Prognostic Nomograms based on Homogeneous and Heterogeneous Associated Factors for Predicting the Overall Survival of Colorectal Cancer Patients with Distant Metastases

Abstract Background: To identify the heterogeneous and homogeneous prognostic factors associated with distant metastases in colorectal cancer (CRC) patients and then construct nomograms to predict prognosis.Methods: CRC patients registered in the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2016 were included. Cox regression was used to analyse homogeneous and heterogeneous prognostic factors, and Kaplan-Meier analysis was used to estimate overall survival (OS). Predictive nomograms were constructed, and their performance was evaluated with C-indexes and calibration curves.Results: A total of 34933 patients with distant metastases were included. The median survival time of patients with liver metastases, lung metastases, bone metastases, and brain metastases were 12.00 months (95% CI: 11.71-12.29 months), 10.00 months (95% CI: 9.57-10.43 months), 5.00 months (95% CI: 4.47-5.53 months), and 3.00 months (95% CI: 2.31-3.70 months), respectively. Older age and no surgery were identified as homogeneous prognostic factors of the four types of metastases. Male sex, black race, unmarried status, uninsured status, primary CRC site, poor differentiation/grade, advanced N stage, T stage, high carcinoembryonic antigen (CEA) level and metastatic organ were heterogeneously associated with the prognosis of patients with distant metastases. The calibration curves and C-indexes exhibited good performance for predicting the OS of patients with distant metastases.Conclusion: CRC patients with distant metastases exhibited homogeneous and heterogeneous prognostic factors, all of which were associated with poor survival. The nomograms showed good accuracy and can be used as tools for clinicians to predict the prognosis of CRC patients with distant metastases.