Abstract
PurposeThe 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 MethodsThis 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.ResultsFive 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).ConclusionsOur 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.
Highlights
Colorectal cancer (CRC) is one of the most common tumor types worldwide [1]
The high-risk group benefited from adjuvant chemoradiotherapy (ACRT) plus adjuvant chemotherapy (ACT) when compared with surgery followed by ACRT or ACT, and surgery alone (5-year cancer-specific survival (CSS): 70.8% vs. 57.8% vs. 15.6%, P < 0.001)
Our nomogram predicts 5-year CSS after Total mesorectal excision (TME) surgery for locally advanced rectal cancer and recursive partitioning analysis (RPA)-based stratification indicates that ACRT plus ACT post-surgery may be an important treatment plan with potentially significant survival advantages in high-risk upper rectal cancer (URC)
Summary
Colorectal cancer (CRC) is one of the most common tumor types worldwide [1]. Total mesorectal excision (TME) and perioperative chemoradiotherapy substantially improved locoregional control for rectal cancer (RC). In China, postoperative adjuvant chemoradiotherapy (ACRT) or adjuvant chemotherapy (ACT) is considered the treatment of choice for stage II or III RC due to the traditional Chinese idea that surgery should be the first www.impactjournals.com/oncotarget surgery. Univariate Analysis N (%) CSS (%) HR P
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