Xiong FC, Luo MP, Ruan SM. Construction of a risk prediction model for early postoperative recurrence in stage II/III colorectal cancer. World J Gastrointest Oncol 2025; 17(9): 107968 [PMID: 40977655 DOI: 10.4251/wjgo.v17.i9.107968]
Corresponding Author of This Article
Shan-Ming Ruan, MD, Department of Oncology, The First Affiliated Hospital of Zhejiang Chinese Medical University, No. 54 Youdian Road, Hangzhou 31000, Zhejiang Province, China. shanmingruan@zcmu.edu.cn
Research Domain of This Article
Oncology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Oncol. Sep 15, 2025; 17(9): 107968 Published online Sep 15, 2025. doi: 10.4251/wjgo.v17.i9.107968
Construction of a risk prediction model for early postoperative recurrence in stage II/III colorectal cancer
Feng-Chun Xiong, Ming-Peng Luo, Shan-Ming Ruan
Feng-Chun Xiong, Ming-Peng Luo, Shan-Ming Ruan, Department of Oncology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 31000, Zhejiang Province, China
Co-first authors: Feng-Chun Xiong and Ming-Peng Luo.
Author contributions: Xiong FC contributed to the data collection, compilation, and writing of the manuscript; Luo MP contributed to the design and data analysis of the work; Xiong FC and Luo MP contributed equally to this article, they are the co-first authors of this manuscript; Ruan SM was responsible for the organization, conceptualization, and supervision of the study; and all authors participated in and approved the final manuscript.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Zhejiang Provincial Hospital of Traditional Chinese Medicine, approval No. 2025-KLS-114-01.
Informed consent statement: The informed consent was waived by the Institutional Review Board.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The data supporting the findings of this study are available upon reasonable request from the corresponding author. Contact: Shanmingruan@zcmu.edu.cn.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shan-Ming Ruan, MD, Department of Oncology, The First Affiliated Hospital of Zhejiang Chinese Medical University, No. 54 Youdian Road, Hangzhou 31000, Zhejiang Province, China. shanmingruan@zcmu.edu.cn
Received: April 2, 2025 Revised: May 26, 2025 Accepted: August 1, 2025 Published online: September 15, 2025 Processing time: 166 Days and 19.3 Hours
Abstract
BACKGROUND
Colorectal cancer (CRC) recurrence within a year post-surgery poses significant challenges for stage II/III patients. Few models currently predict this early recurrence with multi-dimensional considerations for risk stratification.
AIM
To develop a model for predicting the risk of recurrence within one year after surgery in patients with stage II/III CRC.
METHODS
We conducted a retrospective cohort study at Zhejiang Provincial Hospital of Chinese Medicine, including 349 stage II/III CRC patients. Clinical data were collected, and the dataset was randomly divided into training (n = 244) and testing (n = 105) sets. Univariate and multivariate logistic regression analyses identified risk factors for postoperative recurrence. Then a nomogram model was constructed and evaluated via receiver operating characteristic curves, calibration curves and decision curve analysis.
RESULTS
During the one-year follow-up, 10.9% (38/349) of patients experienced recurrence. Univariate analysis identified tumor size, lymph node metastasis (N2 stage), neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, fatigue, and appetite loss as significant correlates of recurrence. Multivariate logistic regression confirmed N2 stage, appetite loss, tumor size, and neutrophil-to-lymphocyte ratio as independent risk factors. The nomogram model showed excellent performance. The area under the receiver operating characteristic was 0.98 (95% confidence interval: 0.97-1.00) in training set and 0.91 (95% confidence interval: 0.84-0.97) in testing set. The decision curve analysis curves showed strong concordance between predicted and observed recurrence probabilities.
CONCLUSION
The model effectively predicts early postoperative recurrence in stage II/III CRC, integrating clinical, inflammatory, and symptomatic factors.
Core Tip: Colorectal cancer recurrence within a year post-surgery poses significant challenges for stage II/III patients. However, few models predict this early recurrence. This study developed a nomogram to predict recurrence of colorectal stage II/III cancers one year after surgery. N2 stage, appetite loss, tumor size, and neutrophil-to-lymphocyte ratio were identified as independent risk factors. The model shows high accuracy, offering a practical tool for clinical management.
