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Development and validation of neoadjuvant rectal score-based signature nomograms to predict overall survival and disease-free survival in locally advanced rectal cancer: a retrospective, double center, cohort study

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Abstract

Aim

To evaluate the prognostic significance of the NAR score and develop nomograms for locally advanced rectal cancer (LARC) treated after neoadjuvant chemo-radiotherapy (nCRT) combined with total meso-rectal excision (TME) surgery to predict prognostic.

Methods

Retrospective collection among LARC patients treated at Fujian Medical University Union Hospital (training cohort) and Fujian Medical University Affiliated Zhangzhou Hospital (external validation cohort) between Jan 10, 2011 and Dec 28, 2021. The NAR score was calculated by formula: [5pN-3(cT-pT) + 12]^2/9.61. NAR score low (< 8), intermediate (8–16), and high (> 16).

Results

1665 patients in the training cohort and 256 patients in the external validation cohorts were enrolled. Lower NAR score was significantly associated with better cumulative incidence of OS, DFS, local recurrence (LR), and distant metastasis (DM) (all P < 0.001). Multivariate Cox regression analysis indicates that NAR score, distance to the anal verge, no.253 LN metastasis, post-CRT carbohydrate antigen 19–9, tumor regression grade, and surgery method are independent predictors of OS and DFS (all P < 0.001). Among these independent factors, the NAR score had the highest area under the curve (AUC) and the nomograms to predict OS and DFS were generated. The AUCs for the accuracy of the prediction OS were 1 year = 0.742, 3 years = 0.749, 5 years = 0.713; prediction DFS were 1 year = 0.727, 3 years = 0.739, 5 years = 0.718, the models have good accuracy.

Conclusions

The NAR score can effectively classify patients with LARC into groups with varying outcomes of OS, DFS, LR, and DM. Moreover, the novel nomograms comprising the NAR score were developed and validated to help predict OS and DFS.

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Data availability

All data obtained or analyzed during this work are included within the article.

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Acknowledgements

The authors thank all foundations for their support.

Funding

This study was supported by the Startup Fund for Scientific Research, Fujian Medical University (grant number: 2019QH1276); Natural Science Foundation of Fujian Province (2020J011030); Medical Science Research Foundation of Beijing Medical and Health Foundation (B20062DS); Fujian provincial health technology project (2020CXA025); Bethune Charitable Foundation (X-J-2018-004); Joint Funds for the innovation of science and Technology, Fujian province (2020Y9071).

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Author notes

  1. Guancong Wang, Jiahong Ye, Zihan Tang, and Haiwen Tang contributed equally to this work and should be considered co-first authors.

Authors and Affiliations

  1. Department of Colorectal and Anal Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, 363000, China

    Guancong Wang, Haiwen Tang, Kaiyuan Yao, Qunzhang Zeng, Yugang Yang, Muhai Fu, Lixiong Luo, Qiyuan Shen, Xun Fang, Bijuan Ling, Yicong Fang & Yincong Guo

  2. Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China

    Zihan Tang, Jiahong Ye & Ying Huang

Authors
  1. Guancong Wang
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Contributions

Protocol/project development: GW, YH, YG; Data collection or management: JY, ZT, HT, BL, XF, LL, MF, QS; Data analysis: GW, YF, KY, QZ, YY; Manuscript writing/editing: GW. Other: YH, YG and YF contributed equally to this work as co-corresponding author; GW, JY, ZT and HT contributed equally to this work and should be considered co-first authors. All authors reviewed the manuscript.

Corresponding authors

Correspondence to Yicong Fang, Yincong Guo or Ying Huang.

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The authors declare no competing interests. The authors have no conflicts of interest related to this study.

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Wang, G., Tang, Z., Ye, J. et al. Development and validation of neoadjuvant rectal score-based signature nomograms to predict overall survival and disease-free survival in locally advanced rectal cancer: a retrospective, double center, cohort study. Int J Clin Oncol 28, 268–279 (2023). https://doi.org/10.1007/s10147-022-02281-y

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