Nomogram and Recursive Partitioning Analysis to Determine the Risk of Cancer-Spe
PUBLISHED: 2015-11-27  194 total views, 1 today

Xin Wang1, Jing Jin2, Yong Yang2, Wenyang Liu2, Hua Ren2, Yanru Feng2Qin Xiao3, Ning Li2, Hui Fang2, Hao Jing2, Ningning Lu2, Yu Tang2, Lei Deng2Jian-yang Wang2, Shulian Wang2, Weihu Wang2, Yong-wen Song2Yue-ping Liu2, Xin-fan Liu2, Zihao Yu2, Yexiong Li2

1Department of RadiationOncology, Cancer Hospital and Institute, National Cancer Center, ChineseAcademy of Medical Sciences (CAMS), 2National Cancer Center,Cancer Hospital and Institute, 3The Affiliated CancerHospital of Xiangya School of Medicine, Hunan Cancer Hospital


Objective: Whetheradjuvant chemoradiotherapy (ACRT) or chemotherapy (ACT) will benefit for stageII or III upper rectal cancer (URC) after radical surgery remains unclear. Theaim of this study was to develop t a clinical nomogram and a recursivepartitioning analysis (RPA) based risk stratification system for the predictionof 5-year cancer-specific survival (CSS), trying to reveal whether ACRT or ACTis necessary for these patients. Method: This retrospective analysisincluded 547 primary URC patients who were extracted from 3995 rectal cancerpatients admitted in Cancer Hospital, Chinese Academy of Medical Sciences fromJanuary 2000 to December 2010. Lower margin of the tumor located 10-400px fromthe anal verge determined by colonoscope, underwent radical resection (R0) andpathologically staged as II/III were included. A nomogram was developed basedon the Cox regression model predicting 5-year CSS and RPA stratified patientsinto risk groups based on their tumor characteristics. Kaplan-Meier curves wereused to estimate CSS rates in each risk group according to ACRT or ACT status. Result:With a median follow-up of 68 months (range 4.6~182.5), the actually 5-yearoverall survival, disease-free survival, CSS, local recurrence free survivaland distant metastasis free survival of the entire cohort were 79.7%, 76.1%,83.3% and 93.7% and 79.8%, respectively. Of the 547 patients, 379 (69.3%)received ACRT or adjuvant radiotherapy and 327 (59.9%) patients received ACT.Five independent prognostic factors including age, preoperative increasedlevels of CEA and CA19-9, number of positive lymph nodes (PLNs), tumor deposit(TD), pathologic T category were identified and entered into nomogram thatpredicts the probability of 5-year CSS. The bootstrap-corrected c-index was0.757. When patients were divided into three risk groups on the basis of RPA,Only the high-risk group (patients with PLN ≤ 6 and TD, or PLN>6) benefitedfrom ACRT plus ACT when compared with surgery followed by ACRT or ACT orsurgery alone (5-year CSS: 70.8% vs. 57.8% vs. 15.6%, P<0.001). While, ACRT and ACT following surgery achieved nosignificant difference in CSS outcome in the intermediate- (P=0.159) andlow-risk groups (P=0.576). Conclusion: The outcome of URC is goodfollowing radical surgery. Our study indicates that ACRT plus ACT post-surgerymay be an important treatment plan with potentially significant survival advantagesin high-risk URC.


Key Words: upper rectal cancer  adjuvant chemoradiotherapy 


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