Table 1.
Details on included prognostic tools for colorectal cancer
| Tool Citation |
Tumour Location |
Population | Dates of Data Collection |
Study Design |
Sample Size |
# Events |
Duration of Follow- Up |
Outcome | Final Variables in Model |
Internal Validation |
External Validation |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Prognostic tools not specific to a particular TNM stage grouping | |||||||||||
| [25] | Colon | Stage I–IV | 1988–1999 | Other | NR | NR | NR | DSS | Age, sex, comorbidity, depth of invasion, # of positive lymph nodes, # of examined lymph nodes, histologic grade | None | Calibration: Y |
| [50] | Colon | Stage I–IV | NR | Other | NR | NR | NR | NOS | Age, sex, tumour diameter, # positive lymph nodes, CEA, histological type, grade, site, farthest tumour extension (including metastasis) | None | None |
| [31] | Colon | Stage I–IV | 1988–2000 | Retrospective Cohort | 83,419 | NR | Median 87 months | CDSS | Age, sex, ethnicity, tumour grade, AJCC stage | Approach: Bootstrap Calibration: Y Discrimination: 0.816 |
None |
| [39] | CRC | Stage I–IV | 1990–1999 | Retrospective Cohort | ** | NR | Mean 43.9 months | OTHER | Tumour depth of invasion, # of metastatic lymph nodes, metastasis, CEA, differentiation, resectability, tumor location, blood transfusion | Approach: Apparent Overall: R2: −0.64, −0.65 |
None |
| [49] | CRC | Locally advanced/Metastatic | 1990–1998 | Retrospective Cohort | 1057 | 161 | ≥ 2 years | OTHER | Performance status, differentiation, primary site, Duke’s stage, number of sites of metastatic disease, CEA, response rate, treatment, number of chemotherapy lines | None | None |
| [56] | CRC | Dukes B | 1988–1996 | Prospective Cohort | 268 | 63 | Median 65 months | DSS | Peritoneal involvement, venous invasion, margin involvement, tumour perforation | Approach: Apparent* | None |
| [65] | Rectal | Locally advanced | 1992–2003 | RCT-PC | 2242 | 850 | Median 55.2 months | OS | pT stage, pN stage, cT stage, age, adjuvant chemotherapy, surgery procedure, radiotherapy dose, sex | Approach: Apparent Discrimination: 0.68 |
Calibration: Y Discrimination: 0.70 |
| [66] | Rectal | Stage I–IV | 1994–2003 | Retrospective Cohort | 42,830 | NR | NR | COS | Age, sex, race, stage | Approach: Bootstrap Calibration: Y Discrimination: 0.75 |
None |
| Stage I–III | |||||||||||
| [33] | CRC | Stage II | 1988–1997 | Retrospective Cohort | 238 | 53 | Median 110 months | DSS | Tumour growth pattern, extent of tumour spread beyond muscularis propria | Type: Apparent* | None |
| [24] | CRC | Stage I–III, PALN | 2001–2011 | Retrospective | 409 | NR | NR | OS | LVI, pN+ status, serum CEA ≥10ng/mL, short axis diameter PALNs ≥10mm | Type: Apparent* | None |
| [73] | Colon | Stage II or III | NR | RCT-PC | 3,302 | NR | Maxiumum 8 years | OS | # of positive lymph nodes, depth of tumour, tumour grade, age | Type: Bootstrap Calibration: Y Discrimination: 0.655 |
Calibration: Y |
| [55] | Rectal | Stage II–III | 1986–2005 | Retrospective | 833 | 263 | Median (in survivors) 51 months | OS | Gender, age, CEA, tumor location, T stage, N stage, Ratio of metastatic lymph nodes, adjuvant chemotherapy, adjuvant chemoradiotherapy | Type: Cross-Validation Discrimination: 0.67 |
Discrimination: 0.76 |
| [29] | Rectal | Stage I–III | NR | NR | NR | NR | NR | NOS | Age, sex, race, grade, stage, extent of surgery | None | None |
| [28] | Rectal | Stage I–III | NR | NR | NR | NR | NR | NOS | Age, sex, race, grade, stage, extent of surgery | None | None |
| [27] | Rectal | Stage I–III | NR | NR | NR | NR | NR | NOS | Age, sex, race, grade, stage, extent of surgery | None | None |
| [59] | Colon | Stage III | RCT-PC | 1989–2002 | 15995 | NR | NR | OS | Age, sex, race, BMI, performance status, tumor grade, tumor stage, ratio of the number of postiive lymph nodes to nodes examines, number and location of primary tumors, systemic treatment class | Type: Bootstrap Calibration: Y Discrimination: 0.66 |
Calibration: Y |
| [72] | Rectal | Stage I–III | RCT-PC | 1987–2002 | 2618 | 1077 | Median 39.5–75.3 months | OS | Age, gender, tumour distance, surgery type, residual disease, p-T, p-N, presence of post-operative complications | Type: Cross-Validation Calibration: Y Discrimination 0.752 |
None |
| [68] | Colon | Stage I–III | Retrospective Cohort | 1994–2005 | 128,853 | NR | NR | OS | T-stage, n-stage, number of positive LN, tumour differentiation, patient age, sex | Type: Split Sample Calibration: Y Discrimination: 0.68 |
None |
| Stage IV | |||||||||||
| [32] | CRC | Stage IV | NR | RCT-PC | 803 | NR | median 35.3–46.3 months | OS | performance status, LDH, ALP, number of metastatic sites, time to metastasis | Approach: Split Sample Calibration: Y Discrimination: 0.60 |
Discrimination: 0.63 |
| [34] | CRC | Stage IV | 1995–2010 | Retrospective | 443 | 385 | Median 62.4 months (range 55.6–77.6) | OS | Number of liver metastases, PCI, type of surgery | Approach: Apparent Calibration: Y Discrimination: 0.61 |
None |
| [71] | CRC | Stage IV | 1997–2007 | Retrospective | 1133 | 278 | NR | OS | Post-operative CEA, depth of tumor invasion, lymph node metastasis, peritoneal dissemination | Approach: Split Sample Calibration: Y Discrimination: 0.64 |
None |
| [44] | CRC | Stage IV | 1984–1999 | Prospective | 9624 | NR | NR | OS | Depth of tumor invasion, regional lymph node metastasis, hitologic grade, liver metastasis, lung metastasis, distant lymph node metastasis, peritoneal metastasis, noncurative resection for metastatic lesions | Approach: Apparent* | None |
| [38] | CRC | Stage IV | 1982–1996 | RCT-PC | 3817 | NR | NR | OS | ECOG, WBC count, number of tumor sites, alkaline phosphatase, platelets, location of primary, hemoglobin, peritoneal metastases | Approach: Apparent* | Calibration: Y Discrimination: 0.52 & 0.54 Overall: Schemper: 1.6% |
| [62] | CRC | Stage IV | 2005–2008 | Retrospective | 124 | 74 | NR | OS | Performance status, pathology, peritoneal metastasis, LDH, PFS interval | Approach: Apparent* | Survival Curves |
| [30] | Rectal | Stage IV | NR | Other | NR | NR | NR | NOS | Age, sex, race, grade, stage, extent of surgery | None | None |
| [26] | CRC | Liver mets | 1988–1999 | Retrospective Cohort | 138 | 99 | mean 48.7 months | OS | location of primary, number of liver metastases, preoperative CA19-9, preoperative tumour size | Approach: Apparent* | Discrimination: 0.64 |
| [23] | CRC | Liver mets | 2003–2010 | Retrospective | 100 | 66 | Mean 60 weeks (range 10–238 weeks) | OS | Prior liver surgery, CEA, transaminase toxicity, CT size of two largest lesions | Approach: Apparent Discrimination: 0.81 |
Discrimination: 0.83 |
| [35] | CRC | Liver mets | 1985–1998 | Retrospective Cohort | 1001 | 393 | median 32 months | OS | nodal status of primary, disease-free interval before presentation of liver metastases, number of tumours, preoperative CEA level, size of the largest tumour | Approach: Apparent Overall: R2: 0.92 |
Discrimination: 0.533–0.68 |
| [36] | CRC | Liver mets | 1996–2007 | Retrospective Cohort | 280 | NR | median 50.1 months | OS | CEA, number of liver metastases, recurrence pattern, recurrence pattern | Approach: Bootstrap Discrimination: 0.67 |
None |
| [37] | CRC | Liver mets | 1981–1996 | Retrospective Cohort | 243 | 225 | median 32 months | OS | tumour number, tumour size, interval between resection of primary and liver metastases, distribution of liver tumours | None | Discrimination: 0.53–0.64 |
| [40](pre-op) | CRC | Liver mets | 1990–1998 | Retrospective Cohort | 578 | 337 | median 55.2 months | OS, DSS | extrahepatic disease, number of metastatic LN, histology of primary, prehepatectomy CEA level, number of hepatic tumours | Approach: Bootstrap Calibration: Y Discrimination: 0.66 |
Discrimination: 0.69 |
| [40](post-op) | CRC | Liver mets | 1990–1998 | Retrospective Cohort | 578 | 337 | median 55.2 months | OS, DSS | extrahepatic disease, hilar metastatic LN, number of metastatic LN (primary), histology of primary, surgical margin, prehepatectomy CEA | Approach: Bootstrap Calibration: Y Discrimination: 0.68 |
Discrimination: 0.7 |
| [42] | CRC | Liver mets | 1985–1999 | Retrospective Cohort | 148 | NR | NR | OS | extent of liver metastasis, depth of tumour invasion, peritoneal metastasis | Approach: Apparent* | None |
| [43] | CRC | Liver mets | 1986–2004 | Retrospective Cohort | 1477 | NR | NR | DSS | sex, age, primary site, disease-free interval, pre-operative CEA, number of tumours, largest site of metastasis, bilateral resection, number of involved lobes, primary N stage | Approach: Bootstrap Calibration: Y Discrimination: 0.688 |
Discrimination: 0.602 & 0.62 |
| [45] | CRC | Liver mets | 1993–2006 | Retrospective Cohort | 201 | 98 | median 31 months | OS | number of metastases, time of diagnosis of the liver metastases, CEA level | Approach: Apparent* | Discrimination: 0.54–0.58 |
| [46] | CRC | Liver mets | 1994–2005 | Retrospective Cohort | 138 | NR | median 47.2 months | OS | liver resection margin, CEA, number of liver metastasis, lymph node status | Approach: Apparent* | Survival Curves |
| [47] | CRC | Liver mets | 1977–1997 | Retrospective Cohort | 135 | 65 | median 73 months | OS | % liver involvement, colic LN, Duke’s stage, number of metastases, size of metastases, preoperative: -GT, GPT, type of resection, resection margins | Approach: Apparent* | None |
| [48] | CRC | Liver mets | 1993–2006 | Retrospective Cohort | 700 | NR | median 34 months | OS | Number of metastases, inflammatory response to tumour | Approach: Apparent* | None |
| [51] | CRC | Liver mets | 1980–2002 | Retrospective Cohort | 369 | NR | mean 4.11 years | DSS | Hepatic LN metastases, number of LN around primary tumour, CEA at hepatectomy, number of liver metastases | Approach: Split Sample* | None |
| [52] | CRC | Liver mets | 1981–1997 | Retrospective Cohort | 81 | NR | median 36.3 months | DSS | Serosal invasion, LN positivity, number of liver metastases, diameter of largest hepatic metastasis, extrahepatic metastasis | Approach: Apparent* | Discrimination: 0.60–0.65 |
| [53] | CRC | Liver mets | 1990–2005 | Retrospective Cohort | 121 | 52 | median 68 months | OS | Location of hepatic metastases, number of metastatic tumours, LN status of primary | Approach: Apparent* | None |
| [54] | CRC | Liver mets | 1968–1990 | Retrospective Cohort | 1532 | 689 | median 19 months | OS | Age, extension of primary into serosa, lymphatic spread, time interval from primary tumour to metastases, size of largest liver lesion, number of liver lesions, resection margin | Approach: Apparent* | Discrimination: 0.55–0.64 |
| [58](pre-op) | CRC | Liver mets | 1987–2005 | Retrospective Cohort | 929 | 459 | median 26.4 months | DSS | Primary tumour LN status, primary tumour differentiation, CEA, largest tumour diameter, extrahepatic metastatic disease, resection margin | Approach: Split Sample Calibration: Y Discrimination: 0.805 |
Discrimination: 0.59–0.66 |
| [58](post-op) | CRC | Liver mets | 1987–2005 | Retrospective Cohort | 929 | 459 | median 26.4 months | DSS | Primary tumour LN status, primary tumour differentiation, CEA, number of hepatic metastases, largest tumour diameter, extrahepatic metastatic disease | Approach: Split Sample Calibration: Y Discrimination: 0.781 |
Discrimination: 0.63–0.74 |
| [60] | CRC | Liver mets | 1988–2002 | Retrospective Cohort | 337 | NR | median 16.4 months | CS | Duke’s stage, CEA, alkaline phosphatase, number of liver lesions, albumin | Approach: Apparent* | Survival Curves |
| [61] | CRC | Liver mets | 1995–2009 | Retrospective | 382 | 327 | Median (in survivors) 47 months | DSS | Extrahepatic disease, pN category, number of liver lesions | Approach: Apparent* | None |
| [63] | CRC | Liver mets | 2002–2007 | Retrospective | 88 | 76 | Median 99 months | OS | Response to systemic therapy, number of CLM, maximum size of CLM, CEA | Approach: Apparent* | None |
| [64] | CRC | Liver mets | 1995–2005 | Retrospective Cohort | 285 | NR | median 4.4–4.6 years | OS | Tumour grade, nodal status | Approach: Apparent Discrimination: 0.59 |
None |
| [67] | CRC | Liver mets | 1993–2006 | Retrospective Cohort | 252 | NR | NR | DSS | Number of liver metastases, preoperative CEA levels, resection of liver metastases | Approach: Apparent* | None |
| [69] | CRC | Liver mets | 1992–1996 | Prospective Cohort | 478 | NR | NR | OS | Maximum liver metastasis diameter, # of liver metastasis, number of positive lymph nodes, presence of extrahepatic metastases | Approach: Apparent* | Discrimination: 0.54–0.58 |
| [70] | CRC | Liver mets | 1960–1995 | Retrospective Cohort | 662 | 428 | median 3 years | DSS | Diameter of largest liver tumour, interval from primary tumour to metastasis, hepatoduodenal LN positivity, blood transfusions, primary cancer regional LN, number of metastases’ | Approach: Bootstrap Discrimination: 0.61 |
Discrimination: 0.54–0.58 |
| [41] | CRC | Lung mets | 1980–1998 | Retrospective Cohort | 313 | 179 | median 29 months | OS | Primary histology, number of pulmonary tumours, hilar or mediastinal LN, extrathoracic disease, prethoracotomy CEA level | Approach: Bootstrap Calibration: Y Discrimination: 0.72 |
Discrimination: 0.66 & 0.81 |
| [57] | CRC | MSCC | NR | Retrospective | 121 | NR | NR | NOS | ECOG performance status, Ambuulatory status prior to RT, visceral metastases, time of developing motor deficits | Approach: Apparent* | None |
1= 3-year survival (dichotomous); 5-year survival (dichotomous); 2=: more than 2 year survival;
**
= 3-year survival N=93, 5-year survival N=71;
MSCC=malignant spinal cord compression; OS= overall survival; NOS= not otherwise specified; CRC=colorectal cancer; NR= not reported; DSS= disease specific survival; Schemper=percent of variability in survival explained by the model; LN=lymph nodes