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BMI May Be a Prognostic Factor for Local Advanced Rectal Cancer Patients Treated with Long-Term Neoadjuvant
Hengchang Liu1, Ran Wei1, Chunxiang Li2
1Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, People's Republic of China.
This study developed nomograms to predict survival for locally advanced rectal cancer (LARC) patients after neoadjuvant chemoradiotherapy (nCRT) and surgery. Key predictors include BMI, CA19-9, ypStage, neural invasion, age, and adjuvant chemotherapy.
Area of Science:
- Oncology
- Surgical Oncology
- Radiotherapy Oncology
Background:
- Locally advanced rectal cancer (LARC) requires multimodal treatment, including neoadjuvant chemoradiotherapy (nCRT) and surgery.
- Accurate prediction of overall survival (OS) and cancer-specific survival (CSS) is crucial for treatment planning and patient management.
- Existing prognostic models may not fully capture the complexity of outcomes in LARC patients treated with nCRT and total mesorectal excision (TME).
Purpose of the Study:
- To develop and validate nomograms for predicting OS and CSS in LARC patients.
- To identify independent prognostic factors influencing survival after nCRT and TME.
- To provide a tool for personalized risk assessment and treatment stratification.
Main Methods:
- Retrospective analysis of 243 LARC patients who underwent nCRT followed by TME.
- Collection of preoperative clinical and postoperative pathological data.
- Application of Cox regression analysis to identify predictors and develop nomograms for OS and CSS.
- Assessment of nomogram performance using concordance index and calibration plots.
Main Results:
- Low BMI (< 18.5), high preoperative CA19-9, high ypStage, positive neural invasion, and lack of adjuvant chemotherapy were associated with poor OS.
- Predictors of poor CSS included age ≥70, low BMI, positive preoperative CA19-9, high ypStage, and positive neural invasion.
- Developed nomograms demonstrated good predictive performance with C-indices of 0.837 for OS and 0.760 for CSS, confirmed by calibration plots.
Conclusions:
- Body Mass Index (BMI) is a significant independent prognostic factor for both OS and CSS in LARC patients.
- The developed nomogram, incorporating BMI, neural invasion, preoperative CA19-9, ypStage, age, and adjuvant chemotherapy, can aid in predicting survival.
- These nomograms offer a valuable tool for risk stratification and personalized management of LARC patients.
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