Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Oct;37(10):2157-2166.
doi: 10.1007/s00384-022-04247-y. Epub 2022 Sep 1.

A nomogram for predicting good response after neoadjuvant chemoradiotherapy for locally advanced rectal cancer: a retrospective, double-center, cohort study

Guancong Wang #  1 , Zhifang Zheng #  2 , Jinhua Chen #  3 , Jiahong Ye  2 , Zihan Tang  2 , Yicong Fang  1 , Kaiyuan Yao  1 , Qunzhang Zeng  1 , Yugang Yang  1 , Haiwen Tang  1 , Bijuan Lin  1 , Yincong Guo  4 , Ying Huang  5
Affiliations

A nomogram for predicting good response after neoadjuvant chemoradiotherapy for locally advanced rectal cancer: a retrospective, double-center, cohort study

Guancong Wang et al. Int J Colorectal Dis. 2022 Oct.

Abstract

Aim: The purpose of this study was to explore the clinical factors associated with achieving good response after neoadjuvant chemoradiotherapy (nCRT) in patients with locally advanced rectal cancer (LARC) and to develop and validate a nomogram.

Methods: A total of 1724 consecutive LARC patients treated at Fujian Medical University Union Hospital from January 2010 to December 2021 were retrospectively evaluated as the training cohort; 267 consecutive LARC patients treated at Zhangzhou Affiliated Hospital of Fujian Medical University during the same period were evaluated as the external 2 cohorts. Based on the pathological results after radical surgery, treatment response was defined as follows: good response, stage ypT0∼2N0M0 and poor response, ypT3∼4N0M0 and/or N positive. Independent influencing factors were analyzed by logistic regression, a nomogram was developed and validated, and the model was evaluated using internal and external data cohorts for validation.

Results: In the training cohort, 46.6% of patients achieved good response after nCRT combined with radical surgery. The rate of the retained anus was higher in the good response group (93.5% vs. 90.7%, P < 0.001). Cox regression analysis showed that the risk of overall survival and disease-free survival was significantly lower among good response patients than poor response patients, HR = 0.204 (95%CI: 0.146-0.287). Multivariate logistic regression analysis showed an independent association with 9 clinical factors, including histopathology, and a nomogram with an excellent predictive response was developed accordingly. The C-index of the predictive accuracy of the nomogram was 0.764 (95%CI: 0.742-0.786), the internal validation of the 200 bootstrap replication mean C-index was 0.764, and the external validation cohort showed an accuracy C-index of 0.789 (95%CI: 0.734-0.844), with good accuracy of the model.

Conclusion: We identified factors associated with achieving good response in LARC after treatment with nCRT and developed a nomogram to contribute to clinical decision-making.

Keywords: Good response; Locally advanced rectal cancer; Neoadjuvant chemoradiotherapy; Nomogram.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Survival curve plots of overall survival (A) and disease-free survival (B) for patients with good vs. poor response after nCRT for locally advanced rectal cancer in the training cohort
Fig. 2
Fig. 2
Nomogram for predicting good tumor response after neoadjuvant chemoradiotherapy for locally advanced rectal cancer
Fig. 3
Fig. 3
Area under the curve (AUC) for the training cohort (A) and external validation cohort (B) for good response
Fig. 4
Fig. 4
Calibration plots for the training cohort (A) and external validation cohort (B) for good response. The solid line represents the performance of the present nomogram, and the dashed line represents the performance of an ideal nomogram
Fig. 5
Fig. 5
Decision curve analysis for the training cohort (A) and external validation cohort (B) for good response. All points are located above the None and All lines
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Wiegering A, Isbert C, Dietz UA, et al. Multimodal therapy in treatment of rectal cancer is associated with improved survival and reduced local recurrence - a retrospective analysis over two decades. BMC Cancer. 2014;14:816. doi: 10.1186/1471-2407-14-816. - DOI - PMC - PubMed
    1. Benson AB, Venook AP, Al-Hawary MM, et al. Rectal cancer, version 2.2018, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2018;16(7):874–901. doi: 10.6004/jnccn.2018.0061. - DOI - PMC - PubMed
    1. Pang X, Gao Y, Yi H, Liu H, Liu S, Zheng J. Associations between clinical characteristics and tumor response to neoadjuvant chemoradiotherapy in rectal cancer. Cancer Med. 2021;10(14):4832–4843. doi: 10.1002/cam4.4051. - DOI - PMC - PubMed
    1. Lee L, Kelly J, Nassif GJ, et al. Chemoradiation and local excision for T2N0 rectal cancer offers equivalent overall survival compared to standard resection: a national cancer database analysis. J Gastrointest Surg. 2017;21(10):1666–1674. doi: 10.1007/s11605-017-3536-5. - DOI - PubMed
    1. Del Carmen S, Corchete LA, González Velasco C, et al. High-risk clinicopathological and genetic features and outcomes in patients receiving neoadjuvant radiochemotherapy for locally advanced rectal cancer. Cancers (Basel). 2021;13:3166. doi: 10.3390/cancers13133166. - DOI - PMC - PubMed

LinkOut - more resources