title: Nomograms to predict survival and the risk for developing local or distant recurrence in patients with rectal cancer treated with optional short-term radiotherapy.
abstract: BACKGROUND
  In many European countries, short-term 5 × 5 Gy radiotherapy has become the standard preoperative treatment of patients with resectable rectal cancer. Individualized risk assessment might allow a better selection of patients who will benefit from postoperative treatment and intensified follow-up.
  
  
  METHODS
  From patient's data from three European rectal cancer trials (N = 2881), we developed multivariate cox nomograms reflecting the risk for local recurrence (LR), distant metastases (DM) and overall survival (OS). Evaluated variables were age, gender, tumour distance from the anal verge, the use of radiotherapy, surgical technique (total mesorectal excision/conventional surgery), surgery type (low anterior resection/abdominoperineal resection), time from randomization to surgery, residual disease (R0 versus R1 + 2), pT-stage, pN-stage and surgical complications.
  
  
  RESULTS
  Pathological T- and N-status are of vital importance for an accurate prediction of LR, DM and OS. Short-course radiotherapy reduces the rate of LR. The developed nomograms are capable of predicting events with a validation c-index of 0.79 (LR), 0.76 (DM) and 0.75 (OS). The proposed stratification in risk groups allowed significant distinction between Kaplan-Meier curves for outcome.
  
  
  CONCLUSIONS
  The developed nomograms can contribute to better individual risk prediction for LR, DM and OS for patients operated on rectal cancer. The practicality of the defined risk groups makes decision support in the consulting room feasible, assisting physicians to select patients for adjuvant therapy or intensified follow-up.
authors.affiliation: Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: willem@vangijn.com.
authors.forename: W
authors.initials: W
authors.lastname: van Gijn
authors.affiliation: Department of Radiation Oncology (MAASTRO), GROW, University Medical Centre Maastricht, Maastricht; Department of Knowledge Engineering, Faculty of Humanities and Sciences, Maastricht University, Maastricht, The Netherlands.
authors.forename: R G P M
authors.initials: RGPM
authors.lastname: van Stiphout
authors.affiliation: Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: C J H
authors.initials: CJH
authors.lastname: van de Velde
authors.affiliation: Radiation Oncology Department, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Valentini
authors.affiliation: Department of Radiation Oncology (MAASTRO), GROW, University Medical Centre Maastricht, Maastricht.
authors.forename: G
authors.initials: G
authors.lastname: Lammering
authors.affiliation: Radiation Oncology Department, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: M A
authors.initials: MA
authors.lastname: Gambacorta
authors.affiliation: Department of Surgical Science, Uppsala University, Uppsala, Sweden.
authors.forename: L
authors.initials: L
authors.lastname: Påhlman
authors.affiliation: Department of Radiotherapy, The Maria Sklodowska-Curie Memorial Cancer Centre, Warsaw, Poland.
authors.forename: K
authors.initials: K
authors.lastname: Bujko
authors.affiliation: Department of Radiation Oncology (MAASTRO), GROW, University Medical Centre Maastricht, Maastricht.
authors.forename: P
authors.initials: P
authors.lastname: Lambin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003661:Decision Support Techniques; D005060:Europe; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy / Q000009:adverse effects / Q000401:mortality; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D049451:Nomograms; D018579:Patient Selection; D016016:Proportional Hazards Models; D011829:Radiation Dosage; D018714:Radiotherapy, Adjuvant; D016032:Randomized Controlled Trials as Topic; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: local recurrence; metastases; nomogram; prediction; rectal cancer; short-term radiotherapy