Comparison of the value of two scores for predicting prognosis in patients with locally advanced rectal cancer undergoing concurrent chemoradiotherapy plus surgery
Chen Silin1, Tang Yuan1, Li Ning1,2, Jiang Liming3, Jiang Jun3, Wang Shulian1, Song Yongwen1, Liu Yueping1, Fang Hui1, Lu Ningning1, Qi Shunan1, Chen Bo1, Li Yexiong1, Jin Jing1,2
1Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China; 2Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, China; 3Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Abstract：Objective To evaluate the prognostic significance of neoadjuvant rectal (NAR) score and downstaging depth score (DDS) after neoadjuvant chemoradiotherapy (nCRT) for locally advanced rectal cancer (LARC). Methods Retrospective analysis was performed for 200 patients with LARC (T3-T4 and/or N1-N2,M0), who were initially treated in the Cancer Hospital of Chinese Academy of Medical Sciences from 2015 to 2018. All patients had baseline MRI data and received preoperative nCRT and radical resection. All patients received preoperative radiotherapy with a dose of 45-50Gy combined with concurrent capecitabine. The effect of NAR and DDS scores on clinical prognosis was statistically compared. The 3-year disease-free survival (DFS) was calculated using the Kaplan-Meier method and compared by the log-rank test. Cox proportional hazards model was used to perform multivariate survival analysis. The predictive performance for 3-year DFS was calculated using the receiver operating characteristic (ROC) curve. Results The median follow-up time was 30.5(10.6-54.0) months. In terms of DDS, the 3-year DFS rate was 56.4% in the DDS ≤0 group, significantly lower than 83.0% in the DDS >0 group (P=0.002). In terms of NAR score, the 3-year DFS rates were 90.1%, 73.8% and 53.6% in NAR score ≤8, 8-16 and>16 groups, respectively (P<0.001). In the whole cohort, the area under the ROC curve (AUC) of DDS and NAR scores for predicting 3-year DFS were 0.683 and 0.756(P=0.037). In yp0-I stage patients (n=72), the AUC of DDS and NAR scores for predicting 3-year DFS were 0.762 and 0.569(P=0.032). Conclusions High DDS and low NAR scores after nCRT indicate good prognosis for patients with LARC. NAR score yields better accuracy than DDS in predicting clinical prognosis, but DDS is significantly better than NAR score in yp0-I stage population.
Chen Silin,Tang Yuan,Li Ning et al. Comparison of the value of two scores for predicting prognosis in patients with locally advanced rectal cancer undergoing concurrent chemoradiotherapy plus surgery[J]. Chinese Journal of Radiation Oncology, 2021, 30(6): 563-568.
[1] Network NCC. Clinical practice guidelines in oncology. Rectal cancer, version 6.2020[DB/OL][2020-10-20]. https://www.nccn.org/professionals/physician_gls/pdf/rectal.pdf, 2020. [2] Park IJ, You YN, Skibber JM, et al. Comparative analysis of lymph node metastases in patients with ypT0-2 rectal cancers after neoadjuvant chemoradiotherapy[J]. Dis Colon Rectum, 2013, 56(2):135-141.DOI:10.1097/DCR.0b013e318278ff8a. [3] Duchalais E, Glyn Mullaney T, Spears GM, et al. Prognostic value of pathological node status after neoadjuvant radiotherapy for rectal cancer[J]. Br J Surg, 2018, 105(11):1501-1509. DOI:10.1002/bjs.10867. [4] George TJ Jr, Allegra CJ, Yothers G. Neoadjuvant rectal (nar) score:a new surrogate endpoint in rectal cancer clinical trials[J]. Curr Colorect Cancer Rep, 2015, 11(5):275-280.DOI:10.1007/s11888-015-0285-2. [5] 李宁,金晶,余静,等. 术前同期放化疗后yp0-Ⅰ期直肠癌预后分析[J]. 中华放射肿瘤学杂志, 2017, 26(3):296-301.DOI:10.3760/cma.j.issn.1004?4221.2017.03.010. Li N, Jin J, Yu J, et al. Prognosis analysis of rectal cancer after yp0-Ⅰ radiotherapy and chemotherapy before operation[J]. Chin J Radiat Oncol, 2017, 26(3):296-301.DOI:10.3760/cma.j.issn.1004?4221.2017.03.010. [6] Rödel C, Graeven U, Fietkau R, et al. Oxaliplatin added to fluorouracil-based preoperative chemoradiotherapy and postoperative chemotherapy of locally advanced rectal cancer (the German CAO/ARO/AIO-04study):final results of the multicentre, open-label, randomised, phase 3 trial[J]. Lancet Oncol, 2015, 16(8):979-989. DOI:10.1016/s1470-2045(15)00159-x. [7] Li N, Jin J, Yu J, et al. Down-staging depth score to predict outcomes in locally advanced rectal cancer achieving ypI stage after neoadjuvant chemo-radiotherapy versus de novo stage pI cohort:A propensity score-matched analysis[J]. Chin J Cancer Res, 2018, 30(3):373-381.DOI:10.21147/j.issn.1000-9604.2018.03.09. [8] Beets-Tan RGH, Lambregts DMJ, Maas M. Magnetic resonance imaging for clinical management of rectal cancer:Updated recommendations from the 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting[J]. Eur Radiol, 2018, 28. DOI:10.1007/s00330-017-5026-2. [9] Stephen E, David RB, Carolyn C, et al. AJCC cancer staging handbook:from the AJCC cancer staging manual (7th ed)[B]. Springer-Verlag New York, 2010, 978-0-387-88442-4. [10] Roels S, Duthoy W, Haustermans K, et al. Definition and delineation of the clinical target volume for rectal cancer[J]. Int J Radiat Oncol Biol Phys, 2006, 65(4):1129-1142. DOI:10.1016/j.ijrobp.2006.02.050. [11] Washington MK, Berlin J, Branton P, et al. Protocol for the examination of specimens from patients with primary carcinoma of the colon and rectum[J]. Arch Pathol Lab Med, 2009, 133(10):1539-1551.DOI:10.1043/1543-2165-133.10.1539. [12] Boyle KM, Sagar PM, Chalmers AG, et al. Surgery for locally recurrent rectal cancer[J]. Dis Colon Rectum, 2005, 48(5):929-937.DOI:10.1007/s10350-004-0909-0 [13] Glynne-Jones R, Wyrwicz L, Tiret E, et al. Rectal cancer:ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up[J]. Ann Oncol, 2018, 29(Suppl 4):iv263.DOI:10.1093/annonc/mdy161. [14] 肖琴,金晶,李晔雄,等. 局部晚期中低位直肠癌奥沙利铂联合卡培他滨术前同期放化疗的疗效分析[J]. 中华放射肿瘤学杂志, 2014, 23(2):99-103.DOI:10.3760/cma.j.issn.1004-4221.2014.02.005. Xiao Q, Jin J, Li YX, et al. Analysis of the efficacy of oxaliplatin combined with capecitabine in concurrent radiotherapy and chemotherapy for locally advanced middle and low rectal cancer[J]. Chin J Radiat Oncol, 2014, 23(2):99-103.DOI:10.3760/cma.j.issn.1004-4221.2014.02.005. [15] Valentini V, van Stiphout RG, Lammering G, et al. 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[J]. J Clin Oncol, 2011, 29(23):3163-3172. DOI:10.1200/jco.2010.33.1595. [16] Sun Y, Zhang Y, Wu X, et al. Prognostic significance of neoadjuvant rectal score in locally advanced rectal cancer after neoadjuvant chemoradiotherapy and construction of a prediction model[J]. J Surg Oncol, 2018, 117(4):737-744.DOI:10.1002/jso.24907. [17] Mansmann UR, Laubender RP. Methodologic diligence is needed to define and validate tumor-size response metrics to predict overall survival in first-line metastatic colorectal cancer[J]. J Clin Oncol, 2013, 31(34):4373-4374.DOI:10.1200/jco.2013.51.2954. [18] Piessevaux H, Buyse M, De Roock W, et al. Radiological tumor size decrease at week 6 is a potent predictor of outcome in chemorefractory metastatic colorectal cancer treated with cetuximab (BOND trial)[J]. Ann Oncol, 2009, 20(8):1375-1382. DOI:10.1093/annonc/mdp011. [19] Kulinna C, Scheidler J, Strauss T, et al. Local staging of rectal cancer:assessment with double-contrast multislice computed tomography and transrectal ultrasound[J]. J Comput Assist Tomogr, 2004, 28(1):123-130.DOI:10.1097/00004728-200401000-00021. [20] Lambregts DM, Maas M, Riedl RG, et al. Value of ADC measurements for nodal staging after chemoradiation in locally advanced rectal cancer-a per lesion validation study[J]. Eur Radiol, 2011, 21(2):265-273.DOI:10.1007/s00330-010-1937-x. [21] Sargent DJ, Wieand HS, Haller DG, et al. Disease-free survival versus overall survival as a primary end point for adjuvant colon cancer studies:individual patient data from 20,898 patients on 18 randomized trials[J]. J Clin Oncol, 2005, 23(34):8664-8670.DOI:10.1200/jco.2005.01.6071. [22] Yothers G, George TJ, Allegra CJ, et al. Predictive validity of neoadjuvant rectal (NAR) score and pathologic complete response (ypCR) for overall survival (OS) as surrogate endpoints in rectal cancer clinical trial[J]. J Clin Oncol, 2016, 34(15suppl):3533-3533.DOI:10.1200/JCO.2016.34.15_suppl.3533. [23] Maeda K, Shibutani M, Tachimori A, et al. Prognostic significance of neoadjuvant rectal score and indication for postoperative adjuvant therapy in rectal cancer patients after neoadjuvant chemoradiotherapy[J]. in vivo, 2020, 34(1):283-289. DOI:10.21873/invivo.11772. [24] Bregni G, Akin Telli T, Camera S, et al. Adjuvant chemotherapy for rectal cancer:Current evidence and recommendations for clinical practice[J]. Cancer Treat Rev, 2020, 83:101948. DOI:10.1016/j.ctrv.2019.101948.
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