Baseline Quality of Life of Physical Function Is Highly Relevant for Overall Survival in Advanced Rectal Cancer

In advanced rectal cancer, neoadjuvant radiochemotherapy and total mesorectal excision lead to long overall survival. The quality of life (QOL) of the patients is clearly related to the prognosis. Our question was whether the prognosis can be represented with only one question or one score from the QOL questionnaires. 360 consecutively recruited patients diagnosed with advanced rectal cancer were questioned during radiochemotherapy and a follow-up of 8 years. The questionnaires QLQ-C30 and QLQ-CR38 were used; 10 functional and 17 symptom scores were calculated. The functional score “physical function” and the symptom scores “fatigue”, “nausea and vomiting”, “pain” and “appetite loss” were highly prognostic (p < 0.001) for overall survival. “Physical function” was highly prognostic at all time points up to 1 year after starting therapy (p ≤ 0.001). The baseline “physical function” score divided the cohort into a favorable group with an 8-year overall survival rate of 70.4% versus an unfavorable group with 47.5%. In the multivariable analysis, baseline “physical function”, age and distant metastases were independent predictors of overall survival. The score “physical function” is a powerful unrelated risk factor for overall survival in patients with rectal cancer. Future analyses should study whether increased “physical function” after diagnosis could improve survival.

Metabolic and Texture Features of PET/CT Scan to Predict Response in Patients with Locally Advanced Rectal Cancer Treated by Concurrent Neoadjuvant Chemoradiotherapy

Background: Neoadjuvant chemoradiotherapy (nCRT) before surgical resection is the standard treatment for patients with locally advanced rectal cancer (LARC). Radiomics can be used as noninvasive biomarker for response prediction. The purpose of our study was to evaluate the potential of PET/CT texture features to predict the responses of LARC subjects treated with nCRT.Methods: One week prior to nCRT, patients underwent Positron Emission Tomography/Computed Tomography (PET/CT) scan and then received concurrent nCRT. For each patient, intensity, shape and texture-based features were derived from PET/CT images using the IBEX software. The logistic regression classifier was used to identify the responders from non-responders. Results: In this study, 23 patients with LARC were included. The patients’ responses included 5 patients with Grade 0, 7 with Grade 1, 6 with Grade 2, and 5 with Grade 3 according to American Joint Committee on Cancer/College of American Pathologists (AJCC/CAP) pathologic grading. In quantitative texture features analysis, the dissimilarity feature had the highest performance [Area under Curve (AUC) = 0.65] and in metabolic parameters analysis the best performance was for total lesion glycolysis (TLG; AUC= 0.61)Conclusions: In conclusion, performance of quantitative texture features is better than metabolic parameters but their performance should be improved.