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European Spine Journal

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01-06-2019 | Metastasis | Original Article

Development of a novel model for predicting survival of patients with spine metastasis from colorectal cancer

Authors: Yujie Liu, Minglei Yang, Bo Li, Kehan Xu, Xin Gao, Jialin Li, Haifeng Wei, Quan Huang, Wei Xu, Jianru Xiao

Published in: European Spine Journal | Issue 6/2019

Abstract

Objective

To develop a novel nomogram for predicting survival of patients with spine metastasis from colorectal cancer (SMCRC) based on the clinical characteristics and prognostic factors.

Methods

Included in this study were 93 SMCRC patients who received treatments in our institute between 2006 and 2017, whose clinical data were analyzed retrospectively by univariate and multivariate analysis to identify independent variables that could predict prognosis. A nomogram for survival prediction was established on the basis of preoperative independent factors, and then subjected to bootstrap re-samples for internal validation. The discrimination was measured by concordance index (C-index). We used ROC analysis with the corresponding AUROC to compare the prediction accuracy of Changzheng Nomogram with three existing prognostic systems (Tomita, Tokuhashi and Bauer).

Results

The high and median degrees of primary tumor differentiation, primary tumor surgery, carcinoembryonic antigen ≤ 5 ng/ml, no visceral metastases and ECOG-PS (0–2) were favorable prognostic factors for CRC metastases in the spine. These five preoperative independent factors were identified and entered into the nomogram with the C-index of 0.786 (0.739–0.833). The calibration curves for probability of 12- and 24-month overall survival (OS) showed good agreement between the predictive risk and the actual risk, and calibration was assessed. Compared with the previous prognostic systems, Changzheng Nomogram reported in this study showed higher accuracy in predicting OS of patients with SMCRC spinal metastases (p < 0.05).

Conclusion

By using this novel predictive model, clinicians could more precisely estimate the survival outcome of individual patients by evaluating clinical characteristics and identify subgroups of patients who are in need of a specific individual treatment strategy.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

Available only for authorised users

Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A (2015) Global cancer statistics, 2012. CA Cancer J Clin 65:87–108. https://doi.org/10.3322/caac.21262 CrossRefPubMed

Brenner H, Kloor M, Pox CP (2014) Colorectal cancer. Lancet (Lond Engl) 383:1490–1502. https://doi.org/10.1016/s0140-6736(13)61649-9 CrossRef

Siegel R, Desantis C, Jemal A (2014) Colorectal cancer statistics, 2014. CA Cancer J Clin 64:104–117. https://doi.org/10.3322/caac.21220 CrossRefPubMed

Douillard JY, Siena S, Cassidy J, Tabernero J, Burkes R, Barugel M, Humblet Y, Bodoky G, Cunningham D, Jassem J, Rivera F, Kocakova I, Ruff P, Blasinska-Morawiec M, Smakal M, Canon JL, Rother M, Oliner KS, Wolf M, Gansert J (2010) Randomized, phase III trial of panitumumab with infusional fluorouracil, leucovorin, and oxaliplatin (FOLFOX4) versus FOLFOX4 alone as first-line treatment in patients with previously untreated metastatic colorectal cancer: the PRIME study. J Clin Oncol Off J Am Soc Clin Oncol 28:4697–4705. https://doi.org/10.1200/jco.2009.27.4860 CrossRef

Saltz LB, Clarke S, Diaz-Rubio E, Scheithauer W, Figer A, Wong R, Koski S, Lichinitser M, Yang TS, Rivera F, Couture F, Sirzen F, Cassidy J (2008) Bevacizumab in combination with oxaliplatin-based chemotherapy as first-line therapy in metastatic colorectal cancer: a randomized phase III study. J Clin Oncol Off J Am Soc Clin Oncol 26:2013–2019. https://doi.org/10.1200/jco.2007.14.9930 CrossRef

Van Cutsem E, Kohne CH, Hitre E, Zaluski J, Chang Chien CR, Makhson A, D’Haens G, Pinter T, Lim R, Bodoky G, Roh JK, Folprecht G, Ruff P, Stroh C, Tejpar S, Schlichting M, Nippgen J, Rougier P (2009) Cetuximab and chemotherapy as initial treatment for metastatic colorectal cancer. New Engl J Med 360:1408–1417. https://doi.org/10.1056/NEJMoa0805019 CrossRefPubMed

Tokuhashi Y, Ajiro Y, Umezawa N (2009) Outcome of treatment for spinal metastases using scoring system for preoperative evaluation of prognosis. Spine 34:69–73. https://doi.org/10.1097/BRS.0b013e3181913f19 CrossRefPubMed

Tomita K, Kawahara N, Kobayashi T, Yoshida A, Murakami H, Akamaru T (2001) Surgical strategy for spinal metastases. Spine 26:298–306CrossRefPubMed

Bauer HC, Wedin R (1995) Survival after surgery for spinal and extremity metastases. Prognostication in 241 patients. Acta Orthop Scand 66:143–146CrossRefPubMed

10.

Tokuhashi Y, Matsuzaki H, Oda H, Oshima M, Ryu J (2005) A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis. Spine 30:2186–2191CrossRefPubMed

11.

Tokuhashi Y, Matsuzaki H, Toriyama S, Kawano H, Ohsaka S (1990) Scoring system for the preoperative evaluation of metastatic spine tumor prognosis. Spine 15:1110–1113CrossRefPubMed

12.

Quraishi NA, Manoharan SR, Arealis G, Khurana A, Elsayed S, Edwards KL, Boszczyk BM (2013) Accuracy of the revised Tokuhashi score in predicting survival in patients with metastatic spinal cord compression (MSCC). Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 22(Suppl 1):S21–S26. https://doi.org/10.1007/s00586-012-2649-5 CrossRef

13.

Karakiewicz PI, Briganti A, Chun FK, Trinh QD, Perrotte P, Ficarra V, Cindolo L, De la Taille A, Tostain J, Mulders PF, Salomon L, Zigeuner R, Prayer-Galetti T, Chautard D, Valeri A, Lechevallier E, Descotes JL, Lang H, Mejean A, Patard JJ (2007) Multi-institutional validation of a new renal cancer-specific survival nomogram. J Clin Oncol Off J Am Soc Clin Oncol 25:1316–1322. https://doi.org/10.1200/jco.2006.06.1218 CrossRef

14.

Wierda WG, O’Brien S, Wang X, Faderl S, Ferrajoli A, Do KA, Cortes J, Thomas D, Garcia-Manero G, Koller C, Beran M, Giles F, Ravandi F, Lerner S, Kantarjian H, Keating M (2007) Prognostic nomogram and index for overall survival in previously untreated patients with chronic lymphocytic leukemia. Blood 109:4679–4685. https://doi.org/10.1182/blood-2005-12-051458 CrossRefPubMed

15.

Bochner BH, Kattan MW, Vora KC (2006) Postoperative nomogram predicting risk of recurrence after radical cystectomy for bladder cancer. J Clin Oncol Off J Am Soc Clin Oncol 24:3967–3972. https://doi.org/10.1200/jco.2005.05.3884 CrossRef

16.

Sternberg CN (2006) Are nomograms better than currently available stage groupings for bladder cancer? J Clin Oncol Off J Am Soc Clin Oncol 24:3819–3820. https://doi.org/10.1200/jco.2006.07.1290 CrossRef

17.

Mariani L, Miceli R, Kattan MW, Brennan MF, Colecchia M, Fiore M, Casali PG, Gronchi A (2005) Validation and adaptation of a nomogram for predicting the survival of patients with extremity soft tissue sarcoma using a three-grade system. Cancer 103:402–408. https://doi.org/10.1002/cncr.20778 CrossRefPubMed

18.

Wang L, Hricak H, Kattan MW, Chen HN, Scardino PT, Kuroiwa K (2006) Prediction of organ-confined prostate cancer: incremental value of MR imaging and MR spectroscopic imaging to staging nomograms. Radiology 238:597–603. https://doi.org/10.1148/radiol.2382041905 CrossRefPubMed

19.

Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, Carbone PP (1982) Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 5:649–655CrossRefPubMed

20.

Vogelaar I, van Ballegooijen M, Schrag D, Boer R, Winawer SJ, Habbema JD, Zauber AG (2006) How much can current interventions reduce colorectal cancer mortality in the U.S.? Mortality projections for scenarios of risk-factor modification, screening, and treatment. Cancer 107:1624–1633. https://doi.org/10.1002/cncr.22115 CrossRefPubMed

21.

Chen W, Zheng R, Zuo T, Zeng H, Zhang S, He J (2016) National cancer incidence and mortality in China, 2012. Chin J Cancer Res Chung-kuo yen cheng yen chiu 28:1–11. https://doi.org/10.3978/j.issn.1000-9604.2016.02.08 CrossRefPubMed

22.

Roth ES, Fetzer DT, Barron BJ, Joseph UA, Gayed IW, Wan DQ (2009) Does colon cancer ever metastasize to bone first? A temporal analysis of colorectal cancer progression. BMC Cancer 9:274. https://doi.org/10.1186/1471-2407-9-274 CrossRefPubMedPubMedCentral

23.

Santini D, Tampellini M, Vincenzi B, Ibrahim T, Ortega C, Virzi V, Silvestris N, Berardi R, Masini C, Calipari N, Ottaviani D, Catalano V, Badalamenti G, Giannicola R, Fabbri F, Venditti O, Fratto ME, Mazzara C, Latiano TP, Bertolini F, Petrelli F, Ottone A, Caroti C, Salvatore L, Falcone A, Giordani P, Addeo R, Aglietta M, Cascinu S, Barni S, Maiello E, Tonini G (2012) Natural history of bone metastasis in colorectal cancer: final results of a large Italian bone metastases study. Ann Oncol Off J Eur Soc Med Oncol 23:2072–2077. https://doi.org/10.1093/annonc/mdr572 CrossRef

24.

Sundermeyer ML, Meropol NJ, Rogatko A, Wang H, Cohen SJ (2005) Changing patterns of bone and brain metastases in patients with colorectal cancer. Clin Colorectal Cancer 5:108–113CrossRefPubMed

25.

Sun C, Deng Y, Zhou H, Hu ZQ (2015) Risk factors for the development of metachronous bone metastasis in colorectal cancer patients after curative resection. Int J Surg (Lond Engl) 21:145–149. https://doi.org/10.1016/j.ijsu.2015.07.706 CrossRef

26.

Choi M, Craft B, Geraci SA (2011) Surveillance and monitoring of adult cancer survivors. Am J Med 124:598–601. https://doi.org/10.1016/j.amjmed.2010.07.031 CrossRefPubMed

27.

Comito T, Cozzi L, Clerici E, Campisi MC, Liardo RL, Navarria P, Ascolese A, Tozzi A, Iftode C, De Rose F, Villa E, Personeni N, Rimassa L, Santoro A, Fogliata A, Mancosu P, Tomatis S, Scorsetti M (2014) Stereotactic ablative radiotherapy (SABR) in inoperable oligometastatic disease from colorectal cancer: a safe and effective approach. BMC Cancer 14:619. https://doi.org/10.1186/1471-2407-14-619 CrossRefPubMedPubMedCentral

28.

Giantonio BJ, Catalano PJ, Meropol NJ, O’Dwyer PJ, Mitchell EP, Alberts SR, Schwartz MA, Benson AB 3rd (2007) Bevacizumab in combination with oxaliplatin, fluorouracil, and leucovorin (FOLFOX4) for previously treated metastatic colorectal cancer: results from the Eastern Cooperative Oncology Group Study E3200. J Clin Oncol Off J Am Soc Clin Oncol 25:1539–1544. https://doi.org/10.1200/jco.2006.09.6305 CrossRef

29.

Hurwitz HI, Tebbutt NC, Kabbinavar F, Giantonio BJ, Guan ZZ, Mitchell L, Waterkamp D, Tabernero J (2013) Efficacy and safety of bevacizumab in metastatic colorectal cancer: pooled analysis from seven randomized controlled trials. Oncologist 18:1004–1012. https://doi.org/10.1634/theoncologist.2013-0107 CrossRefPubMedPubMedCentral

30.

Saltz LB, Cox JV, Blanke C, Rosen LS, Fehrenbacher L, Moore MJ, Maroun JA, Ackland SP, Locker PK, Pirotta N, Elfring GL, Miller LL (2000) Irinotecan plus fluorouracil and leucovorin for metastatic colorectal cancer. Irinotecan Study Group. New Engl J Med 343:905–914. https://doi.org/10.1056/nejm200009283431302 CrossRefPubMed

31.

Aranda E, Valladares M, Martinez-Villacampa M, Benavides M, Gomez A, Massutti B, Marcuello E, Constenla M, Camara JC, Carrato A, Duenas R, Reboredo M, Navarro M, Diaz-Rubio E (2009) Randomized study of weekly irinotecan plus high-dose 5-fluorouracil (FUIRI) versus biweekly irinotecan plus 5-fluorouracil/leucovorin (FOLFIRI) as first-line chemotherapy for patients with metastatic colorectal cancer: a Spanish Cooperative Group for the Treatment of Digestive Tumors Study. Ann Oncol Off J Eur Soc Med Oncol 20:251–257. https://doi.org/10.1093/annonc/mdn557 CrossRef

32.

Adachi T, Hinoi T, Egi H, Shimomura M, Ohdan H (2015) Oxaliplatin and molecular-targeted drug therapies improved the overall survival in colorectal cancer patients with synchronous peritoneal carcinomatosis undergoing incomplete cytoreductive surgery. Surg Today 45:986–992. https://doi.org/10.1007/s00595-014-1017-y CrossRefPubMed

33.

Clezardin P, Teti A (2007) Bone metastasis: pathogenesis and therapeutic implications. Clin Exp Metastasis 24:599–608. https://doi.org/10.1007/s10585-007-9112-8 CrossRefPubMed

34.

Nozue M, Oshiro Y, Kurata M, Seino K, Koike N, Kawamoto T, Taniguchi H, Todoroki T, Fukao K (2002) Treatment and prognosis in colorectal cancer patients with bone metastasis. Oncol Rep 9:109–112PubMed

35.

Harries M, Taylor A, Holmberg L, Agbaje O, Garmo H, Kabilan S, Purushotham A (2014) Incidence of bone metastases and survival after a diagnosis of bone metastases in breast cancer patients. Cancer Epidemiol 38:427–434. https://doi.org/10.1016/j.canep.2014.05.005 CrossRefPubMed

36.

Portales F, Thezenas S, Samalin E, Assenat E, Mazard T, Ychou M (2015) Bone metastases in gastrointestinal cancer. Clin Exp Metastasis 32:7–14. https://doi.org/10.1007/s10585-014-9686-x CrossRefPubMed

37.

Shibutani M, Maeda K, Nagahara H, Ohtani H, Sakurai K, Toyokawa T, Kubo N, Tanaka H, Muguruma K, Ohira M, Hirakawa K (2014) Significance of CEA and CA19-9 combination as a prognostic indicator and for recurrence monitoring in patients with stage II colorectal cancer. Anticancer Res 34:3753–3758PubMed

38.

Aggarwal C, Meropol NJ, Punt CJ, Iannotti N, Saidman BH, Sabbath KD, Gabrail NY, Picus J, Morse MA, Mitchell E, Miller MC, Cohen SJ (2013) Relationship among circulating tumor cells, CEA and overall survival in patients with metastatic colorectal cancer. Ann Oncol Off J Eur Soc Med Oncol 24:420–428. https://doi.org/10.1093/annonc/mds336 CrossRef

39.

Wang W, Li Y, Zhang X, Jing J, Zhao X, Wang Y, Han C (2014) Evaluating the significance of expression of CEA mRNA and levels of CEA and its related proteins in colorectal cancer patients. J Surg Oncol 109:440–444CrossRefPubMed

40.

Gutman M, Fidler IJ (1995) Biology of human colon cancer metastasis. World J Surg 19:226–234CrossRefPubMed

41.

Rama N, Monteiro A, Bernardo JE, Eugenio L, Antunes MJ (2009) Lung metastases from colorectal cancer: surgical resection and prognostic factors. Eur J Cardiothorac Surg Off J Eur Assoc Cardiothorac Surg 35:444–449. https://doi.org/10.1016/j.ejcts.2008.10.047 CrossRef

42.

Takagawa R, Fujii S, Ohta M, Nagano Y, Kunisaki C, Yamagishi S, Osada S, Ichikawa Y, Shimada H (2008) Preoperative serum carcinoembryonic antigen level as a predictive factor of recurrence after curative resection of colorectal cancer. Ann Surg Oncol 15:3433–3439. https://doi.org/10.1245/s10434-008-0168-8 CrossRefPubMed

43.

Wang JY, Tang R, Chiang JM (1994) Value of carcinoembryonic antigen in the management of colorectal cancer. Dis Colon Rectum 37:272–277CrossRefPubMed

44.

Yang M, Xu W, Liu T, Yang X, Wang P, Wu S, Wei H, Zhao J, Yang C, Xiao J (2018) Development and validation of a novel survival prediction model in patients with spinal metastasis from non-small cell lung cancer. Spine. https://doi.org/10.1097/brs.0000000000002816 CrossRefPubMed

45.

Tang Y, Qu J, Wu J, Li S, Zhou Y, Xiao J (2015) Metastatic spinal cord compression from non-small-cell lung cancer treated with surgery and adjuvant therapies: a retrospective analysis of outcomes and prognostic factors in 116 patients. J Bone Jt Surg Am 97:1418–1425. https://doi.org/10.2106/jbjs.n.01124 CrossRef

46.

Matsumoto M, Tsuji T, Iwanami A, Watanabe K, Hosogane N, Ishii K, Nakamura M, Morioka H, Toyama Y (2013) Total en bloc spondylectomy for spinal metastasis of differentiated thyroid cancers: a long-term follow-up. J Spinal Disord Tech 26:E137–E142. https://doi.org/10.1097/BSD.0b013e318278c8e4 CrossRefPubMed

47.

Chataigner H, Onimus M (2000) Surgery in spinal metastasis without spinal cord compression: indications and strategy related to the risk of recurrence. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 9:523–527CrossRef

48.

Boriani S, Gasbarrini A, Bandiera S, Ghermandi R, Lador R (2016) Predictors for surgical complications of en bloc resections in the spine: review of 220 cases treated by the same team. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 25:3932–3941. https://doi.org/10.1007/s00586-016-4463-y CrossRef

49.

Dea N, Fisher CG (2014) Evidence-based medicine in metastatic spine disease. Neurol Res 36:524–529. https://doi.org/10.1179/1743132814y.0000000365 CrossRefPubMed

50.

Patchell RA, Tibbs PA, Regine WF, Payne R, Saris S, Kryscio RJ, Mohiuddin M, Young B (2005) Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet (Lond Engl) 366:643–648. https://doi.org/10.1016/s0140-6736(05)66954-1 CrossRef

51.

Lei M, Liu Y, Yan L, Tang C, Yang S, Liu S (2016) A validated preoperative score predicting survival and functional outcome in lung cancer patients operated with posterior decompression and stabilization for metastatic spinal cord compression. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 25:3971–3978. https://doi.org/10.1007/s00586-015-4290-6 CrossRef

52.

Fakih MG (2015) Metastatic colorectal cancer: current state and future directions. J Clin Oncol Off J Am Soc Clin Oncol 33:1809–1824. https://doi.org/10.1200/jco.2014.59.7633 CrossRef

Title: Development of a novel model for predicting survival of patients with spine metastasis from colorectal cancer
Authors: Yujie Liu
Minglei Yang
Bo Li
Kehan Xu
Xin Gao
Jialin Li
Haifeng Wei
Quan Huang
Wei Xu
Jianru Xiao
Publication date: 01-06-2019
Publisher: Springer Berlin Heidelberg
Keywords: Metastasis
Spinal Metastasis
Colorectal Cancer
Colorectal Cancer
Published in: European Spine Journal / Issue 6/2019
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-019-05879-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Development of a novel model for predicting survival of patients with spine metastasis from colorectal cancer

Abstract

Objective

Methods

Results

Conclusion

Graphical abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

Graphical abstract

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