1. 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
- Author
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Guido Lammering, Marek Bębenek, Bruce D. Minsky, Krzysztof Bujko, M.C. Barba, Maria Antonietta Gambacorta, Aldo Sainato, Jean Pierre Gerard, Philippe Lambin, Ruud G.P.M. van Stiphout, Vincenzo Valentini, Laurence Collette, Rolf Sauer, Luca Cionini, Jean François Bosset, Franck Bonnetain, Claus Rödel, Centre d'épidémiologie des populations (CEP), Université de Bourgogne (UB)-Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER-UNICANCER, Service d'Oncologie Médicale [CHRU Besançon], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC (EA 3181) (CEF2P / CARCINO), Centre de Lutte contre le Cancer Antoine Lacassagne [Nice] (UNICANCER/CAL), UNICANCER-Université Côte d'Azur (UCA), Centre de Recherche en Physique de la Matière et du Rayonnement [Namur] (PMR), Université de Namur [Namur] (UNamur), Centre d'épidémiologie des populations ( CEP ), Université de Bourgogne ( UB ) -Centre Régional de Lutte contre le cancer - Centre Georges-François Leclerc ( CRLCC - CGFL ), Service d'oncologie Médicale, Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Hôpital Jean Minjoz, Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC ( CEF2P / CARCINO ), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Université Bourgogne Franche-Comté ( UBFC ) -Université de Franche-Comté ( UFC ), Centre Antoine Lacassagne, CRLCC Antoine Lacassagne, Centre de Recherche en Physique de la Matière et du Rayonnement [Namur] ( PMR ), and Université de Namur [Namur]
- Subjects
Oncology ,Male ,Cancer Research ,Colorectal cancer ,MESH : Aged ,Kaplan-Meier Estimate ,MESH : Randomized Controlled Trials as Topic ,law.invention ,[ SDV.CAN ] Life Sciences [q-bio]/Cancer ,0302 clinical medicine ,Randomized controlled trial ,law ,MESH : Female ,Stage (cooking) ,Neoplasm Metastasis ,MESH: Models, Theoretical ,MESH : Rectal Neoplasms ,Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA ,Randomized Controlled Trials as Topic ,MESH: Aged ,0303 health sciences ,MESH: Middle Aged ,MESH : Neoplasm Recurrence, Local ,Age Factors ,Middle Aged ,MESH : Adult ,3. Good health ,Europe ,030220 oncology & carcinogenesis ,MESH : Neoplasm Metastasis ,Female ,MESH: Neoplasm Recurrence, Local ,Adult ,medicine.medical_specialty ,MESH : Sex Factors ,MESH : Male ,MESH : Europe ,[SDV.CAN]Life Sciences [q-bio]/Cancer ,MESH : Kaplan-Meier Estimate ,03 medical and health sciences ,RECTAL CANCER ,Sex Factors ,MESH: Sex Factors ,Internal medicine ,medicine ,Humans ,MESH : Middle Aged ,Survival analysis ,MESH: Kaplan-Meier Estimate ,030304 developmental biology ,Aged ,MESH: Age Factors ,MESH: Humans ,Proportional hazards model ,business.industry ,Rectal Neoplasms ,MESH : Models, Theoretical ,MESH : Humans ,MESH: Rectal Neoplasms ,MESH: Adult ,Nomogram ,Models, Theoretical ,medicine.disease ,MESH: Neoplasm Metastasis ,MESH: Male ,Surgery ,Clinical trial ,MESH: Randomized Controlled Trials as Topic ,MESH : Age Factors ,MESH: Europe ,Neoplasm Recurrence, Local ,business ,MESH: Female ,Chemoradiotherapy - Abstract
Purpose 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. Patients and Methods 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. Results 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. Conclusion 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 ).
- Published
- 2011
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