TY - JOUR
T1 - A prediction model for lung metastases in patients with indeterminate pulmonary nodules in newly diagnosed colorectal cancer
AU - Nuijens, Brigitha W.
AU - Lindeboom, Robert
AU - van den Broek, Joris J.
AU - Geenen, Remy W. F.
AU - Schreurs, Wilhelmina H.
N1 - Publisher Copyright: © 2024
PY - 2024/6/1
Y1 - 2024/6/1
N2 - Introduction: Multidisciplinary teams treating patients with newly diagnosed Colorectal Cancer (CRC) often encounter the appearance of Indeterminate Pulmonary Nodules (IPNs) that warrants follow–up with repetitive medical imaging and anxiety for patients. We determined the incidence of IPNs in patients with newly diagnosed CRC and developed and validated a model for individualized risk prediction of IPNs being lung metastases. Material and methods: Newly diagnosed CRC who underwent surgery between November 2011 to June 2014 were included to create the risk model, developed using both clinical experience and statistical selection. Discrimination and calibration slopes of the risk score were evaluated in an independent temporal validation sample. A nomogram is presented to assist clinicians in estimating an individual risk score. Results: Out of 2111 CRC patients staged with chest CT, 204 (9.6%) had IPNs and 54/204 (26%) had lung metastases. We identified 4 predictors: “location of primary tumour”, “pathological nodal stage”, “size of the largest nodule” and “extrapulmonary synchronous metastases at diagnosis”. Discrimination of the final model in the validation sample was demonstrated by the difference in mean predicted risk between progressed cases en non-progressed cases (49% versus 21%, p = <0.001). Conclusion: A prediction model with 4 clinical risk factors can be used to assist multidisciplinary teams in the prediction of individualized risk of lung metastases and imaging strategy in patients with IPNs and newly diagnosed colorectal cancer. The model performed well in new patients not included in the model development.
AB - Introduction: Multidisciplinary teams treating patients with newly diagnosed Colorectal Cancer (CRC) often encounter the appearance of Indeterminate Pulmonary Nodules (IPNs) that warrants follow–up with repetitive medical imaging and anxiety for patients. We determined the incidence of IPNs in patients with newly diagnosed CRC and developed and validated a model for individualized risk prediction of IPNs being lung metastases. Material and methods: Newly diagnosed CRC who underwent surgery between November 2011 to June 2014 were included to create the risk model, developed using both clinical experience and statistical selection. Discrimination and calibration slopes of the risk score were evaluated in an independent temporal validation sample. A nomogram is presented to assist clinicians in estimating an individual risk score. Results: Out of 2111 CRC patients staged with chest CT, 204 (9.6%) had IPNs and 54/204 (26%) had lung metastases. We identified 4 predictors: “location of primary tumour”, “pathological nodal stage”, “size of the largest nodule” and “extrapulmonary synchronous metastases at diagnosis”. Discrimination of the final model in the validation sample was demonstrated by the difference in mean predicted risk between progressed cases en non-progressed cases (49% versus 21%, p = <0.001). Conclusion: A prediction model with 4 clinical risk factors can be used to assist multidisciplinary teams in the prediction of individualized risk of lung metastases and imaging strategy in patients with IPNs and newly diagnosed colorectal cancer. The model performed well in new patients not included in the model development.
KW - Colorectal neoplasms
KW - Decision making
KW - Indeterminate pulmonary nodules
KW - Lung metastases
KW - Nomogram
UR - http://www.scopus.com/inward/record.url?scp=85189009146&partnerID=8YFLogxK
U2 - 10.1016/j.ejso.2024.108305
DO - 10.1016/j.ejso.2024.108305
M3 - Article
C2 - 38552417
SN - 0748-7983
VL - 50
JO - European Journal of Surgical Oncology
JF - European Journal of Surgical Oncology
IS - 6
M1 - 108305
ER -