Construction and validation of a clinicopathologic signature for predicting the prognosis of stage II and III colorectal cancer

Abstract Background: Various clinical and pathological indicators affect the prognosis of stage II and III colorectal cancer (CRC). Nevertheless, few studies have systematically integrated these indicators to construct a signature for assessing the prognostic risk.Methods: Patients with stage II-III CRC underwent R0 radical resection from 2009 to 2016 were included in this study. All clinical and follow-up data were collected. Our study mainly incorporated an internal training cohort and an external validation cohort from two centers. Data processing and data analysis were performed in the R language. Cox proportional hazard regression was used for univariate and multivariable analyses. The log-rank test was performed to compare prognosis among groups.Results: A total of 1200 eligible patients were included in our study. 8 variables, including T/N stage, lymphatic/vascular infiltration, preoperative CEA, CA125 and CA199, were included and the nomogram was established in the signature for predicting OS. The concordance index of the signature was 0.72. The 3-year and 5-year calibration curves of CRC based on the nomogram showed perfect correlation between predicted and observed outcomes. Obvious differences were observed in the survival of different risk groups (p < 0.001). Patients with low risk score signature had a 5-year OS rate of 77%, whereas patients with high risk score signature had the worst 5-year OS rate (only 8%). Furthermore, our signature also achieved similar performance in external cohort validation.Conclusions: The signature based on clinical and pathologic factors had favorable accuracy for predicting the prognosis of CRC. Therefore, our signature may provide significant suggestions for clinical work, particularly in identifying high-risk stage II and III CRC.