Nomogram Predictive Tools--Are they accurate?

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vincent33
Posts: 13
Joined: Thu Mar 12, 2020 9:11 pm
Facebook Username: Vincent Smith

Nomogram Predictive Tools--Are they accurate?

Postby vincent33 » Thu Mar 12, 2020 9:30 pm

I'm curious if anyone has used the tools on this site. I have plugged in my information and I'm getting much better numbers than given me by my oncologist. If anyone would like to try it out and let me know how it compares with what your oncologist told you, I would appreciate it.

https://www.mskcc.org/nomograms/colorec ... robability
January 2019, pain in abdomen that I thought was muscular or nerve related persisted many months
November 2019, CT scan revealed large mass in colon
December 10, 2019, surgery, right hemicolectomy, 8cm t4b tumor removed, margins clear, 47 negative nodes removed, 1 positive node removed
February and March 2020, beginning week 8 after surgery have received 3 folfox infusions every 2 weeks
have been applying ice to hands and feet during infusions

zx10guy
Posts: 219
Joined: Mon Jan 07, 2013 12:54 pm

Re: Nomogram Predictive Tools--Are they accurate?

Postby zx10guy » Fri Mar 13, 2020 7:58 am

I've used them in the past when I was first diagnosed. It really depends. Each nomogram's results are based on the collection/pool of data fed into it. So you would need to examine how large of a sampling the tool has access to and if the data has been updated recently.

Two others that are out there are one from Mayo Clinic and Adjuvant Online. Adjuvant Online is a tool geared towards doctors and it'll say you have to be a doctor to register for access. I still registered using made up info where necessary and got an account. I know my first oncologist used the Adjuvant Online tool.

Rock_Robster
Posts: 474
Joined: Thu Oct 25, 2018 5:27 am
Location: Melbourne, Australia

Re: Nomogram Predictive Tools--Are they accurate?

Postby Rock_Robster » Fri Mar 13, 2020 8:43 am

There’s two main issues to consider really:

1) you need to fit the criteria for the tools; specially MSK’s nomograms only apply for stages I-III patients with complete resections. They don’t cover stage IV or unresectable cases.

2) the data that feeds these is pretty old. MSK’s uses a large study spanning 1994-2005, so around 15-25 years old. I would hope we’ve improved in treatment and prognoses during that time.

Rob
Male 38; Australia
10/2018 Dx 3.5cm RC adenocarcinoma, 12cm from AV
Mod diff, EMVI+ LVI+. 4 liver mets
pT3N1aM1a; Stage IVa. MSS, NRAS (G13R)
CEA: Oct-18= 12; Nov-18= 14, Mar-19= 2.4, Aug-19 <2.0, Mar-20=2.2
11/18- FOLFOX x6
3/19- Liver resection
5/19- 25 x pelvic VMAT radiation; complete metabolic response
07/19- ULAR (robot), temp ileo, 1/27 LN
08/19- Missed a liver spot
08-11/19- FOLFOX x1, FOLFOXIRI x1, FOLFIRI x5
12/19- Liver resection #2
02/20- Ileostomy reversed
03/20- PET & MRI = NED!

Beckster
Posts: 414
Joined: Thu Jan 12, 2017 3:01 pm
Location: New Jersey

Re: Nomogram Predictive Tools--Are they accurate?

Postby Beckster » Fri Mar 13, 2020 9:38 am

A 2017 nomogram is available at. https://qcancer.org/colorectal-survival/
57/F
DX:(CC) 10/19/16
11/4/16- Lap right hemi(cecum)
CEA- Pre Op (1.9), Pre Chemo (2.5)
Type: Adenocarcinoma
Tumor size:3.5 cm x 2.5 x 0.7 cm
Grade: G3 (path) G2 (pre-op)
TNM: T3N0M0/IIA
LN: 0/24
LVI present
Surgical margins: clear
MSS
12/27/2016 - Capeox, anaphylactic reaction
1/2/17 to 6/9/17- Xeloda monotherapy
6/17,12/17,6/18,12/18, 6/19, 12/19 CT Scan NED :D
CEA- 6/17- 3.6, 9/17- 2.8 12/17-2.8, 3/18-3.1, 6/18-3.0, 9/18 2.8, 12/18 2.5 3/19 3.1 6/19 3.1 9/19 2.6 12/19 2.8
Clear Colonoscopy 10/17, 11/19 :D

Rock_Robster
Posts: 474
Joined: Thu Oct 25, 2018 5:27 am
Location: Melbourne, Australia

Re: Nomogram Predictive Tools--Are they accurate?

Postby Rock_Robster » Fri Mar 13, 2020 6:57 pm

Beckster wrote:A 2017 nomogram is available at. https://qcancer.org/colorectal-survival/

I’m struggling with this calculator - it doesn’t ask about N- or M-score at all. Do we assume this is only for stage I-II disease then?

Thanks,
Rob
Male 38; Australia
10/2018 Dx 3.5cm RC adenocarcinoma, 12cm from AV
Mod diff, EMVI+ LVI+. 4 liver mets
pT3N1aM1a; Stage IVa. MSS, NRAS (G13R)
CEA: Oct-18= 12; Nov-18= 14, Mar-19= 2.4, Aug-19 <2.0, Mar-20=2.2
11/18- FOLFOX x6
3/19- Liver resection
5/19- 25 x pelvic VMAT radiation; complete metabolic response
07/19- ULAR (robot), temp ileo, 1/27 LN
08/19- Missed a liver spot
08-11/19- FOLFOX x1, FOLFOXIRI x1, FOLFIRI x5
12/19- Liver resection #2
02/20- Ileostomy reversed
03/20- PET & MRI = NED!

Claudine
Posts: 301
Joined: Tue Mar 12, 2019 2:41 pm
Location: Montana

Re: Nomogram Predictive Tools--Are they accurate?

Postby Claudine » Fri Mar 13, 2020 7:42 pm

I’m struggling with this calculator - it doesn’t ask about N- or M-score at all. Do we assume this is only for stage I-II disease then?


The drop down menu for tumor stage goes form 1 through 4 - isn’t that equivalent to cancer stage I-IV?
Wife of Dx 04/18 (51 yo). MSS, KRAS G12A
No primary (involuted?)
Lytic tumor L4 vertebrae, EBRT radiation 04/18, SBRT 02/19
Resection small intestine 05/18 (no cancer found - Crohn's)
Failed adjuvant Xelox
Folfiri + Avastin since 03/19
6.7 cm left adrenal mass 03/19, 3.67 cm 12/19, successful resection 02/20
CEA since 03/19: high 58, low 3.2, now 7.6
Scan 03/19: Multiple small lung nodules up to 5mm
Scan 12/19: 2 calcified granulomas, one 1mm stable nodule

Rock_Robster
Posts: 474
Joined: Thu Oct 25, 2018 5:27 am
Location: Melbourne, Australia

Re: Nomogram Predictive Tools--Are they accurate?

Postby Rock_Robster » Fri Mar 13, 2020 9:43 pm

Claudine wrote:
I’m struggling with this calculator - it doesn’t ask about N- or M-score at all. Do we assume this is only for stage I-II disease then?


The drop down menu for tumor stage goes form 1 through 4 - isn’t that equivalent to cancer stage I-IV?

I think that’s T-stage (ie the stage of the primary tumour, T1-4), not disease stage (ie stage I to IV). It doesn’t ask about lymphatic spread or metastases which are some of the most important prognostic factors, so makes me think it doesn’t cover these. Also the results look very optimistic if it were to be stage IV disease.
Male 38; Australia
10/2018 Dx 3.5cm RC adenocarcinoma, 12cm from AV
Mod diff, EMVI+ LVI+. 4 liver mets
pT3N1aM1a; Stage IVa. MSS, NRAS (G13R)
CEA: Oct-18= 12; Nov-18= 14, Mar-19= 2.4, Aug-19 <2.0, Mar-20=2.2
11/18- FOLFOX x6
3/19- Liver resection
5/19- 25 x pelvic VMAT radiation; complete metabolic response
07/19- ULAR (robot), temp ileo, 1/27 LN
08/19- Missed a liver spot
08-11/19- FOLFOX x1, FOLFOXIRI x1, FOLFIRI x5
12/19- Liver resection #2
02/20- Ileostomy reversed
03/20- PET & MRI = NED!

vincent33
Posts: 13
Joined: Thu Mar 12, 2020 9:11 pm
Facebook Username: Vincent Smith

Re: Nomogram Predictive Tools--Are they accurate?

Postby vincent33 » Sat Mar 14, 2020 6:14 am

I would appreciate if we could go back to the original post and the nomogram tool linked in that post. This tool is far superior to the one later linked. I'm hoping some will consider putting in their own stats and letting me know if the results are consistent with what they were told by their oncologists. Thanks.
January 2019, pain in abdomen that I thought was muscular or nerve related persisted many months
November 2019, CT scan revealed large mass in colon
December 10, 2019, surgery, right hemicolectomy, 8cm t4b tumor removed, margins clear, 47 negative nodes removed, 1 positive node removed
February and March 2020, beginning week 8 after surgery have received 3 folfox infusions every 2 weeks
have been applying ice to hands and feet during infusions

Claudine
Posts: 301
Joined: Tue Mar 12, 2019 2:41 pm
Location: Montana

Re: Nomogram Predictive Tools--Are they accurate?

Postby Claudine » Sat Mar 14, 2020 10:23 am

Ha ok, thanks Rob! It’s true that the input is very minimal. Regardless, what I found interesting is that the output stated « Of those who don't survive, 39 are likely to die due to their colorectal cancer and 23 due to other causes.«  That surprised me, I'd have expected a much lower value than 23%, but I guess there are many comorbidities associated with cancer, like this friend of my parents who had lung cancer but had a heart attack during surgery...
Wife of Dx 04/18 (51 yo). MSS, KRAS G12A
No primary (involuted?)
Lytic tumor L4 vertebrae, EBRT radiation 04/18, SBRT 02/19
Resection small intestine 05/18 (no cancer found - Crohn's)
Failed adjuvant Xelox
Folfiri + Avastin since 03/19
6.7 cm left adrenal mass 03/19, 3.67 cm 12/19, successful resection 02/20
CEA since 03/19: high 58, low 3.2, now 7.6
Scan 03/19: Multiple small lung nodules up to 5mm
Scan 12/19: 2 calcified granulomas, one 1mm stable nodule

vincent33
Posts: 13
Joined: Thu Mar 12, 2020 9:11 pm
Facebook Username: Vincent Smith

Re: Nomogram Predictive Tools--Are they accurate?

Postby vincent33 » Sat Mar 14, 2020 11:05 am

Can someone link to "adjuvent online"? I can't find it. Thanks.
January 2019, pain in abdomen that I thought was muscular or nerve related persisted many months
November 2019, CT scan revealed large mass in colon
December 10, 2019, surgery, right hemicolectomy, 8cm t4b tumor removed, margins clear, 47 negative nodes removed, 1 positive node removed
February and March 2020, beginning week 8 after surgery have received 3 folfox infusions every 2 weeks
have been applying ice to hands and feet during infusions

Beckster
Posts: 414
Joined: Thu Jan 12, 2017 3:01 pm
Location: New Jersey

Re: Nomogram Predictive Tools--Are they accurate?

Postby Beckster » Sat Mar 14, 2020 11:47 am

vincent33 wrote:Can someone link to "adjuvent online"? I can't find it. Thanks.


Adjuvent online is still upgrading...however try this. https://oncoassist.com/adjuvant-tools/ You have to create an account so I used "other" in the required fields and it accepted the information. I was never able to find this before....The results from my information showed a difference from taking chemo to not. The old MSK showed a lower survival if I took chemo, but this one shows a benefit, which correlates to the current research.
57/F
DX:(CC) 10/19/16
11/4/16- Lap right hemi(cecum)
CEA- Pre Op (1.9), Pre Chemo (2.5)
Type: Adenocarcinoma
Tumor size:3.5 cm x 2.5 x 0.7 cm
Grade: G3 (path) G2 (pre-op)
TNM: T3N0M0/IIA
LN: 0/24
LVI present
Surgical margins: clear
MSS
12/27/2016 - Capeox, anaphylactic reaction
1/2/17 to 6/9/17- Xeloda monotherapy
6/17,12/17,6/18,12/18, 6/19, 12/19 CT Scan NED :D
CEA- 6/17- 3.6, 9/17- 2.8 12/17-2.8, 3/18-3.1, 6/18-3.0, 9/18 2.8, 12/18 2.5 3/19 3.1 6/19 3.1 9/19 2.6 12/19 2.8
Clear Colonoscopy 10/17, 11/19 :D

boxhill
Posts: 491
Joined: Fri Apr 06, 2018 11:40 am

Re: Nomogram Predictive Tools--Are they accurate?

Postby boxhill » Sat Mar 14, 2020 12:07 pm

Whether these things are accurate probably depends on what therapies you can use effectively. I very much doubt that they include many cases of Stage 4 people who are excellent responders to immunotherapy, for example.
F, 64 at DX CRC Stage IV
3/17/18 blockage, r hemi
11 of 25 nodes,5 mesentery nodes
5mm liver met out
pT3 pN2b pM1
BRAF wild, KRAS G12D
dMMR, MSI-H
5/18 FOLFOX
Neulasta 6/28
7/18 CT NED
11/18 CT NED
12/18 MRI 5mm liver mass, 2 lymph nodes in porta hepatis
12/31/18 Keytruda
6/19 Multiphasic CT LNs normal, Liver stable
6/28/19 Pause Key, predisone for joint pain
7/31/19 Restart Key
9/19 CT stable
Pain: many fails before Celebrex helps
12/23/19 CT stable

JJH
Posts: 254
Joined: Mon Apr 24, 2017 7:26 am

Re: Nomogram Predictive Tools--Are they accurate?

Postby JJH » Tue Mar 17, 2020 8:12 am

I am posting the information below so that we may more fully understand the colon cancer, Stage I to Stage III nomograms available on the MSK website:

There are two colon cancer nomograms listed the MSK website, and I will call them MSK-nomogram and SEER-nomogram, respectively:

  • MSK-nomogram
    https://www.mskcc.org/nomograms/colorectal/disease_free_probability
    This nomogram is based on a sample of 1,320 Stage I, II, III colon cancer patients, all from MSK, who had all cancer removed by surgery and were observed from 1990 though 2000. During this period, the only available adjuvant chemo regimen was raw 5-FU monotherapy. The outcome variables for this nomogram were "5-year and 10-year Disease-Free Probability Following Surgery" i.e., the probability of being disease free at the end of the 5-year or 10-year observation periods.
    .
  • SEER-nomogram,
    https://www.mskcc.org/nomograms/colorectal/overall_survival_probability
    This nomogram is based on a sample of 128,853 Stage I, II, III colon cancer patients, from various hospitals nationwide, who had all cancer removed by surgery and were observed from 1994 until 2005. During this period several different adjuvant chemo regimens became available as they were approved by FDA, including: 5-FU monotherapy, 5-FU/Leucovorin, Irinotecan, FOLFIRI, FOLFOX, XELOX/CAPEOX, Erbitux, FOLFOX+Avastin. The outcome variable for this nomogram was "5-year Overall Survival Following Surgery"

FDA Approv.
========
1962-06-01 Adrucil (5-FU)
<<<< 2000 Cut-off date for MSK nomogram: " Disease-Free Probability Following Surgery" (1,320 patients) >>>>

2000-05-01 Camptosar (Irinotecan Hydrochloride)
2001-08-01 Xeloda (Capecitabine)
2002-02-12 Leucovorin (Folinic acid)
2002-08-09 Eloxatin (Oxaliplatin)
2004-02-12 Erbitux (Cetuximab)
2004-02-26 Avastin (Bevacizumab)
<<<< 2005 Cut-off date for SEER nomogram: "Overall Survival Probability Following Surgery " (128,853 patients) >>>>

2006-09-27 Vectibix (Panitumumab)
2012-08-03 Zaltrap (Ziv-Aflibercept)
2012-09-27 Stivarga (Regorafenib)
2015-04-24 Cyramza (Ramucirumab)
2015-08-22 Lonsurf (Trifluridine and Tipiracil Hydrochloride)
2017-05-23 Keytruda (Pembrolizumab)
2017-08-01 Opdivo (Nivolumab)
2018-07-10 Yervoy (Ipilimumab)


There are a number of questions that could be posed concerning these two nomograms. For example:

DATA TOO OLD?
Old, out-of-date chemo regimens?
Old surgical techniques? no laparoscopy; no robotic?
Old technology? old staplers; old suture technology?
Old radiation protocols?

SAMPLING FRAME ADEQUATE?
- Biased sample?
- Small sample?

SCOPE TOO NARROW?
- Location of tumor: Only colon tumors included; rectal tumors not included
- Staging: Stage I, II or III only; no Stage IV/mCRC
- Resectability: Only R0 (totally resectable) cases included; no partial resections included

METHODOLOGY?
-Cox proportional hazards model appropriate? Was "proportional hazards assumption" met?

PREDICTOR VARIABLES APPROPRIATELY CHOSEN?
- Too few biomarkers? CEA only; no CA-19-9; no KRAS/NRAS/BRAF bio-markers; no MSI status
- No chemo regimen details for SEER; No info on time spent on chemo.
- No details on type of surgery.
- No details on possible co-morbidities (e.g., diabetes; heart condition, etc.)
- No details on possible additional risk factors (e.g., smoking; obesity, etc.)
- Overlapping or intercorrelated predictors? (absence of orthogonality/independence of predictors, etc.)

OUTCOME VARIABLES APPROPRIATELY CHOSEN?
- etc.

Any thoughts?
Last edited by JJH on Tue Mar 17, 2020 11:07 am, edited 1 time in total.
"The darkest hour is just before the dawn" - Thomas Fuller (1650)

Claudine
Posts: 301
Joined: Tue Mar 12, 2019 2:41 pm
Location: Montana

Re: Nomogram Predictive Tools--Are they accurate?

Postby Claudine » Tue Mar 17, 2020 9:58 am

Nothing for stage IV I take it...
Wife of Dx 04/18 (51 yo). MSS, KRAS G12A
No primary (involuted?)
Lytic tumor L4 vertebrae, EBRT radiation 04/18, SBRT 02/19
Resection small intestine 05/18 (no cancer found - Crohn's)
Failed adjuvant Xelox
Folfiri + Avastin since 03/19
6.7 cm left adrenal mass 03/19, 3.67 cm 12/19, successful resection 02/20
CEA since 03/19: high 58, low 3.2, now 7.6
Scan 03/19: Multiple small lung nodules up to 5mm
Scan 12/19: 2 calcified granulomas, one 1mm stable nodule


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