【摘 要】
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Purpose: The role of adjuvant chemoradiotherapy (ACRT) or adjuvant chemotherapy (ACT) in treating patients with locally advanced upper rectal cancer (URC) after total mesorectal excision (TME) surgery
【机 构】
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Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical
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Purpose: The role of adjuvant chemoradiotherapy (ACRT) or adjuvant chemotherapy (ACT) in treating patients with locally advanced upper rectal cancer (URC) after total mesorectal excision (TME) surgery remains unclear.We developed a clinical nomogram and a recursive partitioning analysis (RPA)-based risk stratification system for predicting 5-year cancer-specific survival (CSS) to determine whether these individuals require ACRT or ACT.Materials and Methods: This retrospective analysis included 547 patients with primary URC.A nomogram was developed based on the Cox regression model.The performance of the model was assessed by concordance index (C-index) and calibration curve in internal validation with bootstrapping.RPA stratified patients into risk groups based on their tumor characteristics.Results: Five independent prognostic factors (age, preoperative increased carcinoembryonic antigen and carcinoma antigen 19-9, positive lymph node [PLN] number, tumor deposit [TD], pathological T classification) were identified and entered into the predictive nomogram.The bootstrap-corrected C-index was 0.757.RPA stratification of the three prognostic groups showed obviously different prognosis.Only the high-risk group (patients with PLN ≤ 6 and TD, or PLN > 6) benefited from ACRT plus ACT when compared with surgery followed by ACRT or ACT, and surgery alone (5-year CSS: 70.8% vs.57.8% vs.15.6%, P < 0.001).Conclusions: Our nomogram predicts 5-year CSS after TME surgery for locally advanced rectal cancer and RPA-based stratification indicates that ACRT plus ACT post-surgery may be an important treatment plan with potentially significant survival advantages in high-risk URC.This may help to select candidates of adjuvant treatment in prospective studies.
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