Nomogram basing pre-treatment parameters predicting early response for locally advanced rectal cancer with neoadjuvant chemotherapy alone: a subgroup efficacy analysis of FOWARC study.

Jianwei Zhang,Liang Kang,Jian Xiao,Lei Wang,Hui Wang,Jiayu Ling,Ping Lan,Huabin Hu,Yanhong Deng,Jianping Wang,Meijin Huang,Xiaojian Wu,Yue Cai

doi:10.18632/oncotarget.6469

Jianwei Zhang, Liang Kang + Show 11 more

Open Access

https://doi.org/10.18632/oncotarget.6469

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Abstract

ObjectiveTo develop an accurate model with pre-treatment parameters to predict tumor regression and down-staging in locally advanced rectal cancer patients, basing the cohort of preoperative chemotherapy alone in FOWARC study.Patients and MethodsFrom Jan 2011 to Feb 2015, complete data was available for 137 out of 165 patients who received preoperative chemotherapy alone. All pre-treatment clinical parameters were collected. Tumor regression grade (TRG) 0-1 was defined as good regression, and pathological TNM stage (ypTNM) 0-I after neoadjuvant treatment was defined as good down-staging. Nomogram was established to predict tumor regression and down-staging. The predictive performance of the model was assessed with concordance index and calibration plots.ResultsOf the 137 patients, 10 had TRG 0 (complete regression); 32 patients, TRG 1; and 95 patients, TRG 2 and 3 (poor regression); 56 (40.9%) patients were classified as good down-staging with ypTNM stage 0-I. The predictive nomograms were developed to predict the probability of TRG 0-1 and good down-staging with a C-index of 0.72 (95% CI: 0.604-0.797) and 0.76 (95% CI: 0.681-0.844). Calibration plots showed good statistical performance on internal validation. Predictive factors in the models included tumor length, tumor circumferential extent, age, and ApoA1.ConclusionsThe model based on available clinical parameters could accurately predict early efficacy with neoadjuvant mFOLFOX6 chemotherapy alone, which might help in patient selection for optimized treatment.

Highlights

In the past few decades, treatment outcomes for rectal cancer have shown tremendous improvement
The predictive nomograms were developed to predict the probability of Tumor regression grade (TRG) 0-1 and good down-staging with a concordance index (C-index) of 0.72 and 0.76
The model based on available clinical parameters could accurately predict early efficacy with neoadjuvant mFOLFOX6 chemotherapy alone, which might help in patient selection for optimized treatment

Summary

Introduction

In the past few decades, treatment outcomes for rectal cancer have shown tremendous improvement. Adoption of better surgical techniques and total mesorectal excision (TME) are cornerstones of the therapy [1, 2]. The introduction of neoadjuvant treatment in locally advanced rectal cancer further decreased the risk of local-regional recurrence [3, 4]. Oncology/Radiation Oncology/Medical Oncology of the German Cancer Society) study in 2004 [5], preoperative chemoradiotherapy (CRT) with infusional fluorouracil and TME surgery became the standard-of-care for patients with stage II-III rectal cancer. About 30% of patients still developed distant metastasis after long-term follow-up, which remains the www.impactjournals.com/oncotarget main obstacle for improving survival. The survival of patients with LARC is still as low as 65% [6].

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