Liu Hengchang, Wei Ran, Li Chunxiang, Zhao Zhixun, Guan Xu, Yang Ming, Liu Zheng, Wang Xishan, Jiang Zheng
Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, People's Republic of China.
Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, People's Republic of China.
Cancer Manag Res. 2020 Oct 20;12:10321-10332. doi: 10.2147/CMAR.S268928. eCollection 2020.
This study aims to develop feasible nomograms to predict the overall survival (OS) and cancer-specific survival (CSS) of the local advanced rectal cancer (LARC) patients who were treated with neoadjuvant chemoradiotherapy (nCRT) and operation.
A total of 243 LARC patients undergoing nCRT followed by total mesorectal excision (TME) were enrolled. Preoperative clinical features and postoperative pathological characteristics were collected. A Cox regression analysis was performed, and Cox-based nomograms were developed to predict the OS and CSS. We assessed the predictive performance of the nomogram with concordance index and calibration plots.
A total of 243 patients were included with a median follow-up period of 46 months (range from 9 to 86 months). Cox regression analysis showed that low BMI (BMI < 18.5, HR= 21.739, < 0.05), high level of preoperative CA19-9 (HR = 3.369, = 0.036), high ypStage (HR = 19.768, < 0.001), positive neural invasion (HR = 4.218, = 0.026) and no adjuvant chemotherapy (HR = 5.495, < 0.001) were independent predictors of poor OS. Age ≥70 (HR = 2.284, <0.001), low BMI (BMI < 18.5, HR = 3.906, < 0.05), positive preoperative CA19-9 (HR = 1.920, = 0.012), high ypStage (HR = 5.147, <0.001) and positive neural invasion (HR = 2.873, = 0.022) were independent predictors of poor CSS. The predictive nomograms were developed to predict the OS and CSS with a C-index of 0.837 and 0.760. Good statistical performance on internal validation was shown by calibration plots.
In conclusion, this study demonstrated that BMI was an independent prognostic factor for OS and CSS in LARC patients treated with nCRT followed TME. A nomogram incorporating BMI, neural invasion, pre-CA19-9, ypStage, age, and adjuvant chemotherapy could be helpful to predict the OS and CSS.
本研究旨在开发可行的列线图，以预测接受新辅助放化疗（nCRT）及手术治疗的局部晚期直肠癌（LARC）患者的总生存期（OS）和癌症特异性生存期（CSS）。
共纳入243例接受nCRT后行全直肠系膜切除术（TME）的LARC患者。收集术前临床特征和术后病理特征。进行Cox回归分析，并基于Cox模型开发列线图以预测OS和CSS。我们通过一致性指数和校准图评估列线图的预测性能。
共纳入243例患者，中位随访期为46个月（9至86个月）。Cox回归分析显示，低体重指数（BMI<18.5，HR=21.739，P<0.05）、术前CA19-9水平高（HR=3.369，P=0.036）、高yp分期（HR=19.768，P<0.001）、神经侵犯阳性（HR=4.218，P=0.026）及未接受辅助化疗（HR=5.495，P<0.001）是OS不良的独立预测因素。年龄≥70岁（HR=2.284，P<0.001）、低体重指数（BMI<18.5，HR=3.906，P<0.05）、术前CA19-9阳性（HR=1.920，P=0.012）、高yp分期（HR=5.147，P<0.001）及神经侵犯阳性（HR=2.873，P=0.022）是CSS不良的独立预测因素。开发的预测列线图用于预测OS和CSS，C指数分别为0.837和0.760。校准图显示内部验证具有良好的统计学性能。
总之，本研究表明，BMI是接受nCRT后行TME治疗的LARC患者OS和CSS的独立预后因素。纳入BMI、神经侵犯、术前CA19-9、yp分期、年龄及辅助化疗的列线图有助于预测OS和CSS。
