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Survival outcome and prognostic factors for colorectal cancer with synchronous bone metastasis: a population-based study

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Abstract

Prognostic factors of synchronous bone metastatic colorectal cancer (CRC) are still undetermined. We aimed to investigate survival outcome and prognostic factors of patients with synchronous bone metastatic CRC. Information of patients with synchronous bone metastatic CRC were obtained from the Surveillance, Epidemiology, and End Results (SEER) and West China Hospital (WCH) databases. Cases from SEER database composed construction cohort, while cases from WCH database were used as validation cohort. A novel nomogram was constructed to predict individual survival probability based on Cox regression model. The performance of the nomogram was internally and externally validated using calibration curves and concordance index (C-index). Three hundred and eighty-one patients from SEER database were eligible. The median disease specific OS was 9.0 months (95% confidence interval [CI]: 7.3–10.7 months). Multivariate Cox analysis identified seven independent prognostic factors including histological type, differentiation grade, T stage of primary tumor, CEA level, systemic chemotherapy, combined with liver metastasis and combined with lung metastasis. A novel nomogram was established based on these variables. In the internal validation, the C-index (0.72, 95% CI 0.69–0.75) and calibration curve indicated well performance of this nomogram at predicting survival outcome in bone metastatic CRC. In the external validation, the C-index was 0.57 (95% CI 0.46–0.68). The prognosis of synchronous bone metastatic CRC is very poor. Histological type, differentiation grade, T stage of primary tumor, CEA level, systemic chemotherapy, combined with liver metastasis and combined with lung metastasis are independent prognostic factors. Further study is warranted to confirm the practicality of the prognostic nomogram.

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Abbreviations

CEA:

Carcinoembryonic antigen

CI:

Confidence interval

C-index:

Concordance index

CRC:

Colorectal cancer

HR:

Hazard ratio

OS:

Overall survival

SEER:

The Surveillance, Epidemiology, and End Results

ULN:

Upper limit of normal

US:

United States

WCH:

West China Hospital

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Acknowledgements

The authors acknowledge the National Cancer Institute for providing the SEER dataset.

Funding

This work was supported by the Youth Program of National Natural Science Foundation of China (No. 81402358).

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Authors and Affiliations

  1. Department of Abdominal Oncology, West China Hospital of Medicine, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People’s Republic of China

    Xiaofen Li, Hongna Sun & Hongfeng Gou

  2. Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education), The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China

    Wangxiong Hu

Authors
  1. Xiaofen Li
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  2. Wangxiong Hu
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  3. Hongna Sun
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  4. Hongfeng Gou
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Contributions

XL and HG conceived of and designed this study. XL, WH performed the analyses. XL, WH and HS prepared tables and figures. XL wrote the main manuscript. All authors approved to the submission.

Corresponding author

Correspondence to Hongfeng Gou.

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The authors declare no conflict of interest.

Ethical approval

This study was approved by the West China Hospital, Sichuan University Ethic Committee for Clinical Investigation.

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Written informed consent for publication was obtained from all patients at the time of admission as a routine practice at West China Hospital, Sichuan University.

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Li, X., Hu, W., Sun, H. et al. Survival outcome and prognostic factors for colorectal cancer with synchronous bone metastasis: a population-based study. Clin Exp Metastasis 38, 89–95 (2021). https://doi.org/10.1007/s10585-020-10069-5

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  • DOI: https://doi.org/10.1007/s10585-020-10069-5

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