Back to all available

Nomogram based on Prognostic Nutritional Index (PNI) for predicting acute radiation proctitis in locally advanced rectal cancer patients with neoadjuvant chemoradiotherapy

oncology
healthcare-services

Abstract

Background: Radiation-induced proctitis is a frequent adverse effect that negatively impacts the quality of life in rectal cancer patients receiving neoadjuvant chemoradiotherapy (nCRT). Identifying high-risk factors and predicting their occurrence are crucial for preventing acute radiation proctitis (ARP). This study aimed to identify potential risk factors and develop a nomogram to predict the risk of ARP.

Methods: A total of 561 locally advanced rectal cancer (LARC) patients from January 1, 2019, to December 31, 2021, were collected. Patients were randomly allocated to the training and validation cohorts in a 7:3 ratio. Univariate and multivariate logistic regression analyses were conducted to determine potential predictive factors. A nomogram was created using predictive factors for ARP. The model's performance was assessed using the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis (DCA).

Results: Among 561 patients, 131 were diagnosed with ARP. Multivariable analysis identified Body Mass Index (BMI), tumor volume (TV), and Prognostic Nutritional Index (PNI) as independent predictors for ARP. Their odds ratios (OR) and 95% confidence intervals (95% CI) were as follows: BMI (0.394, 0.230-0.675, P < 0.001), TV (2.242, 1.366-3.680, P=0.001), and PNI (0.470, 0.279-0.790, P=0.004). The nomogram showed strong discrimination, demonstrating, with an AUC of 0.689 (95% CI: 0.629-0.749) in the training cohort and 0.725 (95% CI: 0.636-0.815) in the validation cohort. Calibration curves and DCA further validated the nomogram's excellent consistency and clinical utility.

Conclusion: Lower BMI, PNI, and higher TV were independent predictors for ARP in LARC patients receiving nCRT.

Ask to review this manuscript

Notes for potential reviewers

  • Volunteering is not a guarantee that you will be asked to review. There are many reasons: reviewers must be qualified, there should be no conflicts of interest, a minimum of two reviewers have already accepted an invitation, etc.
  • This is NOT OPEN peer review. The review is single-blind, and all recommendations are sent privately to the Academic Editor handling the manuscript. All reviews are published and reviewers can choose to sign their reviews.
  • What happens after volunteering? It may be a few days before you receive an invitation to review with further instructions. You will need to accept the invitation to then become an official referee for the manuscript. If you do not receive an invitation it is for one of many possible reasons as noted above.
  • PeerJ does not judge submissions based on subjective measures such as novelty, impact or degree of advance. Effectively, reviewers are asked to comment on whether or not the submission is scientifically and technically sound and therefore deserves to join the scientific literature. Our Peer Review criteria can be found on the "Editorial Criteria" page - reviewers are specifically asked to comment on 3 broad areas: "Basic Reporting", "Experimental Design" and "Validity of the Findings".
  • Reviewers are expected to comment in a timely, professional, and constructive manner.
  • Until the article is published, reviewers must regard all information relating to the submission as strictly confidential.
  • When submitting a review, reviewers are given the option to "sign" their review (i.e. to associate their name with their comments). Otherwise, all review comments remain anonymous.
  • All reviews of published articles are published. This includes manuscript files, peer review comments, author rebuttals and revised materials.
  • Each time a decision is made by the Academic Editor, each reviewer will receive a copy of the Decision Letter (which will include the comments of all reviewers).

If you have any questions about submitting your review, please email us at [email protected].