title: 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.
abstract: OBJECTIVE
  The purpose of this study was to develop accurate models and nomograms to predict local recurrence, distant metastases, and survival for patients with locally advanced rectal cancer treated with long-course chemoradiotherapy (CRT) followed by surgery and to allow for a selection of patients who may benefit most from postoperative adjuvant chemotherapy and close follow-up.
  
  
  METHODS
  All data (N = 2,795) from five major European clinical trials for rectal cancer were pooled and used to perform an extensive survival analysis and to develop multivariate nomograms based on Cox regression. Data from one trial was used as an external validation set. The variables used in the analysis were sex, age, clinical tumor stage stage, tumor location, radiotherapy dose, concurrent and adjuvant chemotherapy, surgery procedure, and pTNM stage. Model performance was evaluated by the concordance index (c-index). Risk group stratification was proposed for the nomograms.
  
  
  RESULTS
  The nomograms are able to predict events with a c-index for external validation of local recurrence (LR; 0.68), distant metastases (DM; 0.73), and overall survival (OS; 0.70). Pathologic staging is essential for accurate prediction of long-term outcome. Both preoperative CRT and adjuvant chemotherapy have an added value when predicting LR, DM, and OS rates. The stratification in risk groups allows significant distinction between Kaplan-Meier curves for outcome.
  
  
  CONCLUSIONS
  The easy-to-use nomograms can predict LR, DM, and OS over a 5-year period after surgery. They may be used as decision support tools in future trials by using the three defined risk groups to select patients for postoperative chemotherapy and close follow-up (http://www.predictcancer.org).
authors: Università Cattolica S. Cuore, Rome.
authors: Vincenzo
authors: V
authors: Valentini
authors: Ruud G P M
authors: RG
authors: van Stiphout
authors: Guido
authors: G
authors: Lammering
authors: Maria Antonietta
authors: MA
authors: Gambacorta
authors: Maria Cristina
authors: MC
authors: Barba
authors: Marek
authors: M
authors: Bebenek
authors: Franck
authors: F
authors: Bonnetain
authors: Jean-Francois
authors: JF
authors: Bosset
authors: Krzysztof
authors: K
authors: Bujko
authors: Luca
authors: L
authors: Cionini
authors: Jean-Pierre
authors: JP
authors: Gerard
authors: Claus
authors: C
authors: Rödel
authors: Aldo
authors: A
authors: Sainato
authors: Rolf
authors: R
authors: Sauer
authors: Bruce D
authors: BD
authors: Minsky
authors: Laurence
authors: L
authors: Collette
authors: Philippe
authors: P
authors: Lambin
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D005060:Europe; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology; D016032:Randomized Controlled Trials as Topic; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology*; D012737:Sex Factors