2015) Metastatic spinal cord compression from non-small-cell lung cancer treated with surgery and adjuvant therapies: a retrospective analysis of outcomes and prognostic factors in 116 patients. J Bone Jt Surg Am 97:1418–1425. https://doi.org/10.2106/jbjs.n.01124 CrossRefGoogle Scholar
- 46.Matsumoto M, Tsuji T, Iwanami A, Watanabe K, Hosogane N, Ishii K, Nakamura M, Morioka H, Toyama Y (2013) Total en bloc spondylectomy for spinal metastasis of differentiated thyroid cancers: a long-term follow-up. J Spinal Disord Tech 26:E137–E142. https://doi.org/10.1097/BSD.0b013e318278c8e4 CrossRefGoogle Scholar
- 48.Boriani S, Gasbarrini A, Bandiera S, Ghermandi R, Lador R (2016) Predictors for surgical complications of en bloc resections in the spine: review of 220 cases treated by the same team. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 25:3932–3941. https://doi.org/10.1007/s00586-016-4463-y CrossRefGoogle Scholar
- 50.Patchell RA, Tibbs PA, Regine WF, Payne R, Saris S, Kryscio RJ, Mohiuddin M, Young B (2005) Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet (Lond Engl) 366:643–648. https://doi.org/10.1016/s0140-6736(05)66954-1 CrossRefGoogle Scholar
- 51.Lei M, Liu Y, Yan L, Tang C, Yang S, Liu S (2016) A validated preoperative score predicting survival and functional outcome in lung cancer patients operated with posterior decompression and stabilization for metastatic spinal cord compression. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 25:3971–3978. https://doi.org/10.1007/s00586-015-4290-6 CrossRefGoogle Scholar