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Analysis of risk characteristics for early progression and late progression in locally advanced rectal cancer patients: a large population-based and validated study

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Abstract

Background and objective

The current study aimed to explore the factors influencing early progression (EP) and late progression (LP) in locally advanced rectal cancer (LARC) patients.

Methods

The patients were classified into EP and LP groups using one year as a cutoff. The random survival forest model was utilized to calculate the probability of time-to-progression. Besides, inverse probability of treatment weighting (IPTW) analysis and the Surveillance, Epidemiology, and End Results (SEER) were conducted to validate our results.

Results

Our study revealed that PNI, CEA level, and pathological stage were independent prognostic factors for PFS both in EP group and LP group. For EP group patients, Group 1 had the highest probability of progression at the 9th month of follow-up, while Group 2 exhibited the highest probability at the 6th month. Group 3, on the other hand, showed two peaks of progression at the 4th and 8th months of follow-up. As for LP group patients, Groups 4, 5, and 6 all exhibited peaks of progression between the 18th and 24th months of follow-up. Furthermore, our results suggested that PNI was also an independent prognostic factor affecting OS in both EP group and LP group. Finally, the analysis of IPTW and SEER database further confirmed our findings.

Conclusions

Our results indicated a significant correlation between immune and nutritional status with PFS and OS in both EP and LP groups. These insights can aid healthcare professionals in effectively identifying and evaluating patients' nutritional status, enabling them to develop tailored nutrition plans and interventions.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Abbreviations

RC:

Rectal cancer

LARC:

Locally advanced rectal cancer

EP:

Early progression

LP:

Late progression

IPTW:

Inverse probability of treatment weighting

SEER:

Surveillance, Epidemiology, and End Results

TNM:

Tumor-node-metastasis

AJCC:

American joint Committee on cancer

BMI:

Body mass index

PNI:

Prognostic nutritional index

NRI:

Nutritional risk index

PAR:

Platelet to albumin ratio

CEA:

Carcinoembryonic antigen

MRF:

Mesorectal fascia involvement

EMVI:

Extra-mural vascular invasion

PC:

Postoperative chemotherapy

PR:

Postoperative radiotherapy

VCE:

Vascular cancer embolus

PI:

Perineural invasion

TD:

Tumor deposit

PFS:

Progression-free survival

OS:

Overall survival

RSF:

Random survival forest

HR:

Hazard ratio

CI:

Confidence interval

C-index:

Concordance-index

SMD:

Standardized mean difference

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Acknowledgements

We thank all the investigators and patients who participated in the present study.

Funding

This work was supported by the Joint Funds for the National Clinical Key Specialty Construction Program (Grant No. 2021), the Fujian Provincial Clinical Research Center for Cancer Radiotherapy and Immunotherapy (Grant No. 2020Y2012), and Fujian Clinical Research Center for Radiation and Therapy of Digestive, Respiratory and Genitourinary Malignancies (Grant No. 2021Y2014).

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Author notes

  1. Yilin Yu, Haixia Wu, and Jianjian Qiu contributed equally as first authors to this manuscript

Authors and Affiliations

  1. Department of Radiation Oncology, Fujian Cancer Hospital, Clinical Oncology School of Fujian Medical University, Fuzhou, Fujian, China

    Yilin Yu, Jianjian Qiu, Shiji Wu, Yixiu Gan, Lingdong Shao, Cheng Lin, Liang Hong & Junxin Wu

  2. Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China

    Haixia Wu

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  1. Yilin Yu
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Contributions

YY, JW, HW, JQ, CL, and LH designed this study. YY, HW, SW, YG, and LS contributed to the data collection. YY, HW, and JQ analyzed the data. JW, CL, and LH supervised the study. YY, HW, and JQ wrote the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Cheng Lin, Liang Hong or Junxin Wu.

Ethics declarations

Ethical approval and consent to participate

The current study was approved by the ethics committee of Fujian Medical University Cancer Hospital, Fuzhou, China and conducted in accordance with the principles of the Declaration of Helsinki and its amendment. All patients provided written informed consent prior to treatment, and all the information was anonymized prior to analysis.

Consent for publication

The manuscript has been approved by all authors for publication.

Competing interests

The authors report that they have no conflicts of interest pertaining to this work.

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Junxin Wu, Cheng Lin, and Liang Hong contributed equally as corresponding authors to this manuscript

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Yu, Y., Wu, H., Qiu, J. et al. Analysis of risk characteristics for early progression and late progression in locally advanced rectal cancer patients: a large population-based and validated study. Support Care Cancer 32, 340 (2024). https://doi.org/10.1007/s00520-024-08546-8

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