A Postsurgical Prognostic Nomogram for Locally Advanced Rectosigmoid Cancer to Assist in Patient Selection for Adjuvant Chemotherapy

Zhang, Chao; Wang, Xudong

doi:10.3389/fonc.2021.772482

Cited by 5 publications

(3 citation statements)

References 40 publications

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“…Another study of patients with locally advanced rectosigmoid colon cancer identi ed factors such as age, tumor grade, tumor size, T stage, and positive lymph nodes. These were independent prognostic factors in patients without adjuvant chemotherapy [19]. Similar conclusions were observed in a study of the prognostic risk of RC.…”

Section: Discussionsupporting

confidence: 86%

Prognostic nomograph of patients with locally advanced (stage II-III) rectal adenocarcinoma after surgery - A Study based on the SEER Database and a Chinese Cohort

Yong-ping

Zhang

et al. 2022

Preprint

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Background: Rectal cancer has a very high global incidence rate, among which rectal adenocarcinoma is the most common. The treatment of rectal adenocarcinoma involves surgery, chemotherapy, radiotherapy, and biological immunity. However, radical resection and total mesenteric resection are standard surgical methods for locally advanced rectal adenocarcinoma (stage II-III). The current study aimed to investigate the factors of overall survival (OS) after local advanced rectal cancer (LARC) surgery. Moreover, a prognostic nomograph was constructed to predict OS. Methods: We collected the clinical data of stage II-III rectal adenocarcinoma patients undergoing radical surgery from 2010 to 2015 from the monitoring, epidemiology, and final results (SEER) database. They were divided into training and validation cohort. Simultaneously, 393 patients were retrospectively obtained from Yunnan Cancer Hospital as the external validation queue. Depending on the risk factors affecting the prognosis, the Cox proportional hazard regression model was utilized to construct a nomograph. The identification and calibration of the nomogram were evaluated using the C index, receiver operating characteristic (ROC), and calibration curve. Result: A total of 1317 patients with stage II-III rectal adenocarcinoma were enrolled. This included 924 in the training group, 393 in the internal validation group, and 393 in the external validation group. Multivariate COX analysis revealed that age, chemotherapy history, carcinoembryonic antigen (CEA), and neural invasion (PNI) were associated with postoperative OS. Nomograms were developed after independent prognostic factors were identified through univariate and multivariate analyses.The C index of nomographs in the training and internal validation cohorts was 0.682(95%CI0.610-0.754) and 0.672(95%CI0.510-0.734),respectively.In the training cohort,the AUC(ROC curve) at 3 years was 0.7(95%CI:0.667-0.733) and 0.657(95%CI:0.631-0.683) at 5 years.In the internal validation cohorts,the AUC (ROC curve) at 3 years was 0.656(95%CI:0.618-0.694) and 0.633(95%CI:0.598-0.668) at 5 years.In the external validation cohort, the C index was 0.701(95%CI0.602-0.780), and the AUC (ROC curve) at 3 years was 0.669(95%CI:0.634-0.704) and 0.71(95%CI:0.68-0.74) at 5 years,indicating good discrimination for the model. The calibration curve of 3-year and 5-year OS probability had good consistency between the predicted and actual survival rates. In addition, patients were divided into three different OS risk groups based on the nomograph: high-risk, medium-risk, and high-risk. The Kaplan-Meier curve indicated that the nomograph had a strong predictive effect on the prognosis of the three groups (P<0.001). Conclusion: In this study, a nomogram was established for patients with locally advanced rectal adenocarcinoma after surgery, which has been an effective clinical tool and can predict the prognosis of patients after surgery.

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Section: Discussionsupporting

confidence: 86%

Prognostic nomograph of patients with locally advanced (stage II-III) rectal adenocarcinoma after surgery - A Study based on the SEER Database and a Chinese Cohort

Yong-ping

Zhang

et al. 2022

Preprint

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“…For example, Du et al developed a risk strati cation method using a nomogram for the identi cation of uterine carcinoma patients who may bene t from PORT based on a large population database [11]. In addition, Zhang et al built a risk evaluator using a nomogram that successfully screened candidates for POCT among patients with locally advanced rectosigmoid cancer [12]. Therefore, we aimed to develop a novel risk strati cation method based on a nomogram to effectively select pIII-N2 NSCLC candidates for PORT after primary resection.…”

Section: Introductionmentioning

confidence: 99%

A novel nomogram to identify the III-N2 non-small cell lung cancer patients who may benefit from adjuvant radiotherapy

Deng

et al. 2023

Preprint

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Purpose We aimed to develop a novel risk stratification system based on a prognostic nomogram to identify patients with pIII-N2 non-small cell lung cancer (NSCLC) who may benefit from postoperative radiotherapy (PORT) after complete resection. Methods We retrospectively enrolled 3,520 eligible NSCLC patients with pIII-N2 stage disease from the Surveillance, Epidemiology, and End Results database. Stabilized inverse probability of treatment weighting (sIPTW) was used to equilibrate the characteristic baseline to reduce bias. We established a risk stratification tool using a nomogram that incorporated independent factors identified using least absolute shrinkage and selection operator (LASSO) Cox regression. Kaplan–Meier and subgroup survival analyses were conducted to estimate the benefit of PORT in every risk stratification. Results Kaplan–Meier survival analysis observed that high-risk patients owned a significant improvement in overall survival (OS) after PORT (p = 0.002), while those in low- or intermediate-risk cohorts did not show such improvement. Subgroup survival analysis suggested that patients with a high lymph node ratio ≥ 0.56 (hazard ratio [HR] = 0.803; 95% confidence interval [CI]:0.661–0.975, p = 0.027), without postoperative chemotherapy (HR = 0.782; 95% CI: 0.619–0.989; p = 0.040), and those in the high-risk group (HR = 0.577; 95% CI: 0.410–0.812; p = 0.001) achieved a significant OS advantage from PORT. Conclusion This novel risk stratification system based on nomogram provides a preliminary identification of potential pIII-N2 NSCLC patients who are more likely to benefit from PORT.

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“…By scoring each single predictor, total scores can be obtained in different stages of the disease, enabling the prognosis prediction in a more intuitive manner [ 11 ]. A model for the perioperative treatment of locally advanced rectosigmoid colon has been previously established by Chao Zhang and colleagues [ 12 ]. This study showed that the current perioperative neoadjuvant therapy for rectal cancer is different from that of RSJC, and proved that lymph node positivity is an important factor in the selection of treatment for patients with locally advanced RSJC [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

A postsurgical prognostic nomogram for patients with lymph node positive rectosigmoid junction adenocarcinoma

2023

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Objective The definition of rectosigmoid junction (RSJ) is still in debate. The treatment and prognosis of patients with rectosigmoid junction cancer (RSJC) and positive lymph nodes (PLN-RSJCs) are mostly based on the American Joint Committee on Cancer (AJCC) staging system. Our study aims to assist clinicians in creating a more intuitive and accurate nomogram model for PLN-RSJCs for the prediction of patient overall survival (OS) after surgery. Methods Based on the Surveillance, Epidemiology, and End Results (SEER) database, we extracted 3384 patients with PLN-RSJCs and randomly divided them into development (n = 2344) and validation (n = 1004) cohorts at a ratio of 7:3. Using univariate and multivariate COX regression analysis, we identified independent risk factors associated with OS in PLN-RSJCs in the development cohort, which were further used to establish a nomogram model. To verify the accuracy of the model, the concordance index (C-index), receiver operating characteristic (ROC) curves, calibration curves, and an internal validation cohort have been employed. Decision curve analysis (DCA) was used to assess the clinical applicability and benefits of the generated model. Survival curves of the low- and high-risk groups were calculated using the Kaplan–Meier method together with the log-rank test. Results Age, marital, chemotherapy, AJCC stage, T and N stage of TNM system, tumor size, and regional lymph nodes were selected as independent risk factors and included in the nomogram model. The C-index of this nomogram in the development (0.751;0.737–0.765) and validation cohorts (0.750;0.764–0.736) were more significant than that of the AJCC 7th staging system (0.681; 0.665–0.697). The ROC curve with the calculated area under the curve (AUC) in the development cohort was 0.845,0.808 and 0.800 for 1-year, 3-year and 5-year OS, AUC in the validation cohort was 0.815,0.833 and 0.814 for 1-year, 3-year and 5-year, respectively. The calibration plots of both cohorts for 1-year,3-year and 5-year OS all demonstrated good agreement between actual clinical observations and predicted outcomes. In the development cohort, the DCA showed that the nomogram prediction model is more advantageous for clinical application than the AJCC 7th staging system. Kaplan–Meier curves in the low and high groups showed significant difference in patient OS. Conclusions We established an accurate nomogram model for PLN-RSJCs, intended to support clinicians in the treatment and follow-up of patients.

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A Postsurgical Prognostic Nomogram for Locally Advanced Rectosigmoid Cancer to Assist in Patient Selection for Adjuvant Chemotherapy

Cited by 5 publications

References 40 publications

Prognostic nomograph of patients with locally advanced (stage II-III) rectal adenocarcinoma after surgery - A Study based on the SEER Database and a Chinese Cohort

Prognostic nomograph of patients with locally advanced (stage II-III) rectal adenocarcinoma after surgery - A Study based on the SEER Database and a Chinese Cohort

A novel nomogram to identify the III-N2 non-small cell lung cancer patients who may benefit from adjuvant radiotherapy

A postsurgical prognostic nomogram for patients with lymph node positive rectosigmoid junction adenocarcinoma

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