Sun Yanwu, Lin Huiming, Lu Xingrong, Huang Ying, Xu Zongbin, Huang Shenghui, Wang Xiaojie, Chi Pan
Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, People's Republic of China.
J Surg Oncol. 2017 Mar;115(4):462-469. doi: 10.1002/jso.24522. Epub 2017 Jan 20.
To compare distant metastasis (DM) in locally advanced rectal cancer (LARC) patients treated with neoadjuvant chemoradiotherapy (nCRT) and surgery alone, and to develop a predictive nomogram for DM following nCRT.
Propensity-scoring match analysis was performed to compare DM in LARC treated with nCRT (n = 375) and surgery alone (n = 375). Cox regression was performed to identify predictors of DM following nCRT. A nomogram was developed and validated by internal (n = 425) and external validation (n = 97).
The 5-year local recurrence rate was significantly lower in the nCRT group (5.6% vs. 10.4%; P = 0.020). The 5-year DM rates (nCRT vs. surgery alone: 25.3% vs. 24.4%; P = 0.235) were similar between groups. Cox regression showed that the post-nCRT pathologic stage (ypTNM stage, OR = 2.022, P = 0.002), IMA nodal metastasis (OR = 2.171, P = 0.023), and CRM involvement (OR = 2.535, P = 0.016) were independently associated with DM following nCRT. A predictive nomogram was developed with a C-index of 0.70 on internal validation, and 0.71 on the external validation.
NCRT improved local control, but not distant metastasis. A nomogram to predict 3- and 5-year DM rates, using clinicopathological parameters, was successfully developed. This prognostic tool could support decision-making in clinical practice and follow-up strategies.
比较接受新辅助放化疗（nCRT）和单纯手术治疗的局部晚期直肠癌（LARC）患者的远处转移（DM）情况，并开发一种用于预测nCRT后DM的预测列线图。
进行倾向评分匹配分析，以比较接受nCRT（n = 375）和单纯手术（n = 375）治疗的LARC患者的DM情况。进行Cox回归以确定nCRT后DM的预测因素。通过内部验证（n = 425）和外部验证（n = 97）开发并验证了列线图。
nCRT组的5年局部复发率显著更低（5.6%对10.4%；P = 0.020）。两组之间的5年DM率相似（nCRT组对单纯手术组：25.3%对24.4%；P = 0.235）。Cox回归显示，nCRT后的病理分期（ypTNM分期，OR = 2.022，P = 0.002）、IMA淋巴结转移（OR = 2.171，P = 0.023）以及环周切缘受累情况（OR = 2.535，P = 0.016）与nCRT后的DM独立相关。开发了一种预测列线图，内部验证时C指数为0.70，外部验证时为0.71。
nCRT改善了局部控制，但未改善远处转移。成功开发了一种使用临床病理参数预测3年和5年DM率的列线图。这种预后工具可支持临床实践中的决策制定和随访策略。
