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01.12.2018 | Research article | Ausgabe 1/2018 Open Access

BMC Cancer 1/2018

A modified TNM staging system for non-metastatic colorectal cancer based on nomogram analysis of SEER database

BMC Cancer > Ausgabe 1/2018
Xiangxing Kong, Jun Li, Yibo Cai, Yu Tian, Shengqiang Chi, Danyang Tong, Yeting Hu, Qi Yang, Jingsong Li, Graeme Poston, Ying Yuan, Kefeng Ding
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1186/​s12885-017-3796-1) contains supplementary material, which is available to authorized users.



To revise the American Joint Committee on Cancer TNM staging system for colorectal cancer (CRC) based on a nomogram analysis of Surveillance, Epidemiology, and End Results (SEER) database, and to prove the rationality of enhancing T stage’s weighting in our previously proposed T-plus staging system.


Total 115,377 non-metastatic CRC patients from SEER were randomly grouped as training and testing set by ratio 1:1. The Nomo-staging system was established via three nomograms based on 1-year, 2-year and 3-year disease specific survival (DSS) Logistic regression analysis of the training set. The predictive value of Nomo-staging system for the testing set was evaluated by concordance index (c-index), likelihood ratio (L.R.) and Akaike information criteria (AIC) for 1-year, 2-year, 3-year overall survival (OS) and DSS. Kaplan–Meier survival curve was used to valuate discrimination and gradient monotonicity. And an external validation was performed on database from the Second Affiliated Hospital of Zhejiang University (SAHZU).


Patients with T1-2 N1 and T1N2a were classified into stage II while T4 N0 patients were classified into stage III in Nomo-staging system. Kaplan–Meier survival curves of OS and DSS in testing set showed Nomo-staging system performed better in discrimination and gradient monotonicity, and the external validation in SAHZU database also showed distinctly better discrimination. The Nomo-staging system showed higher value in L.R. and c-index, and lower value in AIC when predicting OS and DSS in testing set.


The Nomo-staging system showed better performance in prognosis prediction and the weight of lymph nodes status in prognosis prediction should be cautiously reconsidered.
Additional file 1: Table S1. The Demographic Information of the Patients from SEER Database Enrolled in This Study [online only]. Table S2. The Demographic Information of the Patients from SAHZU Database Enrolled in This Study [online only]. Table S3. The Ranking of Average Nomo-score [online only]. Table S4. Comparison of the Predictive Performance of 2 Staging Systems for Overall Survival of SAHZU dataset [online only]. (DOCX 78 kb)
Additional file 2: Figure S1. The distribution of 25 TN combinations (left) and the distribution of colon cancer and rectum cancer (right) between the training set and testing set [online only]. (TIFF 2963 kb)
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