Predictive Nomogram for Recurrence of Stage I Colorectal Cancer After Curative Resection

Chan Kim, Woo Ram Kim, Ki Yeol Kim, Hong Jae Chon, Seung Hoon Beom, Hyojoong Kim, Minkyu Jung, Sang Joon Shin, Nam Kyu Kim, Joong Bae Ahn

Research output: Contribution to journalArticlepeer-review

19 Citations (Scopus)


In a study that aimed to develop a predictive nomogram for postoperative recurrence in stage I colorectal cancer (CRC), a predictive nomogram was developed with a total of 1538 stage I CRC patients and internally validated. This nomogram will assist physicians to more accurately identify high-risk patients who need more active surveillance and will help ensure more efficient disease management. Background: Patients with stage I colorectal cancer (CRC) have excellent prognosis after curative surgery. However, approximately 5% to 10% of patients experience recurrence and have a poor prognosis. Because the incidence of stage I CRC is increasing with active screening programs worldwide, a more accurate and easy-to-use predictive tool for recurrence is becoming more important. This study aimed to develop a predictive nomogram for recurrence in stage I CRC. Patients and Methods: A total of 1538 patients who underwent curative surgery for stage I CRC were enrolled. Predictive factors for recurrence were determined by multivariate Cox regression model and were used to develop a predictive nomogram. This model was internally validated, and performance was evaluated through calibration plots. Results: The cumulative recurrence rate at 5 years after surgery for stage I CRC was 5.3%. In multivariate Cox analysis, independent predictors of recurrence were tumor location at rectum, pT2 stage, and presence of lymphovascular invasion. The 5-year recurrence rate was significantly different depending on the number of risk factors (0.7% for 0, 5.8% for 1, and 9.7% for ≥ 2 risk factors). On this basis, a nomogram for recurrence-free survival was developed and internally validated. The concordance index of the nomogram was 0.71, and the performance was acceptable. Conclusion: We developed and internally validated a nomogram that can predict postoperative recurrence in stage I CRC patients. This nomogram may be used to more accurately stratify the risk of recurrence and to perform personalized postoperative surveillance in stage I CRC patients.

Original languageEnglish
Pages (from-to)e513-e518
JournalClinical Colorectal Cancer
Issue number3
Publication statusPublished - 2018 Sep

Bibliographical note

Funding Information:
Supported in part by a grant from the National R&D Program for Cancer Control, Ministry of Health and Welfare, Republic of Korea (1420270); by a National Research Foundation of Korea (NRF) grant funded by the Ministry of Science, ICT & Future Planning (NRF-2016R1C1B2014671 to C.K.); and by the Bio & Medical Technology Development Program of the NRF, funded by the Ministry of Science & ICT (NRF-2016M3A9E8941664 to H.C.).

Publisher Copyright:
© 2018 Elsevier Inc.

All Science Journal Classification (ASJC) codes

  • Oncology
  • Gastroenterology


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