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PLoS One. 2014 Aug 29;9(8):e106344. doi: 10.1371/journal.pone.0106344. eCollection 2014.

Prognostic nomograms for predicting survival and distant metastases in locally advanced rectal cancers.

Author information

1
Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
2
Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America.
3
Department of Statistics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America.
4
School of Science and Technology, Georgia Gwinnett College, Atlanta, Georgia, United States of America.

Abstract

AIM:

To develop prognostic nomograms for predicting outcomes in patients with locally advanced rectal cancers who do not receive preoperative treatment.

MATERIALS AND METHODS:

A total of 883 patients with stage II-III rectal cancers were retrospectively collected from a single institution. Survival analyses were performed to assess each variable for overall survival (OS), local recurrence (LR) and distant metastases (DM). Cox models were performed to develop a predictive model for each endpoint. The performance of model prediction was validated by cross validation and on an independent group of patients.

RESULTS:

The 5-year LR, DM and OS rates were 22.3%, 32.7% and 63.8%, respectively. Two prognostic nomograms were successfully developed to predict 5-year OS and DM-free survival rates, with c-index of 0.70 (95% CI = [0.66, 0.73]) and 0.68 (95% CI = [0.64, 0.72]) on the original dataset, and 0.76 (95% CI = [0.67, 0.86]) and 0.73 (95% CI = [0.63, 0.83]) on the validation dataset, respectively. Factors in our models included age, gender, carcinoembryonic antigen value, tumor location, T stage, N stage, metastatic lymph nodes ratio, adjuvant chemotherapy and chemoradiotherapy. Predicted by our nomogram, substantial variability in terms of 5-year OS and DM-free survival was observed within each TNM stage category.

CONCLUSIONS:

The prognostic nomograms integrated demographic and clinicopathological factors to account for tumor and patient heterogeneity, and thereby provided a more individualized outcome prognostication. Our individualized prediction nomograms could help patients with preoperatively under-staged rectal cancer about their postoperative treatment strategies and follow-up protocols.

PMID:
25171093
PMCID:
PMC4149564
DOI:
10.1371/journal.pone.0106344
[Indexed for MEDLINE]
Free PMC Article

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