PURPOSE: The purpose of this study was to identify clinical risk factors and establish a prediction scoring system for locally advanced rectal cancer. MATERIALS AND METHODS: Retrospective univariate and multivariate logistic analyses were conducted for 413 curable rectal cancer patients. Clinical factors found to be significantly related with tumor stages were incorporated into a scoring system to predict locally advanced stages, which was validated in an independent cohort of 279 rectal cancer patients. RESULTS: In the training set, tumor size, differentiation, and serum carcinoembryonic antigen (CEA) level (P < 0.01) were significant predictors of locally advanced rectal cancer in both univariate and multivariate analyses, which were incorporated into a proposed scoring system to predict locally advanced stages. The area under the receiver operating characteristic curve (AUROC) of this scoring system was 0.751 and the prediction accuracy was 78.2%. Patients were categorized into three subsets according to the total score. The low-risk group (score 0) had a smaller chance (18.2%) to have locally advanced rectal cancer, compared to mean 49.2% for the intermediate-risk group (score 1) and mean 83.0% for the high-risk group (score of 2-4; P < 0.05). In the validation set, the AUROC of the scoring system was 0.756 and the prediction accuracy was 75.3%. CONCLUSIONS: Tumor size more than 2 cm, poor differentiation, and elevated serum CEA level are high-risk factors of locally advanced rectal cancer. A simple scoring system based on these three factors may be valuable to predict locally advanced rectal cancer.
PURPOSE: The purpose of this study was to identify clinical risk factors and establish a prediction scoring system for locally advanced rectal cancer. MATERIALS AND METHODS: Retrospective univariate and multivariate logistic analyses were conducted for 413 curable rectal cancerpatients. Clinical factors found to be significantly related with tumor stages were incorporated into a scoring system to predict locally advanced stages, which was validated in an independent cohort of 279 rectal cancerpatients. RESULTS: In the training set, tumor size, differentiation, and serum carcinoembryonic antigen (CEA) level (P < 0.01) were significant predictors of locally advanced rectal cancer in both univariate and multivariate analyses, which were incorporated into a proposed scoring system to predict locally advanced stages. The area under the receiver operating characteristic curve (AUROC) of this scoring system was 0.751 and the prediction accuracy was 78.2%. Patients were categorized into three subsets according to the total score. The low-risk group (score 0) had a smaller chance (18.2%) to have locally advanced rectal cancer, compared to mean 49.2% for the intermediate-risk group (score 1) and mean 83.0% for the high-risk group (score of 2-4; P < 0.05). In the validation set, the AUROC of the scoring system was 0.756 and the prediction accuracy was 75.3%. CONCLUSIONS:Tumor size more than 2 cm, poor differentiation, and elevated serum CEA level are high-risk factors of locally advanced rectal cancer. A simple scoring system based on these three factors may be valuable to predict locally advanced rectal cancer.
Authors: Paul F Engstrom; Juan Pablo Arnoletti; Al B Benson; Yi-Jen Chen; Michael A Choti; Harry S Cooper; Anne Covey; Raza A Dilawari; Dayna S Early; Peter C Enzinger; Marwan G Fakih; James Fleshman; Charles Fuchs; Jean L Grem; Krystyna Kiel; James A Knol; Lucille A Leong; Edward Lin; Mary F Mulcahy; Sujata Rao; David P Ryan; Leonard Saltz; David Shibata; John M Skibber; Constantinos Sofocleous; James Thomas; Alan P Venook; Christopher Willett Journal: J Natl Compr Canc Netw Date: 2009-09 Impact factor: 11.908
Authors: Inti Zlobec; Parham Minoo; Eva Karamitopoulou; George Peros; Efstratios S Patsouris; Frank Lehmann; Alessandro Lugli Journal: BMC Gastroenterol Date: 2010-06-15 Impact factor: 3.067