A Prognostic Nomogram for T3N0 Rectal Cancer After Total Mesorectal Excision to Help Select Patients for Adjuvant Therapy.

Chao Zhang,Xudong Wang,Shutao Zhao

doi:10.3389/fonc.2021.698866

Chao Zhang, Xudong Wang + Show 1 more

Open Access

https://doi.org/10.3389/fonc.2021.698866

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Abstract

BackgroundThe recurrence rate of T3N0 rectal cancer after total mesorectal excision (TME) is relatively low, meaning that not all patients need adjuvant therapy (AT) (radiotherapy, chemotherapy, or chemoradiotherapy).MethodsPatients diagnosed with pT3N0M0 rectal cancer after TME were analyzed using the SEER database, of which 4367 did not receive AT and 2794 received AT. Propensity score matching was used to balance the two groups in terms of confounding factors. Cox proportional hazards regression analysis was used to screen independent prognostic factors, which were then used to establish a nomogram. The patients were then divided into three groups with X-tile software according to their risk scores. We enrolled 334 patients as external validation.ResultsThe C-index of the model was 0.725 (95% confidence interval: 0.694–0.756). We divided the patients into three different risk layers based on the nomogram prediction scores, and found that AT did not improve the prognosis of low- and moderate-risk patients, while high-risk patients benefited from AT. External validation data also support the above conclusions.ConclusionThis study developed a nomogram that effectively and comprehensively evaluates the prognosis of T3N0 rectal cancer patients after TME. After using the nomogram, we recommend AT for high-risk patients, but not for low- and moderate-risk patients.

Highlights

The recurrence rate of T3N0 rectal cancer after total mesorectal excision (TME) is relatively low, meaning that not all patients need adjuvant therapy (AT)
Due to the lack of randomized controlled trials (RCTs) of AT in T3N0 patients, this study focused on the clinical effect of AT in T3N0 patients at high-risk of recurrence after TME without neoadjuvant chemoradiotherapy (NCRT)
Our study found that patients ≥65-years old had a poor prognosis (HR: 3.42, 95% confidence interval (CI): 2.97–3.94, P

Summary

Introduction

The recurrence rate of T3N0 rectal cancer after total mesorectal excision (TME) is relatively low, meaning that not all patients need adjuvant therapy (AT) (radiotherapy, chemotherapy, or chemoradiotherapy). Current guidelines recommend neoadjuvant chemoradiotherapy (NCRT) combined with total mesorectal excision (TME) and adjuvant therapy (AT) for locally advanced rectal cancer (RC); the treatment for patients with early-stage RC (T3NO) is controversial. The local recurrence rate of T3NO RC patients is only approximately 10% It is considered potentially more suitable to provide direct surgery combined with AT for patients with such low recurrence risk, thereby avoiding the side effects of overtreatment [6,7,8,9,10]. Due to the lack of randomized controlled trials (RCTs) of AT in T3N0 patients, this study focused on the clinical effect of AT in T3N0 patients at high-risk of recurrence after TME without NCRT

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