Development and validation of web-based risk score predicting prognostic nomograms for elderly patients with primary colorectal lymphoma: A population-based study
Authors: Wang Kui , Zhao Lingying , Che Tianyi , Zhou Chunhua , Qin Xianzheng , Hong Yu , Gao Weitong , Zhang Ling , Gu Yubei , Zou Duowu 
Published: January 2025

Abstract

Background and Objectives
Primary colorectal lymphoma (PCL) is an infrequently occurring form of cancer, with the elderly population exhibiting an increasing prevalence of the disease. Furthermore, advanced age is associated with a poorer prognosis. Accurate prognostication is essential for the treatment of individuals diagnosed with PCL. However, no reliable predictive survival model exists for elderly patients with PCL. Therefore, this study aimed to develop an individualized survival prediction model for elderly patients with PCL and stratify its risk to aid in the treatment and monitoring of patients.

Methods
Patients aged 60 or older with PCL from 1975 to 2013 in the Surveillance, Epidemiology, and End Results database were selected and randomly divided into a training cohort (n = 1305) and a validation cohort (n = 588). The patients from 2014–2015 (n = 207) were used for external validation. The research team utilized both Cox regression and the least absolute shrinkage and selection operator (LASSO) regression to analyze potential predictors, in order to identify the most suitable model for constructing an OS-nomogram and an associated network version. The risk stratification is constructed on the basis of this model. The performance of the model was evaluated based on the consistency index (C-index), calibration curve, and decision curve analysis (DCA) to determine its resolving power and calibration capability.

Results
Age, gender, marital status, Ann Arbor staging, primary site, surgery, histological type, and chemotherapy were independent predictors of Overall Survival (OS) and were therefore included in our nomogram. The Area Under the Curve (AUC) of the 1, 3, and 5-year OS in the training, validation, and external validation sets ranged from 0.732 to 0.829. The Receiver Operating Characteristic (ROC) curves showed that the nomogram model outperformed the Ann Arbor stage system when predicting elderly patients with PCL prognosis at 1, 3, and 5 years in the training set, validation dataset, and external validation cohort. The Concordance Index (C-index) also demonstrated that the nomogram had excellent predictive accuracy and robustness. The calibration curves demonstrated a strong agreement between observed and predicted values. In the external validation cohort, the C-index (0.769, 95%CI: 0.712–0.826) and calibration curves of 1000 bootstrap samples also indicated a high level of concordance between observed and predicted values. The nomogram-related DCA curves exhibited superior clinical utility when compared to Ann Arbor stage. Furthermore, an online prediction tool for overall survival has been developed: https://medkuiwang.shinyapps.io/DynNomapp/.

Conclusion
This was the first study to construct and validate predictive survival nomograms for elderly patients with PCL, which is better than the Ann Arbor stage. It will help clinicians manage elderly patients with PCL more accurately.