Individualized Prediction of Stage I Colorectal Cancer Recurrence Using a Nomogram

Abstract Background Though the prognosis of stage l colorectal cancer (CRC) is suitable, some patients still recurrence and have a poor prognosis. Few prognostic risk models have been proposed. Therefore, we aimed to identify factors affecting the recurrence in patients with stage I CRC and develop a predictive nomogram. Methods The nomogram was based on a retrospective study on patients who underwent radical surgery for stage I CRC at Zhongshan Hospital (Shanghai, China) between August 2008 and December 2016. Predictive factors for recurrence were determined and a nomogram predicting recurrence-free survival was constructed based on Cox regression. This model was internally validated, and performance was evaluated through calibration plots. Results A total of 1,359 patients who underwent curative surgery for stage I CRC were enrolled. With the 62.0 months median follow-up time,71 (5.2%) experienced recurrence. The median time to recurrence was 24 months, 70% was diagnosed within three years after curative resection and 80% within 5 years. The 5-year cumulative recurrence rate was 5.0%, and the 10-year recurrence rate was 6.6%. In multivariate Cox analysis, age, preoperative serum CEA concentration, preoperative serum CA19-9 concentration, preoperative neutrophil-to-lymphocyte ratio, primary tumor location and lymphovascular invasion were the independent predictors of recurrence. A nomogram based on eight factors for recurrence-free survival was developed and internally validated. The concordance index of the nomogram was 0.716. Conclusions For stage I CRC, more than one in every twenty people may experience recurrence within 10 years after radical surgery. The nomogram we developed and internally validated might be helpfulhelpful in postoperative stage I CRC surveillance.