Emmanuel Gabriel1, Kristopher Attwood2, Pragatheeshwar Thirunavukarasu1, Eisar Al-Sukhni1, Patrick Boland3, Steven Nurkin4. 1. Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY. 2. Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, NY. 3. Department of Medical Oncology, Roswell Park Cancer Institute, Buffalo, NY. 4. Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY. Electronic address: steven.nurkin@roswellpark.org.
Abstract
BACKGROUND: Prediction calculators estimate postoperative survival and assist the decision-making process for adjuvant treatment. The objective of this study was to create a postoperative overall survival (OS) calculator for patients with stage II/III colon cancer. Factors that influence OS, including comorbidity and postoperative variables, were included. STUDY DESIGN: The National Cancer Data Base was queried for patients with stage II/III colon cancer, diagnosed between 2004 and 2006, who had surgical resection. Patients were randomly divided to a testing (nt) cohort comprising 80% of the dataset and a validation (nv) cohort comprising 20%. Multivariable Cox proportional hazards regression of nt was performed to identify factors associated with 5-year OS. These were used to build a prediction model. The performance was assessed using the nv cohort and translated into mobile software. RESULTS: A total of 129,040 patients had surgery. After exclusion of patients with carcinoma in situ, nonadenocarcinoma histology, more than 1 malignancy, stage I or IV disease, or missing data, 34,176 patients were used in the development of the calculator. Independent predictors of OS included patient-specific characteristics, pathologic factors, and treatment options, including type of surgery and adjuvant therapy. Length of postoperative stay and unplanned readmission rates were also incorporated as surrogates for postoperative complications (1-day increase in postoperative stay, hazard ratio [HR] 1.019, 95% CI 1.018 to 1.021, p < 0.001; unplanned readmission vs no readmission HR 1.35, 95% CI 1.25 to 1.45, p < 0.001). Predicted and actual 5-year OS rates were compared in the nv cohort with 5-year area under the curve of 0.77. CONCLUSIONS: An individualized, postoperative OS calculator application was developed for patients with stage II/III colon cancer. This prediction model uses nationwide data, culminating in a highly comprehensive, clinically useful tool.
BACKGROUND: Prediction calculators estimate postoperative survival and assist the decision-making process for adjuvant treatment. The objective of this study was to create a postoperative overall survival (OS) calculator for patients with stage II/III colon cancer. Factors that influence OS, including comorbidity and postoperative variables, were included. STUDY DESIGN: The National Cancer Data Base was queried for patients with stage II/III colon cancer, diagnosed between 2004 and 2006, who had surgical resection. Patients were randomly divided to a testing (nt) cohort comprising 80% of the dataset and a validation (nv) cohort comprising 20%. Multivariable Cox proportional hazards regression of nt was performed to identify factors associated with 5-year OS. These were used to build a prediction model. The performance was assessed using the nv cohort and translated into mobile software. RESULTS: A total of 129,040 patients had surgery. After exclusion of patients with carcinoma in situ, nonadenocarcinoma histology, more than 1 malignancy, stage I or IV disease, or missing data, 34,176 patients were used in the development of the calculator. Independent predictors of OS included patient-specific characteristics, pathologic factors, and treatment options, including type of surgery and adjuvant therapy. Length of postoperative stay and unplanned readmission rates were also incorporated as surrogates for postoperative complications (1-day increase in postoperative stay, hazard ratio [HR] 1.019, 95% CI 1.018 to 1.021, p < 0.001; unplanned readmission vs no readmission HR 1.35, 95% CI 1.25 to 1.45, p < 0.001). Predicted and actual 5-year OS rates were compared in the nv cohort with 5-year area under the curve of 0.77. CONCLUSIONS: An individualized, postoperative OS calculator application was developed for patients with stage II/III colon cancer. This prediction model uses nationwide data, culminating in a highly comprehensive, clinically useful tool.
Authors: Michael J O'Connell; Megan E Campbell; Richard M Goldberg; Axel Grothey; Jean-François Seitz; Jacqueline K Benedetti; Thierry André; Daniel G Haller; Daniel J Sargent Journal: J Clin Oncol Date: 2008-05-10 Impact factor: 44.544
Authors: George J Chang; Chung-Yuan Hu; Cathy Eng; John M Skibber; Miguel A Rodriguez-Bigas Journal: J Clin Oncol Date: 2009-10-05 Impact factor: 44.544
Authors: Emmanuel Gabriel; Jin Kim; Katherine T Ostapoff; Kristopher Attwood; Sergei Kurenov; Boris Kuvshinoff; Steven N Hochwald; Steven J Nurkin Journal: J Gastrointest Oncol Date: 2018-04