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Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/21826

Title: Quantitative Contribution of Prognosticators to Oncologic Outcome After Rectal Cancer Resection
Authors: Leonard, Daniel
Penninckx, Freddy
Laenen, Annouschka
Kartheuser, Alex
Issue Date: 2015
Citation: DISEASES OF THE COLON & RECTUM, 58 (6), p. 566-574
Abstract: BACKGROUND: Prognostication is an important aspect of medical practice. It relies on statistical modeling testing the correlation of variables with the outcome of interest. OBJECTIVE: In contrast with the classic approach of predictive modeling, this study aimed to estimate the unique, individual, and relative contributions. This includes the quantitative contributions of patient-, tumor-, and treatment-related factors to oncologic outcome after rectal cancer resection. DESIGN: This was a retrospective analysis of prospectively registered data. SETTINGS: The study included 65 hospitals participating on a voluntary basis in the Project on Cancer of the Rectum, a Belgian multidisciplinary improvement project of rectal cancer care. PATIENTS: A total of 1470 patients presenting midrectal or low-rectal adenocarcinoma without distant metastasis were included. INTERVENTION: The study intervention was total mesorectal excision with or without sphincter preservation. MAIN OUTCOME MEASURES: The unique, individual, and relative contributions of a set of covariables to the statistical variability of the distant metastasis rate and overall survival have been calculated. RESULTS: The 5-year distant metastasis rate was 21% and overall survival 76%. A large amount of the variability of the outcomes (ie, 83.6% to 84.2%) could not be predicted by the prognostic factors. Unique contributions of the predictors ranged from 0.1% to 3.1%. The 3 risk factors with the highest unique contribution for distant metastasis were lymph node ratio, pathologic tumor stage, and total mesorectal quality; for overall survival they were age, lymph node ratio, and ASA score. LIMITATIONS: The main weakness of this study was incomplete participation and registration in the Project on Cancer of the Rectum. CONCLUSIONS: Several factors influence oncologic outcomes and are present in prediction models. However, the models predict relatively little of outcome variation.
Notes: [Leonard, Daniel; Kartheuser, Alex] Clin Univ St Luc, Colorectal Surg Unit, B-1200 Brussels, Belgium. [Penninckx, Freddy] Univ Clin Gasthuisberg, Dept Abdominal Surg, Leuven, Belgium. [Laenen, Annouschka] Katholieke Univ Leuven, I Biostat, Leuven, Belgium. [Laenen, Annouschka] Univ Hasselt, I Biostat, Hasselt, Belgium.
URI: http://hdl.handle.net/1942/21826
DOI: 10.1097/DCR.0000000000000334
ISI #: 000354100400009
ISSN: 0012-3706
Category: A1
Type: Journal Contribution
Validation: ecoom, 2016
Appears in Collections: Research publications

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