Real-world study of a novel prognostic scoring system: for a more precise prognostication and better clinical treatment guidance in stages II and III colon cancer
This study aimed to improve the American Joint Committee on Cancer (AJCC) Tumor Node Metastases (TNM) staging system and demonstrate the improvement in prognostic accuracy and clinical management guidance in colon cancer using the novel prognostic score (P score).
Eligible patients were identified using the Surveillance, Epidemiology, and End Results database. A P score (based on age, tumor size, and tumor grade) was assigned to each patient. The Cox proportional hazards regression analyses were performed to identify independent factors associated with prognosis. The Kaplan–Meier survival curves were used to analyze the prognosis of patients with colon cancer with different P scores. The TNM staging system was compared with the P score in stages I–IV by calculating the concordance index.
The multivariate Cox analysis indicated that a higher P score was independently associated with a higher risk of cancer-specific mortality. The Kaplan–Meier survival curves showed that the survival benefit gradually increased as the P score decreased. The concordance index rose from 0.5, 0.593, 0.633, and 0.551 of AJCC TNM staging system to 0.709, 0.651, 0.691, and 0.623 of P score in stages I–IV, respectively.
The P score was an independent prognostic factor of colon cancer and had a much better prognostic accuracy than the AJCC TNM staging system in all patients with colon cancer. It may help in identifying patients with high-risk stage II colon cancer who were candidates for adjuvant therapy and differentiating patients with stage III colon cancer for adjuvant therapy.
KeywordsPrognostic score Stage II Stage III Colon cancer SEER
The authors acknowledge the effort that went into compiling and maintaining the Surveillance, Epidemiology, and End Results Program (SEER) tumor registries, including the interpretation and reporting of these data.
This work was supported by the National Natural Science Foundation of China (Grant Nos. 81702353 and 81772599) and Shanghai Municipal Natural Science Foundation (17ZR1406400). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Compliance with ethical standards
The authors declare that they have no conflicts of interest.
- 6.Aquina CT, Mohile SG, Tejani MA, Becerra AZ, Xu Z, Hensley BJ, Arsalani-Zadeh R, Boscoe FP, Schymura MJ, Noyes K, Monson JRT, Fleming FJ (2017) The impact of age on complications, survival, and cause of death following colon cancer surgery. Br J Cancer 116:389–397CrossRefPubMedPubMedCentralGoogle Scholar
- 15.Saha S et al. (2012) Tumor size as a prognostic factor for patients with colon cancer undergoing sentinel lymph node mapping and conventional surgery. Ann Surg Oncol. 20(4): p. -Google Scholar
- 19.Renfro LA, Grothey A, Xue Y, Saltz LB, André T, Twelves C, Labianca R, Allegra CJ, Alberts SR, Loprinzi CL, Yothers G, Sargent DJ, Adjuvant Colon Cancer Endpoints (ACCENT) Group (2014) ACCENT-based web calculators to predict recurrence and overall survival in stage III colon cancer. J Natl Cancer Inst 106(12):dju333CrossRefPubMedPubMedCentralGoogle Scholar
- 25.Labianca R et al (2013) Early colon cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol Off J Euro Soc Med Oncol 24(Suppl 6(3)):vi64Google Scholar
- 27.Lonardi S et al (2016) Phase III trial comparing 3 to 6 months of adjuvant FOLFOX4/XELOX in stage II-III colon cancer: safety and compliance in the TOSCA trial. Ann Oncol Off J Euro Soc Med Oncol 27(11):mdw404Google Scholar
- 28.Cramptom P, Williams R (2009) Adjuvant chemotherapy for stage II colon cancer: the role of molecular markers in choosing therapy. Gastrointest Cancer Res 3(5):191–196Google Scholar