A nomogram predicting pathological complete response to neoadjuvant chemoradiotherapy for locally advanced rectal cancer: implications for organ preservation strategies
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Yanwu Sun1, Pan Chi1, Huiming Lin1, Xingrong Lu1, Ying Huang1, Zongbin Xu1, Shenghui Huang1 and Xiaojie Wang1
1Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, PR China
Pan Chi, email: [email protected]
Keywords: rectal cancer, nomogram, chemoradiotherapy, pathological complete response
Received: January 04, 2017 Accepted: June 02, 2017 Published: June 28, 2017
Purpose: To determine predictors of pathological complete response (pCR) in locally advanced rectal cancer patients treated with neoadjuvant chemoradiotherapy (nCRT), and develop a predictive nomogram.
Methods: A total of 522 locally advanced rectal cancer patients undergoing nCRT and curative resection between 2008 and 2014 were included. Uni- and multivariate analysis was performed to identify predictors of pCR. A nomogram was developed and validated by internal (n=425) and external validation (n=97).
Results: With a median follow-up of 55 months, pCR was associated with better 5-year overall and disease-free survival, distant control, but similar local control. Logistic regression showed that post-CRT distance from the anal verge (OR =0.840, P = 0.022), post-CRT tumor size (OR = 0.565, P = 0.003), post-CRT circumferential extent of tumor (OR = 0.021, P < 0.001), pre-CRT CEA level (OR = 2.004, P = 0.033), and post-CRT CEA level (OR = 3.767, P = 0.038) were independently associated with pCR. A nomogram was developed with a C-index of 0.81 and 0.75 on internal and external validation, respectively.
Conclusion: pCR was associated with better long-term outcome. A nomogram was successfully developed to predict pCR. It could support decision-making in organ preservation strategies.
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