Purpose: There is substantial evidence evaluating the clinical efficacy of adjuvant chemotherapy (AC) for rectal cancer patients staged at ypN+ and ypT0-2N0, but few studies focus on those staged at ypT3-4N0. Methods: Data were collected from the Surveillance, Epidemiology and End Results (SEER) database from January 2011 to December 2015. Stabilized inverse probability of treatment weighting (sIPTW) was adopted to balance the baseline clinicopathological characteristics of ypT3-4N0 patients receiving AC or not. A risk score was established to predict the prognosis in terms of overall survival (OS) and identify who would be the beneficiary of AC. Results: A total of 920 patients staged at ypT3-4N0 were eligible, including 311 patients (33.8%) receiving AC. No significant difference was observed in OS between patients receiving AC or not before and after sIPTW (both P>0.05). The current risk score exhibited better discrimination power and overall net benefit than the 8th AJCC staging system, as well as improved prediction power. Based on the risk score, patients were divided into high- and low-risk subgroups, and only the high-risk subgroup was found to benefit from AC (P<0.05). Lastly, the risk score was validated by 100 consecutive patients from Fujian Cancer Hospital, and the advantage of AC was also confirmed in the high-risk subgroup. Conclusion: In this study, we proposed a risk-adapted and readily accessible risk score to guide the management of AC in ypT3-4N0 patients. According to the risk score, high-risk patients should be routinely recommended AC.
Background: Perineural invasion (PNI) is one of the aggressive characteristics of rectal cancer (RC), but there have been none studies evaluating the clinical efficacy of radiotherapy (RT) on rectal cancer with PNI. Methods: Data on RC patients staged at II/III were extracted from the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2014 to verify the clinical significance of PNI. The primary outcome wre overall survival (OS) and cancer specific survival (CSS). A nomogram was established to predict the prognosis of PNI patients using SEER database and validated by Fujian Cancer Hospital. Kaplan-Meier curve was conducted to investigate the overall survival (OS) between groups. Results: 1596 patients receiving direct surgery and adjuvant chemotherapy were eligible for this study, including 288 patients (18.0%) were present with PNI. PNI was found to be independently associated with OS and CSS after adjusting for age, sex, stage, pathological factors, and treatment factors (all p < 0.05). A nomogram was established to predict the prognosis of PNI patients with high C-index, and then validated by 98 patients from FJCH. And then patients in the high-risk subgroup were found to be benefited from adjuvant RT according to the current nomogram (P<0.05), but not those in the low-risk subgroup (P>0.05). Conclusions: PNI was confirmed to be an independnet prognosis factor of RC patients, and it should also taken into consideration of the postoperative management of RC.
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