Optimizing adjuvant treatment decisions for stage t2 rectal cancer based on mesorectal node size: a decision analysis.
Optimizing adjuvant treatment decisions for stage t2 rectal cancer based on mesorectal node size: a decision analysis.
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DOI：
10.1016/j.acra.2012.07.010
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发表时间：
2013-01
影响因子：
4.8
通讯作者：
Pandharipande, Pari V.
中科院分区：
文献类型：
--
作者：
Hartman, Rebecca I.;Chang, Connie Y.;Wo, Jennifer Y.;Eisenberg, Jonathan D.;Hong, Theodore S.;Harisinghani, Mukesh G.;Gazelle, G. Scott;Pandharipande, Pari V.
To optimize treatment decisions for patients with suspected stage T2 rectal cancer based on mesorectal lymph node size at MRI. We developed a decision-analytic model to predict outcomes for patients with stage T2 rectal cancer at MRI. Node-positive patients were assumed to benefit from chemoradiation prior to surgery. We incorporated imperfect MRI performance for primary cancer and mesorectal nodal staging. Five triage strategies were considered for administering preoperative chemoradiation: treat all patients; treat for any mesorectal node >3-mm; >5-mm; >7-mm; and treat no patients. If nodal metastases or unsuspected T3 disease went untreated preoperatively, postoperative chemoradiation was needed, resulting in poorer outcomes. For each strategy, we computed rates of acute and long-term chemoradiation toxicity, and 5-year local recurrence. Effects of input parameter uncertainty were evaluated in sensitivity analysis. The optimal strategy depended on the outcome prioritized. Acute and long-term chemoradiation toxicity rates were minimized by triaging only patients with nodes >7- mm to preoperative chemoradiation (18.9% and 10.8%, respectively). A treat-all strategy minimized the 5-year local recurrence rate (5.6%). A 7-mm nodal triage threshold increased the 5-year local recurrence rate to 8.0%; when no patients were treated preoperatively, the local recurrence rate was 10.1%. With improved primary tumor staging, all outcomes could be further optimized. Mesorectal nodal size thresholds for preoperative chemoradiation should depend on the outcome prioritized – higher size thresholds reduce chemoradiation toxicity, but increase recurrence rates. Improvements in nodal staging will have greater impact if primary tumor staging can be improved.
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