Dr. Yu talks about the ARCAD nomogram in a real-world CRC population

James Yu, M.D., hematology/oncology fellow at Moffitt Cancer Center, discusses external validation of the ARCAD nomogram in a real-world setting for patients with stage IV colorectal cancer (CRC) and the results from the evaluation. The focus is on the results obtained.

The ARCAD CRC nomogram was developed to predict 1-year survival for stage IV colorectal cancer and validated using a large real-world colorectal cancer patient cohort in the Flatiron database. The survival underestimation observed in the Flatiron real-world cohort suggests advances in CRC treatment, such as targeted therapy and immunotherapy. The ARCAD nomogram has proven promising for clinicians, especially when predicting 1-year overall survival in real-world scenarios.

In 2018, Australian researchers developed the ARCAD nomogram specifically designed to predict one-year survival rates for stage IV colorectal cancer, Yu begins. This nomogram incorporates additional prognostic factors such as age, ECOG performance status (PS), and mutational status. However, a notable limitation is that its construction is based on a clinical trial population. Clinical trials are known to be highly selective, he explains, often including patients with better PS and fewer comorbidities than the real population. In collaboration with Moffitt Cancer Center, the researchers conducted external validation of the nomogram, Yu noted.

This study revealed three important findings. First, the ARCAD nomogram showed fair discrimination in predicting his 1-year survival in a real-world population, with an area under the ROC curve of 0.74. Yu zooms in. Second, he explains that when predicted survival was graphed against observed survival, the slope of the graph indicated effective stratification of groups on mortality. Finally, Yu points out that the nomogram underestimated survival rates. For example, in the total population of the cohort, the model predicted a 1-year survival rate of approximately 64% (95% CI, 63.7%-64.4%), whereas the actual survival rate was 72.7% (95% CI, 71.8%- 64.4%). 73.6%), indicating that 9% is undervalued, he continued. These findings are critical to understanding the performance of nomograms in diverse patient populations outside of clinical trial enrollment criteria, Yu concludes.