Possible contribution of IMRT in postoperative radiochemotherapy for rectal cancer: analysis on 1798 patients by prediction model
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Wen-Yang Liu1, Nicola Dinapoli2, Xin Wang1, Elisa Meldolesi2, Maria Antonietta Gambacorta2, Giuditta Chiloiro2, Hua Ren1, Hui Fang1, Ning-Ning Lu1, Yu Tang1, Lei Deng1, Jian-Yang Wang1, Hao Jing1, Qin Xiao1,3, Yan-Ru Feng1, Ye-Xiong Li1, Shu-Lian Wang1, Yong-Wen Song1, Yue-Ping Liu1, Wei-Hu Wang1, Vincenzo Valentini2, Jing Jin1
1Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
2Department of Radiation Oncology, Università Cattolica del Sacro Cuore, Rome, Italy
3Department of Radiation Oncology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, China
Nicola Dinapoli, email: [email protected]
Vincenzo Valentini, email: [email protected]
Jing Jin, email: [email protected]
Keywords: rectal cancer, nomogram, survival, postoperative radiochemotherapy, intensity-modulated radiation therapy
Received: November 06, 2015 Accepted: June 01, 2016 Published: June 22, 2016
The evidence for adjuvant therapy in locally advanced rectal cancer after TME surgery is sparse. The aim of this study was to identify predicting factors of overall survival (OS) in these patients and combine them into a nomogram for individualized treatment. 1798 patients with pathologically staged II/III rectal adenocarcinoma treated by radical TME surgery from a single center’s database were reviewed. The nomogram was derived by Cox proportional hazards regression. Its performance was assessed by concordance index and calibration curve in internal validation with bootstrapping. Pooled Cox model analysis identified age, sex, grade of histology, pathological T and N stage, residual tumor, concurrent radiochemotherapy (RTCT), adjuvant chemotherapy cycles (CT), radiotherapy (RT) unexpected interruption days and intensity-modulated radiation therapy (IMRT) as significant covariates for 5-year OS (P<0.05). Postoperative RTCT, CT and IMRT all improved OS. The proposed model can predict 5-year OS with a C-index of 0.7105. IMRT significantly benefited OS in multivariate analysis (p=0.0441).
In conclusion, our nomogram can predict 5-year OS after TME surgery for locally advanced rectal cancer with simple and effective advantage. This model may provide not only baseline OS estimate but also a tool for candidates selecting of adjuvant treatment in prospective studies.
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