Adjuvant treatment may benefit patients with high-risk upper rectal cancer: A nomogram and recursive partitioning analysis of 547 patients
Purpose: The role of adjuvant chemoradiotherapy (ACRT) or adjuvant chemotherapy (ACT) in treating patients with locally advanced upper rectal cancer (URC) after total mesorectal excision (TME) surgery remains unclear.We developed a clinical nomogram and a recursive partitioning analysis (RPA)-based risk stratification system for predicting 5-year cancer-specific survival (CSS) to determine whether these individuals require ACRT or ACT.Materials and Methods: This retrospective analysis included 547 patients with primary URC.A nomogram was developed based on the Cox regression model.The performance of the model was assessed by concordance index (C-index) and calibration curve in internal validation with bootstrapping.RPA stratified patients into risk groups based on their tumor characteristics.Results: Five independent prognostic factors (age, preoperative increased carcinoembryonic antigen and carcinoma antigen 19-9, positive lymph node ”PLN” number, tumor deposit ”TD”, pathological T classification) were identified and entered into the predictive nomogram.The bootstrap-corrected C-index was 0.757.RPA stratification of the three prognostic groups showed obviously different prognosis.Only the high-risk group (patients with PLN ≤ 6 and TD, or PLN > 6) benefited from ACRT plus ACT when compared with surgery followed by ACRT or ACT, and surgery alone (5-year CSS: 70.8% vs.57.8% vs.15.6%, P < 0.001).Conclusions: Our nomogram predicts 5-year CSS after TME surgery for locally advanced rectal cancer and RPA-based stratification indicates that ACRT plus ACT post-surgery may be an important treatment plan with potentially significant survival advantages in high-risk URC.This may help to select candidates of adjuvant treatment in prospective studies.
upper rectal cancer nomogram recursive partitioning analysis adjuvant chemoradiotherapy adjuvant chemotherapy
Xin Wang Jing Jin Yong Yang Wen-Yang Liu Hua Ren Yan-Ru Feng Qin Xiao Ning Li Lei Deng Hui Fang Hao Jing Ning-Ning Lu Yu Tang Jian-Yang Wang Shu-Lian Wang Wei-Hu Wang Yong-Wen Song Yue-Ping Liu Ye-Xiong Li
Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Department of Radiation Oncology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya S
国内会议
北京
英文
194-203
2016-10-01（万方平台首次上网日期，不代表论文的发表时间）