Ren DL, Li J, Yu HC, Peng SY, Lin WD, Wang XL, Ghoorun RA, Luo YX. Nomograms for predicting pathological response to neoadjuvant treatments in patients with rectal cancer. World J Gastroenterol 2019; 25(1): 118-137 [PMID: 30643363 DOI: 10.3748/wjg.v25.i1.118]
Corresponding Author of This Article
Yan-Xin Luo, MD, PhD, Associate Professor, Chief Doctor, Surgical Oncologist, Department of Colorectal Surgery, Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, 26 Yuancun Erheng Road, Tianhe District, Guangzhou 510655, Guangdong Province, China. luoyx25@mail.sysu.edu.cn
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Jan 7, 2019; 25(1): 118-137 Published online Jan 7, 2019. doi: 10.3748/wjg.v25.i1.118
Table 1 Predictive factors for complete pathological response in univariate logistic regression analysis for all patients
Variable
Non-pCR (n = 331) n P50 (P25-P75)
pCR (n = 72) n P50 (P25-P75)
pCR rate
P-value
Gender
Male
232
49
17.44%
0.653
Female
96
23
19.33%
Age (yr)
≤ 60
210
54
20.45%
0.07
> 60
119
18
13.14%
BMI (kg/cm2)
< 25
231
53
18.66%
0.581
≥ 25
78
15
16.13%
Hemoglobin (g/L)
≤ 125
109
16
12.80%
0.126
> 125
172
41
19.25%
NLR
> 3
37
11
22.92%
0.227
≤ 3
244
46
15.86%
Platelet (× 109/L)
237.5 (200.25-286.75)
246 (200.5-268.5)
0.981
ApoA1 (g/L)
1.29 (1.13-1.44)
1.3 (1.15-1.52)
0.454
ApoB (g/L)
0.98 (0.79-1.14)
0.97 (0.82-1.19)
0.382
The interval (d)
39 (22.25-54)
50 (42-56.5)
0
CEA (ng/mL)
> 5
163
28
14.66%
0.217
≤ 5
118
29
19.73%
Differentiation
Moderate-poor
274
44
13.84%
0.001
Well
44
20
31.25%
DTAV (cm)
< 5
140
41
22.65%
0.024
≥ 5
191
31
13.96%
TL (cm)
> 3
237
41
14.75%
0.001
≤ 3
73
30
29.13%
TCE
< 50%
37
7
15.91%
0.772
≥ 50%
256
55
17.68%
cT
2
16
5
23.81%
0.405
3
234
56
19.31%
4
54
8
12.90%
cN
+
235
57
19.52%
0.465
-
78
15
16.13%
MRF
-
231
61
20.89%
0.013
+
97
11
10.19%
NT regimen
Capecitabine/de Gramont-RT
102
13
11.30%
0
mFOLFOX6
148
14
8.64%
mFOLFOX6-RT
81
45
35.71%
Table 2 Predictive factors for complete pathological response in multivariate logistic regression analysis for all patients
Variable
P-value
OR
95%CI
Age (yr)
≤ 60
0.703
0.873
0.434-1.756
> 60
1
Differentiation
Well
0.003
2.966
1.449-6.069
Moderate-poor
1
TL (cm)
≤ 3
0.004
2.608
1.347-5.052
> 3
1
DTAV
≥ 5
0.07
0.56
0.299-1.049
< 5
1
MRF
-
0.017
2.729
1.199-6.211
+
1
NT regimen
mFOLFOX6-RT
0
5.339
2.394-11.903
mFOLFOX6
0.402
1.821
0.449-7.387
Capecitabine/de Gramont-RT
1
The interval
0.093
1.029
0.995-1.064
Table 3 Predictive factors for good downstaging in univariate logistic regression analysis for all patients
Variable
Bad downstaging (n = 226) n P50 (P25-P75)
Good downstaging (n = 177) n P50 (P25-P75)
Good downstaging rate
P-value
Gender
Male
164
117
41.64%
0.106
Female
59
60
50.42%
Age (yr)
≤ 60
144
120
45.45%
0.462
> 60
80
57
41.61%
BMI (kg/cm2)
< 25
159
125
44.01%
0.475
≥ 25
56
37
39.78%
Hemoglobin (g/L)
≤ 125
69
56
44.80%
0.426
> 125
127
86
40.38%
NLR
> 3
27
21
43.75%
0.792
≤ 3
169
121
41.72%
Platelet (×109/L)
241 (207-294)
236 (193-272.25)
0.125
ApoA1 (g/L)
1.27 (1.13-1.44)
1.31 (1.15-1.48)
0.228
ApoB (g/L)
0.98 (0.79-1.13)
0.97 (0.79-1.18)
0.88
The interval
39 (23-54)
48 (25.75-55)
0.062
CEA (ng/mL)
> 5
125
66
34.55%
0.002
≤ 5
71
76
51.70%
Differentiation
Moderate-poor
194
124
38.99%
0
Well
20
44
68.75%
DTAV (cm)
< 5
85
96
53.04%
0.001
≥ 5
141
81
36.49%
TL (cm)
> 3
167
111
39.93%
0.002
≤ 3
44
59
57.28%
TCE
< 50%
23
21
47.73%
0.508
≥ 50%
179
132
42.44%
cT
2
4
17
80.95%
0
3
160
130
44.83%
4
46
16
25.81%
cN
+
166
126
43.15%
0.074
-
43
50
53.76%
MRF
-
142
150
51.37%
0
+
81
27
25.00%
NT regimen
Capecitabine/de Gramont-RT
64
51
44.35%
0.061
mFOLFOX6-RT
61
65
51.59%
mFOLFOX6
101
61
37.65%
Table 4 Predictive factors for good downstaging in multivariate logistic regression analysis for all patients
Variable
P-value
OR
95%CI
CEA (ng/mL)
≤ 5
0.095
1.565
0.925-2.647
> 5
1
Differentiation
Well
0
4.814
2.343-9.892
Moderate-poor
1
DTAV (cm)
≥ 5
0.052
0.588
0.345-1.004
< 5
1
TL (cm)
≤ 3
0.9
1.04
0.566-1.909
> 3
1
cT
3
0.046
0.248
0.063-0.974
4
0.127
0.282
0.056-1.434
2
1
MRF
-
0
4.226
1.894-9.426
+
1
Table 5 Distribution of pretreatment clinical parameters in different neoadjuvant therapy regimen groups
Variable
Capecitabine/deGramont-RT n (%) P50 (P25-P75)
mFOLFOX6 n (%) P50 (P25-P75)
mFOLFOX6-RT n (%) P50 (P25-P75)
P-value
Gender
Male
76 (66.67)
107 (66.88)
98 (77.78)
0.083
Female
38 (33.33)
53 (33.13)
28 (22.22)
Age (yr)
≤ 60
66 (57.39)
102 (63.75)
96 (76.19)
0.007
> 60
49 (42.61)
58 (36.25)
30 (23.81)
BMI (kg/cm2)
< 25
83 (76.85)
118 (76.62)
83 (72.17)
0.641
≥ 25
25 (23.15)
36 (23.38)
32 (27.83)
Hemoglobin (g/L)
≤ 125
34 (34.34)
55 (39.29)
36 (36.36)
0.729
> 125
65 (65.66)
85 (60.71)
63 (63.64)
NLR
> 3
16 (16.16)
17 (12.14)
15 (15.15)
0.646
≤ 3
83 (83.84)
123 (87.86)
84 (84.85)
CEA (ng/mL)
> 5
56 (56.57)
79 (56.43)
56 (56.57)
1
≤ 5
43 (43.43)
61 (43.57)
43 (43.43)
Differentiation
Moderate-poor
90 (81.08)
135 (87.1)
93 (80.17)
0.246
Well
21 (18.92)
20 (12.9)
23 (19.83)
DTAV (cm)
< 5
61 (53.04)
62 (38.27)
58 (46.03)
0.049
≥ 5
54 (46.96)
100 (61.73)
68 (53.97)
TL (cm)
> 3
82 (74.55)
105 (70)
91 (75.21)
0.572
≤ 3
28 (25.45)
45 (30)
30 (24.79)
TCE
< 50%
10 (10)
22 (15.28)
12 (10.81)
0.389
≥ 50%
90 (90)
122 (84.72)
99 (89.19)
cN
+
84 (75)
110 (73.33)
98 (79.67)
0.462
-
28 (25)
40 (26.67)
25 (20.33)
MRF
-
85 (74.56)
119 (74.38)
88 (69.84)
0.627
+
29 (25.44)
41 (25.63)
38 (30.16)
pCR
Non-pCR
102 (88.7)
148 (91.36)
81 (64.29)
0
pCR
13 (11.3)
14 (8.64)
45 (35.71)
Downstaging
Bad
64 (55.65)
101 (62.35)
61 (48.41)
0.061
Good
51 (44.35)
61 (37.65)
65 (51.59)
cT
2
9 (8.26)
10 (6.85)
2 (1.69)
0.19
3
85 (77.98)
112 (76.71)
93 (78.81)
4
15 (13.76)
24 (16.44)
23 (19.49)
PLT (×109/L)
230 (188.75-267.25)
236.5 (200.25-290.75)
244 (212-281)
0.168
ApoA1 (g/L)
1.31 (1.14-1.47)
1.29 (1.12-1.44)
1.28 (1.15-1.5)
0.73
ApoB (g/L)
0.97 (0.8-1.09)
0.98 (0.78-1.14)
0.98 (0.81-1.21)
0.425
The interval
54 (49-58.25)
22 (18-25.75)
52 (47-59)
0
Table 6 Predictive factors for complete pathological response in univariate logistic regression analysis for the capecitabine/deGramont-RT regimen
Variable
Non-pCR (n = 102) n P50 (P25-P75)
pCR (n = 13) n P50 (P25-P75)
pCR rate
P-value
Gender
Male
70
6
7.89%
0.096
Female
31
7
18.42%
Age (yr)
≤ 60
56
10
15.15%
0.131
> 60
46
3
6.12%
BMI (kg/cm2)
< 25
75
8
9.64%
0.375
≥ 25
21
4
16.00%
Hemoglobin (g/L)
≤ 125
33
1
2.94%
0.087
> 125
56
9
13.85%
NLR
> 3
12
4
25.00%
0.031
≤ 3
77
6
7.23%
PLT (×109/L)
228 (188.25-266.75)
252 (188.75-319)
0.338
ApoA1 (g/L)
1.3 (1.14-1.48)
1.34 (1.11-1.46)
0.912
ApoB (g/L)
0.97 (0.8-1.09)
0.92 (0.78-1.02)
0.667
The interval
53.97 ± 8.94
52.38 ± 10.79
0.588
CEA (ng/mL)
> 5
51
5
8.93%
0.659
≤ 5
38
5
11.63%
Differentiation
Moderate-poor
82
8
8.89%
0.177
Well
17
4
19.05%
DTAV (cm)
< 5
52
9
14.75%
0.214
≥ 5
50
4
7.41%
TL (cm)
> 3
74
8
9.76%
0.252
≤ 3
23
5
17.86%
TCE
≤ 50%
10
0
0.00%
0.241
> 50%
79
11
12.22%
cT
2
7
2
22.22%
0.521
3
75
10
11.76%
4
14
1
6.67%
cN
+
73
11
13.10%
0.394
-
26
2
7.14%
MRF
-
74
11
12.94%
0.377
+
27
2
6.90%
Table 7 Predictive factors for complete pathological response in multivariate logistic regression analysis for the capecitabine/deGramont-RT regimen
Variable
P value
OR
95%CI
NLR
> 3
0.042
4.278
1.051-17.413
≤ 3
1
Table 8 Predictive factors for complete pathological response in univariate logistic regression analysis for the mFOLFOX6-RT regimen
Variable
Non-pCR (n = 81) n P50 (P25-P75)
pCR (n = 45) n P50 (P25-P75)
pCR rate
P-value
Gender
Male
63
35
35.71%
1
Female
18
10
35.71%
Age (yr)
≤ 60
62
34
35.42%
0.901
> 60
19
11
36.67%
BMI (kg/cm2)
< 25
49
34
40.96%
0.202
≥ 25
23
9
28.13%
Hemoglobin (g/L)
≤ 125
23
13
36.11%
0.905
> 125
41
22
34.92%
NLR
> 3
9
6
40.00%
0.683
≤ 3
55
29
34.52%
PLT (×109/L)
246.5 (214.25-289.75)
239 (197-269)
0.22
ApoA1 (g/L)
1.26 (1.15-1.44)
1.3 (1.15-1.55)
0.453
ApoB (g/L)
1 (0.81-1.24)
0.97 (0.81-1.17)
0.725
The interval
51.5 (43-58.75)
54 (50-62)
0.116
CEA (ng/mL)
> 5
40
16
28.57%
0.107
≤ 5
24
19
44.19%
Differentiation
Moderate-poor
63
30
32.26%
0.311
Well
13
10
43.48%
DTAV (cm)
< 5
33
25
43.10%
0.11
≥ 5
48
20
29.41%
TL (cm)
> 3
64
27
29.67%
0.008
≤ 3
13
17
56.67%
TCE
< 50%
8
4
33.33%
0.944
≥ 50%
65
34
34.34%
cT
2
0
2
100.00%
0.061
3
58
35
37.63%
4
18
5
21.74%
cN
+
62
36
36.73%
0.946
-
16
9
36.00%
MRF
-
49
39
44.32%
0.002
+
32
6
15.79%
Table 9 Predictive factors for complete pathological response in multivariate logistic regression analysis for the mFOLFOX6-RT regimen
Variable
P value
OR
95%CI
TL (cm)
≤ 3
0.046
2.452
1.015-5.926
> 3
1
MRF
-
0.008
3.829
1.42-10.325
+
1
Table 10 Predictive factors for complete pathological response in univariate logistic regression analysis for the mFOLFOX6 regimen
Variable
Non-pCR (n = 148) n P50 (P25-P75)
pCR (n = 14) n P50 (P25-P75)
pCR rate
P-value
Gender
Male
99
8
7.48%
0.418
Female
47
6
11.32%
Age (yr)
≤ 60
92
10
9.80%
0.532
> 60
54
4
6.90%
BMI (kg/cm2)
< 25
107
11
9.32%
0.477
≥ 25
34
2
5.56%
Hemoglobin (g/L)
≤ 125
53
2
3.64%
0.093
> 125
75
10
11.76%
NLR
> 3
16
1
5.88%
0.673
≤ 3
112
11
8.94%
PLT (×109/L)
127.5 (117.5-139)
137.5 (127-142.25)
0.82
ApoA1 (g/L)
1.28 (1.11-1.42)
1.3 (1.15-1.46)
0.542
ApoB (g/L)
0.96 (0.77-1.13)
1.13 (0.86-1.3)
0.051
The interval
21.5 (18-25)
25 (19.25-26.75)
0.09
CEA (ng/mL)
> 5
72
7
8.86%
0.889
≤ 5
56
5
8.20%
Differentiation
Moderate-poor
129
6
4.44%
0
Well
14
6
30.00%
DTAV (cm)
< 5
55
7
11.29%
0.345
≥ 5
93
7
7.00%
TL (cm)
> 3
99
6
5.71%
0.02
≤ 3
37
8
17.78%
TCE
< 50%
19
3
13.64%
0.413
≥ 50%
112
10
8.20%
cT
2
9
1
10.00%
0.974
3
101
11
9.82%
4
22
2
8.33%
cN
+
100
10
9.09%
0.866
-
36
4
10.00%
MRF
-
108
11
9.24%
0.707
+
38
3
7.32%
Table 11 Predictive factors for complete pathological response in multivariate logistic regression analysis for the mFOLFOX6 regimen
Variable
P-value
OR
95%CI
Differentiation
Well
0.002
8.881
2.263-34.85
Moderate-poor
1
TL
≤ 3
0.022
4.805
1.25-18.466
> 3
1
Citation: Ren DL, Li J, Yu HC, Peng SY, Lin WD, Wang XL, Ghoorun RA, Luo YX. Nomograms for predicting pathological response to neoadjuvant treatments in patients with rectal cancer. World J Gastroenterol 2019; 25(1): 118-137