Personalizing the prediction of colorectal cancer prognosis by incorporating comorbidities and functional status into prognostic nomograms

Daniel Boakye, Lina Jansen, Martin Schneider, Jenny Chang-Claude, Michael Hoffmeister, Hermann Brenner*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Citations (Scopus)
1 Downloads (Pure)

Abstract

Despite consistent evidence that comorbidities and functional status (FS) are strong prognostic factors for colorectal cancer (CRC) patients, these important characteristics are not considered in prognostic nomograms. We assessed to what extent incorporating these characteristics into prognostic models enhances prediction of CRC prognosis. CRC patients diagnosed in 2003–2014 who were recruited into a population-based study in Germany and followed over a median time of 4.7 years were randomized into training (n = 1608) and validation sets (n = 1071). In the training set, Cox models with predefined variables (age, sex, stage, tumor location, comorbidity scores, and FS) were used to construct nomograms for relevant survival outcomes. The performance of the nomograms, compared to models without comorbidity and FS, was evaluated in the validation set using concordance index (C-index). The C-indexes of the nomograms for overall and disease-free survival in the validation set were 0.768 and 0.737, which were substantially higher than those of models including tumor stage only (0.707 and 0.701) or models including stage, age, sex, and tumor location (0.749 and 0.718). The nomograms enabled significant risk stratification within all stages including stage IV. Our study suggests that incorporating comorbidities and FS into prognostic nomograms could substantially enhance prediction of CRC prognosis.
Original languageEnglish
Article number1435
Number of pages13
JournalCancers
Volume11
Issue number10
DOIs
Publication statusPublished - 26 Sep 2019
Externally publishedYes

Keywords

  • comorbidity
  • functional status
  • nomogram
  • personalized medicine
  • prognosis
  • colorectal neoplasm

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