Abstract
AimTo develop prognostic nomograms for predicting outcomes in patients with locally advanced rectal cancers who do not receive preoperative treatment.Materials and MethodsA total of 883 patients with stage II–III rectal cancers were retrospectively collected from a single institution. Survival analyses were performed to assess each variable for overall survival (OS), local recurrence (LR) and distant metastases (DM). Cox models were performed to develop a predictive model for each endpoint. The performance of model prediction was validated by cross validation and on an independent group of patients.ResultsThe 5-year LR, DM and OS rates were 22.3%, 32.7% and 63.8%, respectively. Two prognostic nomograms were successfully developed to predict 5-year OS and DM-free survival rates, with c-index of 0.70 (95% CI = [0.66, 0.73]) and 0.68 (95% CI = [0.64, 0.72]) on the original dataset, and 0.76 (95% CI = [0.67, 0.86]) and 0.73 (95% CI = [0.63, 0.83]) on the validation dataset, respectively. Factors in our models included age, gender, carcinoembryonic antigen value, tumor location, T stage, N stage, metastatic lymph nodes ratio, adjuvant chemotherapy and chemoradiotherapy. Predicted by our nomogram, substantial variability in terms of 5-year OS and DM-free survival was observed within each TNM stage category.ConclusionsThe prognostic nomograms integrated demographic and clinicopathological factors to account for tumor and patient heterogeneity, and thereby provided a more individualized outcome prognostication. Our individualized prediction nomograms could help patients with preoperatively under-staged rectal cancer about their postoperative treatment strategies and follow-up protocols.
Highlights
Colorectal cancer is the most commonly diagnosed gastrointestinal malignancy in the world
Substantial variability in terms of 5-year overall survival (OS) and distant metastases (DM)-free survival was observed within each TNM stage category
The prognostic nomograms integrated demographic and clinicopathological factors to account for tumor and patient heterogeneity, and thereby provided a more individualized outcome prognostication
Summary
Colorectal cancer is the most commonly diagnosed gastrointestinal malignancy in the world. As most of patients with rectal cancer present with locally advanced disease at diagnosis, neoajuvant chemoradiation is the standard recommendation to improve patients’ outcomes including quality of life. Approximately 20–50% of patients with stage II–III rectal cancer in North America receive definitive surgery prior to adjuvant treatment [1,2], and the proportion is even higher in Asia [3]. Neoadjuvant chemoradiotherapy (CRT) has been confirmed to improve local control for locally advanced rectal cancer, its efficacy in preventing distant metastases and improving OS remains controversial [4]. Because preoperative CRT is associated with increased complications compared to surgery alone, we sought to characterize patients with locally advanced rectal cancer who were adequately treated with surgery followed by adjuvant chemotherapy[5,6,7]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
