Nomograms to predict survival and the risk for developing local or distant recurrence in patients with rectal cancer treated with optional short-term radiotherapy
Menée à partir des données de trois essais européens portant sur 2 881 patients atteints d'un cancer rectal et ayant reçu un traitement chirurgical en combinaison ou non avec une radiothérapie de courte durée, cette étude évalue la performance de nomogrammes, basés entre autres sur le type de traitement reçu et le stade pathologique de la tumeur et des ganglions, pour prédire la survie des patients et le risque de récidive locale ou distante
Background : In many European countries, short-term 5x5 Gy radiotherapy has become the standard preoperative treatment for patients with resectable rectal cancer. Individualized risk assessment might allow a better selection of patients who will benefit from postoperative treatment and intensified follow-up.
Patients and Methods : From patient data from three European rectal cancer trials (N=2881) we developed multivariate cox nomograms reflecting the risk for local recurrence (LR), distant metastases (DM) and overall survival (OS). Evaluated variables were age, gender, tumour distance from the anal verge, the use of radiotherapy, surgical technique (TME/conventional surgery), surgery type (LAR/APR), time from randomization to surgery, residual disease (R0 vs R1+2), pT-stage, pN-stage and surgical complications.
Results : Pathological T- and N-status are of vital importance for an accurate prediction of local recurrence, distant metastases and overall survival. Short-course radiotherapy reduces local recurrence rate. The developed nomograms are capable of predicting events with a validation c-index of 0.79 (LR), 0.76 (DM) and 0.75 (OS). The proposed stratification in risk groups allowed significant distinction between Kaplan-Meier curves for outcome.
Conclusion : The developed nomograms can contribute to better individual risk prediction for local recurrence, distant metastases and overall survival for patients operated on rectal cancer. The practicality of the defined risk groups makes decision support in the consulting room feasible, assisting physicians to select patients for adjuvant therapy or intensified follow-up.
Annals of Oncology , résumé, 2015