Clinical Research Papers:
Adjuvant treatment may benefit patients with high-risk upper rectal cancer: a nomogram and recursive partitioning analysis of 547 patients
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Xin Wang1, Jing Jin1, Yong Yang1, Wen-Yang Liu1, Hua Ren1, Yan-Ru Feng1, Qin Xiao2, Ning Li1, Lei Deng1, Hui Fang1, Hao Jing1, Ning-Ning Lu1, Yu Tang1, Jian-Yang Wang1, Shu-Lian Wang1, Wei-Hu Wang1, Yong-Wen Song1, Yue-Ping Liu1 and Ye-Xiong Li1
1 Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
2 Department of Radiation Oncology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Hunan, P. R. China
Jing Jin, email:
Keywords: upper rectal cancer, nomogram, recursive partitioning analysis, adjuvant chemoradiotherapy, adjuvant chemotherapy
Received: February 04, 2016 Accepted: July 09, 2016 Published: July 19, 2016
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.
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