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. 2020 Feb 8;8(3):234-241.
doi: 10.1093/gastro/goz073. eCollection 2020 Jun.

Nomogram for predicting pathological complete response and tumor downstaging in patients with locally advanced rectal cancer on the basis of a randomized clinical trial

Jian-Wei Zhang  1   2 , Yue Cai  1   2 , Xiao-Yu Xie  1   2 , Hua-Bin Hu  1   2 , Jia-Yu Ling  1   2 , Ze-Hua Wu  1   2 , Ping Lan  2   3 , Xiao-Jian Wu  2   3 , Mei-Jin Huang  2   3 , Hui Wang  2   3 , Liang Kang  2   3 , Zhi-Yang Zhou  2   4 , Jian-Ping Wang  2   3 , Yan-Hong Deng  1   2
Affiliations

Nomogram for predicting pathological complete response and tumor downstaging in patients with locally advanced rectal cancer on the basis of a randomized clinical trial

Jian-Wei Zhang et al. Gastroenterol Rep (Oxf). .

Abstract

Background: Preoperative fluoropyrimidine with radiotherapy was regarded as the standard of care for locally advanced rectal cancer (LARC). The model for predicting pCR in LARC patients was based on standard treatment only. This study aimed to establish a nomogram with pretherapeutic parameters and different neoadjuvant regimens for predicting pathologic complete response (pCR) and tumor downstaging or good response (ypT0-2N0M0) after receiving neoadjuvant treatment in patients with LARC based on a randomized clinical trial.

Methods: Between January 2011 and February 2015, 309 patients with rectal cancer were enrolled from a prospective randomized study (NCT01211210). All pretreatment clinical parameters were collected to build a nomogram for predicting pCR and tumor downstaging. The model was subjected to bootstrap internal validation. The predictive performance of the model was assessed with concordance index (C-index) and calibration plots.

Results: Of the 309 patients, 53 (17.2%) achieved pCR and 132 (42.7%) patients were classified as tumor downstaging with ypT0-2N0M0. Based on the logistic-regression analysis and clinical consideration, tumor length (P = 0.005), tumor circumferential extent (P = 0.036), distance from the anal verge (P = 0.019), and neoadjuvant treatment regimen (P < 0.001) showed independent association with pCR following neoadjuvant treatment. The tumor length (P = 0.015), tumor circumferential extent (P = 0.001), distance from the anal verge (P = 0.032), clinical T category (P = 0.012), and neoadjuvant treatment regimen (P = 0.001) were significantly associated with good tumor downstaging (ypT0-2N0M0). Nomograms were developed to predict the probability of pCR and tumor downstaging with a C-index of 0.802 (95% confidential interval [CI], 0.736-0.867) and 0.730 (95% CI, 0.672-0.784). Internal validation revealed good performance of the calibration plots.

Conclusions: The nomogram provided individual prediction responses to different preoperative treatment for patients with rectal cancer. This model might help physicians in selecting an optimized treatment, but warrants further external validation.

Keywords: locally advanced rectal cancer; nomogram; pathological complete response; tumor downstaging.

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Figures

Figure 1.
Figure 1.
Nomogram for pathological complete response (pCR) prediction. A score for each predictor can be read out at the top scale (score). All summed scores can be converted directly to the probability of response.
Figure 2.
Figure 2.
Nomogram for good response prediction. A score for each predictor can be read out at the top scale (score). All summed scores can be converted directly to the probability of response.
Figure 3.
Figure 3.
Calibration plots of the predicted and observed probabilities of pathological complete response (pCR) and good response (ypT0-2N0M0). (A) The prediction calculated using the nomograms is plotted on the x-axis and the observed rate of pCR is plotted on the y-axis. (B) The prediction calculated using the nomograms is plotted on the x-axis and the observed rate of tumor downstaging is plotted on the y-axis.
See this image and copyright information in PMC

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