Current treatment and surveillance modalities are not sufficient for advanced stage III colon cancer: Result from a multicenter cohort analysis

Clinical atlas of rectal cancer highlights the barriers and insufficient interventions underlying the unfavorable outcomes in older patients

Background

Aging confers an increased risk of developing cancer, and the global burden of cancer is cumulating as human longevity increases. Providing adequate care for old patients with rectal cancer is challenging and complex.

Method

A total of 428 and 44,788 patients diagnosed with non-metastatic rectal cancer from a referral tertiary care center (SYSU cohort) and the Surveillance Epidemiology and End Results database (SEER cohort) were included. Patients were categorized into old (over 65 years) and young (aged 50-65 years) groups. An age-specific clinical atlas of rectal cancer was generated, including the demographic and clinicopathological features, molecular profiles, treatment strategies, and clinical outcomes.

Results

Old and young patients were similar in clinicopathological risk factors and molecular features, including TNM stage, tumor location, tumor differentiation, tumor morphology, lymphovascular invasion, and perineural invasion. However, old patients had significantly worse nutritional status and more comorbidities than young patients. In addition, old age was independently associated with less systemic cancer treatment (adjusted odds ratio 0.294 [95% CI 0.184-0.463, P < 0.001]). We found that old patients had significantly worse overall survival (OS) outcomes in both SYSU (P < 0.001) and SEER (P < 0.001) cohorts. Moreover, the death and recurrence risk of old patients in the subgroup not receiving chemo/radiotherapy (P < 0.001 for OS, and P = 0.046 for time to recurrence [TTR]) reverted into no significant risk in the subgroup receiving chemo/radiotherapy.

Conclusions

Although old patients had similar tumor features to young patients, they had unfavorable survival outcomes associated with insufficient cancer care from old age. Specific trials with comprehensive geriatric assessment for old patients are needed to identify the optimal treatment regimens and improve unmet cancer care.

Study registration

The study was registered on the research registry with the identifier of researchregistry 7635.

Survival rate of colorectal cancer in China: A systematic review and meta-analysis

Background

This study aims to comprehensively summarize the colorectal survival rate in China. Method: In PubMed and Web of Science, keywords such as "colorectal cancer", "survival" and "China" were used to search literatures in the past 10 years. Random effect models were selected to summarize 1-year, 3-year, and 5-year survival rates, and meta-regression and subgroup analyses were performed on the included studies.

Results

A total of 16 retrospective and prospective studies providing survival rates for colorectal cancer in China were included. The 1-year, 3-year, and 5-year survival rates of colorectal cancer in China were 0.79, 0.72 and 0.62, respectively. In the included studies, the 5-year survival rates of stage I (5474 cases), stage II (9215 cases), stage III (8048 cases), and stage IV (4199 cases) colorectal cancer patients were 0.85, 0.81, 0.57 and 0.30, respectively. Among them, the 5-year survival rates of colorectal cancer were 0.82, 0.76, 0.71, 0.67, 0.66, 0.65 and 0.63 in Tianjin, Beijing, Guangdong, Shandong, Liaoning, Zhejiang and Shanghai, respectively.

Conclusion

The 5-year survival rate in China is close to that of most European countries, but still lower than Japan and South Korea, and the gap is gradually narrowing. Region, stage, differentiation, pathological type, and surgical approach can affect 5-year survival in colorectal cancer.

Systematic review registration

https://www.crd.york.ac.uk/prospero/ identifier, CRD42022357789.

Automatic treatment outcome prediction with DeepInteg based on multimodal radiological images in rectal cancer

Neoadjuvant systemic treatment before surgery is a prevalent regimen in the patients with advanced-stage or high-risk tumor, which has shaped the treatment strategies and cancer survival in the past decades. However, some patients present with poor response to the neoadjuvant treatment. Therefore, it is of great significance to develop tools to help distinguish the patients that could achieve pathological complete response before surgery to avoid inappropriate treatment. Here, this study demonstrated a multi-task deep learning tool called DeepInteg. In the DeepInteg framework, the segmentation module was constructed based on the CE-Net with a context extractor to achieve end-to-end delineation of region of interest (ROI) from radiological images, then the features of segmented Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) images of each case were fused and input to the classification module based on a convolution neural network for treatment outcome prediction. The dataset with 1700 MRI and CT slices collected from the prospectively randomized clinical trial (NCT01211210) on systemic treatment for rectal cancer was used to develop and systematically optimize DeepInteg. As a result, DeepInteg achieved automatic segmentation of tumoral ROI with Dices of 0.766 and 0.719 and mIoUs of 0.788 and 0.756 in CT and MRI images, respectively. In addition, DeepInteg achieved AUC of 0.833, accuracy of 0.826 and specificity of 0.856 in the prediction for pathological complete response after treatment, which showed better performance compared with the model based on CT or MRI alone. This study provide a robust framework to develop disease-specific tools for automatic delineation of ROI and clinical outcome prediction. The well-trained DeepInteg could be readily applied in clinic to predict pathological complete response after neoadjuvant therapy in rectal cancer patients.

Prognostic significance of the preoperative lymphocyte to C-reactive protein ratio in patients with stage III colorectal cancer

BACKGROUND

Stage III colorectal cancer (CRC), which accounts for approximately one third of all CRC cases, is associated with worsened prognosis. The aim of this study was to compare the preoperatively measured systemic inflammatory markers and to define the most significant marker in terms of its prognostic value in stage III CRC.

METHODS

Surgically treated stage III CRC patients were included. Demographics, preoperatively measured Glasgow prognostic score (GPS), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), lymphocyte/C-reactive protein ratio (LCR) and C-reactive protein/albumin ratio (CAR) values, clinicopathological features, surgical, oncological and survival outcomes were recorded and statistically analysed.

RESULTS

The study group of 102 patients consisted of 65 (63.7%) men and 37 (36.3%) women with a median age of 64 (range: 26-89). The mean follow-up period was 42.8 ± 30.5 (range: 6-107) months. Overall survival (OS) and disease-free survival (DFS) rates were 71.6%, and 67.7%, respectively. Elevated CRP, GPS 2, LCR ≤ 0.530, CAR ≥ 0.080, higher numbers of metastatic lymph nodes and N2b nodal status were detected to impair DFS (P = 0.001, P = 0.015, P = 0.001, P = 0.001, P = 0.001 and P = 0.043, respectively). Variables including GPS 2, PLR≥190.83, CAR≥0.045, LCR≤0.684, surgical site infection and longer hospital stay decreased OS (P = 0.004, P = 0.002, P = 0.005, P = 0.001, P = 0.001 and P = 0.001, respectively). According to multivariate analysis; PLR ≥ 190.83 was associated with three times [HR: 2.892 (95% CI: 1.100-7.602), P = 0.031], and LCR ≤ 0.684 was associated with four times [HR: 3.919 (95% CI: 1.130-13.592), P = 0.031] greater risk of cancer-related mortality.

CONCLUSION

As an independent prognostic factor, LCR had the highest impact on predicting survival after curative resection for stage III CRC.