Chao-Tuan Zhang

Department of General Surgery, TCM-Integrated Hospital of Southern Medical University, Guangzhou City, Guangdong Province, 510315, People’s Republic of China

Correspondence: Chao-Tuan Zhang, Department of General Surgery, TCM-Integrated Hospital of Southern Medical University, No. 13, Shiliugang Road, Haizhu District, Guangzhou City, Guangdong Province, 510315, People’s Republic of China, Email ChaoTZhang6789@163.com

Background: Early-stage rectal cancer remains a significant clinical challenge due to variable patient outcomes. Identifying prognostic factors and developing an accurate predictive model is essential for optimizing treatment strategies and improving survival.
Methods: This retrospective study enrolled 156 patients with histologically confirmed early-stage rectal cancer treated from January 2016 to December 2019. Patients with complete clinical, pathological, and laboratory data and a minimum follow-up of 5 years were included. Data on demographics, body mass index, carcinoembryonic antigen levels, tumor characteristics, and lymph node status were extracted from electronic medical records. Univariate survival analysis was performed using the Log rank test, followed by multivariate analysis via Cox proportional hazards regression. A prognostic nomogram was constructed using the rms package, and its performance was evaluated with the concordance index and Hosmer–Lemeshow test. Internal validation was conducted through 1000 bootstrap resampling iterations.
Results: Univariate analysis demonstrated that factors such as age, BMI, CEA levels, T stage, lymph node metastasis, tumor histology, and lymph node retrieval significantly influenced 5-year overall survival. Multivariate analysis confirmed these variables as independent prognostic factors. The resulting nomogram, incorporating seven risk factors, exhibited robust discriminative ability with a corrected C-index of 0.806 (95% CI, 0.768– 0.861) and excellent calibration (Hosmer–Lemeshow χ² = 2.865, P = 0.891).
Conclusion: The predictive nomogram developed in this study provides a practical and reliable tool for individualized risk assessment and treatment planning in early-stage rectal cancer patients, potentially enhancing clinical decision-making and patient outcomes.

Keywords: rectal cancer, early-stage, prognostic factors, nomogram, survival prediction, risk assessment