W van Gijn1, R G P M van Stiphout2, C J H van de Velde3, V Valentini4, G Lammering5, M A Gambacorta4, L Påhlman6, K Bujko7, P Lambin5. 1. Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands willem@vangijn.com. 2. Department of Radiation Oncology (MAASTRO), GROW, University Medical Centre Maastricht, Maastricht Department of Knowledge Engineering, Faculty of Humanities and Sciences, Maastricht University, Maastricht, The Netherlands. 3. Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands. 4. Radiation Oncology Department, Università Cattolica del Sacro Cuore, Rome, Italy. 5. Department of Radiation Oncology (MAASTRO), GROW, University Medical Centre Maastricht, Maastricht. 6. Department of Surgical Science, Uppsala University, Uppsala, Sweden. 7. Department of Radiotherapy, The Maria Sklodowska-Curie Memorial Cancer Centre, Warsaw, Poland.
Abstract
BACKGROUND: In many European countries, short-term 5 × 5 Gy radiotherapy has become the standard preoperative treatment of patients with resectable rectal cancer. Individualized risk assessment might allow a better selection of patients who will benefit from postoperative treatment and intensified follow-up. PATIENTS AND METHODS: From patient's data from three European rectal cancer trials (N = 2881), we developed multivariate cox nomograms reflecting the risk for local recurrence (LR), distant metastases (DM) and overall survival (OS). Evaluated variables were age, gender, tumour distance from the anal verge, the use of radiotherapy, surgical technique (total mesorectal excision/conventional surgery), surgery type (low anterior resection/abdominoperineal resection), time from randomization to surgery, residual disease (R0 versus R1 + 2), pT-stage, pN-stage and surgical complications. RESULTS: Pathological T- and N-status are of vital importance for an accurate prediction of LR, DM and OS. Short-course radiotherapy reduces the rate of LR. The developed nomograms are capable of predicting events with a validation c-index of 0.79 (LR), 0.76 (DM) and 0.75 (OS). The proposed stratification in risk groups allowed significant distinction between Kaplan-Meier curves for outcome. CONCLUSION: The developed nomograms can contribute to better individual risk prediction for LR, DM and OS for patients operated on rectal cancer. The practicality of the defined risk groups makes decision support in the consulting room feasible, assisting physicians to select patients for adjuvant therapy or intensified follow-up.
BACKGROUND: In many European countries, short-term 5 × 5 Gy radiotherapy has become the standard preoperative treatment of patients with resectable rectal cancer. Individualized risk assessment might allow a better selection of patients who will benefit from postoperative treatment and intensified follow-up. PATIENTS AND METHODS: From patient's data from three European rectal cancer trials (N = 2881), we developed multivariate cox nomograms reflecting the risk for local recurrence (LR), distant metastases (DM) and overall survival (OS). Evaluated variables were age, gender, tumour distance from the anal verge, the use of radiotherapy, surgical technique (total mesorectal excision/conventional surgery), surgery type (low anterior resection/abdominoperineal resection), time from randomization to surgery, residual disease (R0 versus R1 + 2), pT-stage, pN-stage and surgical complications. RESULTS: Pathological T- and N-status are of vital importance for an accurate prediction of LR, DM and OS. Short-course radiotherapy reduces the rate of LR. The developed nomograms are capable of predicting events with a validation c-index of 0.79 (LR), 0.76 (DM) and 0.75 (OS). The proposed stratification in risk groups allowed significant distinction between Kaplan-Meier curves for outcome. CONCLUSION: The developed nomograms can contribute to better individual risk prediction for LR, DM and OS for patients operated on rectal cancer. The practicality of the defined risk groups makes decision support in the consulting room feasible, assisting physicians to select patients for adjuvant therapy or intensified follow-up.
Authors: Alyson L Mahar; Carolyn Compton; Susan Halabi; Kenneth R Hess; Martin R Weiser; Patti A Groome Journal: J Surg Oncol Date: 2017-08-02 Impact factor: 3.454
Authors: Wei Xu; Yazhou He; Yuming Wang; Xue Li; Jane Young; John P A Ioannidis; Malcolm G Dunlop; Evropi Theodoratou Journal: BMC Med Date: 2020-06-26 Impact factor: 8.775