Nomogram basing pre-treatment parameters predicting early response for locally advanced rectal cancer with neoadjuvant chemotherapy alone: a subgroup efficacy analysis of FOWARC study

Jianwei Zhang, Yue Cai, Huabin Hu, Ping Lan, Lei Wang, Meijin Huang, Liang Kang, Xiaojian Wu, Hui Wang, Jiayu Ling, Jian Xiao, Jianping Wang, Yanhong Deng, Jianwei Zhang, Yue Cai, Huabin Hu, Ping Lan, Lei Wang, Meijin Huang, Liang Kang, Xiaojian Wu, Hui Wang, Jiayu Ling, Jian Xiao, Jianping Wang, Yanhong Deng

Abstract

Objective: To develop an accurate model with pre-treatment parameters to predict tumor regression and down-staging in locally advanced rectal cancer patients, basing the cohort of preoperative chemotherapy alone in FOWARC study.

Patients and methods: From Jan 2011 to Feb 2015, complete data was available for 137 out of 165 patients who received preoperative chemotherapy alone. All pre-treatment clinical parameters were collected. Tumor regression grade (TRG) 0-1 was defined as good regression, and pathological TNM stage (ypTNM) 0-I after neoadjuvant treatment was defined as good down-staging. Nomogram was established to predict tumor regression and down-staging. The predictive performance of the model was assessed with concordance index and calibration plots.

Results: Of the 137 patients, 10 had TRG 0 (complete regression); 32 patients, TRG 1; and 95 patients, TRG 2 and 3 (poor regression); 56 (40.9%) patients were classified as good down-staging with ypTNM stage 0-I. The predictive nomograms were developed to predict the probability of TRG 0-1 and good down-staging with a C-index of 0.72 (95% CI: 0.604-0.797) and 0.76 (95% CI: 0.681-0.844). Calibration plots showed good statistical performance on internal validation. Predictive factors in the models included tumor length, tumor circumferential extent, age, and ApoA1.

Conclusions: The model based on available clinical parameters could accurately predict early efficacy with neoadjuvant mFOLFOX6 chemotherapy alone, which might help in patient selection for optimized treatment.

Keywords: neoadjuvant chemotherapy; nomogram; predictive; rectal cancer.

Conflict of interest statement

CONFLICTS OF INTEREST

The authors state that they have no conflicts of interest.

Figures

Figure 1. Nomogram for good regression prediction
Figure 1. Nomogram for good regression 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. Nomogram for good down-staging prediction
Figure 2. Nomogram for good down-staging 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. Calibration plot of the predicted…
Figure 3. Calibration plot of the predicted and observed probabilities of regression to TRG 0-1
The prediction calculated using the nomograms were plotted on the X-axis, and the observed rate of regression and down-staging is plotted on the Y-axis.
Figure 4. Calibration plot of the predicted…
Figure 4. Calibration plot of the predicted and observed probabilities of regression to down-staging to ypStage 0-I
The prediction calculated using the nomograms were plotted on the X-axis, and the observed rate of regression and down-staging is plotted on the Y-axis.

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