Clinical decision aids in colon cancer: a comparison of two predictive nomograms.
BACKGROUND
The risk of recurrence of colon cancer after curative surgery can be estimated by using decision aids. These aids use pathologic and patient factors to predict recurrence risk after adjuvant chemotherapy and have been validated when using clinical trial populations; however, the performance of 2 decision aids were compared by using a cohort of patients treated at a single center.


METHODS
Patient data were used to estimate the risk of recurrence when using both the Adjuvant! for colon cancer and Memorial Sloan Kettering Cancer Center (MSKCC) decision aids. A receiver operator characteristic (ROC) curve analyzed the predicted chance of being disease free at 5 years against the actual outcome for each patient. This curve was then used to define cutoff points at a chosen sensitivity and specificity to stratify patients into risk groups, and survival curves for each group calculated.


RESULTS
Data on 134 patients were analyzed. The Pearson correlation between the 2 nomograms was 0.848 (P < .01). The ROC curve for the MSKCC nomogram had an area under the curve of 0.638. At a sensitivity and a specificity of 0.8, the MSKCC curve has a risk recurrence score of 69% and 84%, respectively. By using these cutoffs to stratify patients into 3 risk groups, a statistically significant difference in survival was found between high risk and low risk (P = .025).


CONCLUSIONS
Tools to predict risk or recurrence and estimate benefit from therapy may be enhanced in the future by using genetic profiling, but use of existing tools can help deliver a personalized approach to adjuvant therapy.
Department of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia. Ian.Collins@petermac.org
Ian M
IM
Collins
Fergal
F
Kelleher
Charlotte
C
Stuart
Marnie
M
Collins
John
J
Kennedy
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000145:classification* / Q000188:drug therapy / Q000473:pathology*; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D049451:Nomograms; D012372:ROC Curve; D012307:Risk Factors; D012680:Sensitivity and Specificity