Nomograms for predicting local recurrence, distant metastases, and overall survival for patients with locally advanced rectal cancer on the basis of European randomized clinical trials

The purpose of this study was to develop accurate models and nomograms to predict local recurrence, distant metastases, and survival for patients with locally advanced rectal cancer treated with long-course chemoradiotherapy (CRT) followed by surgery and to allow for a selection of patients who may...

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Published in:Journal of clinical oncology Vol. 29; no. 23; p. 3163
Main Authors: Valentini, Vincenzo, van Stiphout, Ruud G P M, Lammering, Guido, Gambacorta, Maria Antonietta, Barba, Maria Cristina, Bebenek, Marek, Bonnetain, Franck, Bosset, Jean-Francois, Bujko, Krzysztof, Cionini, Luca, Gerard, Jean-Pierre, Rödel, Claus, Sainato, Aldo, Sauer, Rolf, Minsky, Bruce D, Collette, Laurence, Lambin, Philippe
Format: Journal Article
Language:English
Published: United States 10.08.2011
Subjects:
Adult
Age Factors
Aged
Europe
Female
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Models, Theoretical
Neoplasm Metastasis
Neoplasm Recurrence, Local - mortality
Neoplasm Recurrence, Local - pathology
Randomized Controlled Trials as Topic
Rectal Neoplasms - mortality
Rectal Neoplasms - pathology
Sex Factors
Europe
ISSN:1527-7755, 1527-7755
Online Access:Get more information
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Summary:The purpose of this study was to develop accurate models and nomograms to predict local recurrence, distant metastases, and survival for patients with locally advanced rectal cancer treated with long-course chemoradiotherapy (CRT) followed by surgery and to allow for a selection of patients who may benefit most from postoperative adjuvant chemotherapy and close follow-up. All data (N = 2,795) from five major European clinical trials for rectal cancer were pooled and used to perform an extensive survival analysis and to develop multivariate nomograms based on Cox regression. Data from one trial was used as an external validation set. The variables used in the analysis were sex, age, clinical tumor stage stage, tumor location, radiotherapy dose, concurrent and adjuvant chemotherapy, surgery procedure, and pTNM stage. Model performance was evaluated by the concordance index (c-index). Risk group stratification was proposed for the nomograms. The nomograms are able to predict events with a c-index for external validation of local recurrence (LR; 0.68), distant metastases (DM; 0.73), and overall survival (OS; 0.70). Pathologic staging is essential for accurate prediction of long-term outcome. Both preoperative CRT and adjuvant chemotherapy have an added value when predicting LR, DM, and OS rates. The stratification in risk groups allows significant distinction between Kaplan-Meier curves for outcome. The easy-to-use nomograms can predict LR, DM, and OS over a 5-year period after surgery. They may be used as decision support tools in future trials by using the three defined risk groups to select patients for postoperative chemotherapy and close follow-up (http://www.predictcancer.org).
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ISSN:1527-7755
1527-7755
DOI:10.1200/JCO.2010.33.1595