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Yang WN, Li XM, Li CF, Chen C, Feng Y, Dai N, Yang YX, Li MX, Li CX, Qian CY, Wang D, Xiao H, Luo JM. Gustative Roussy Immune Score is a Predictor for Major Pathological Response in Rectal Cancer: A Result from the Preoperative Intraarterial Chemoembolization Combined with Radiotherapy (PCAR) Study. Cancer Invest 2024:1-11. [PMID: 38965994 DOI: 10.1080/07357907.2024.2366912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 06/08/2024] [Indexed: 07/06/2024]
Abstract
Despite the emergence of various treatment strategies for rectal cancer based on neoadjuvant chemoradiotherapy, there is currently a lack of reliable biomarkers to determine which patients will respond well to neoadjuvant chemoradiotherapy. Through collecting hematological and biochemical parameters data of patients prior to receiving neoadjuvant chemoradiotherapy, we evaluated the predictive value of systemic inflammatory indices for pathological response and prognosis in rectal cancer patients. We found that baseline GRIm-Score was an independent predictor for MPR in rectal cancer patients. However, no association was observed between several commonly systemic inflammation indices and long-term outcome.
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Affiliation(s)
- Wei-Na Yang
- Cancer Center, Daping Hospital, Army Medical University, Chongqing, China
| | - Xue-Mei Li
- Cancer Center, Daping Hospital, Army Medical University, Chongqing, China
| | - Chao-Fan Li
- Cancer Center, Daping Hospital, Army Medical University, Chongqing, China
| | - Chuan Chen
- Cancer Center, Daping Hospital, Army Medical University, Chongqing, China
| | - Yan Feng
- Cancer Center, Daping Hospital, Army Medical University, Chongqing, China
| | - Nan Dai
- Cancer Center, Daping Hospital, Army Medical University, Chongqing, China
| | - Yu-Xin Yang
- Cancer Center, Daping Hospital, Army Medical University, Chongqing, China
| | - Meng-Xia Li
- Cancer Center, Daping Hospital, Army Medical University, Chongqing, China
| | - Chun-Xue Li
- Department of General Surgery, Colorectal Division, Daping Hospital, Army Medical University, Chongqing, China
| | - Cheng-Yuan Qian
- Cancer Center, Daping Hospital, Army Medical University, Chongqing, China
| | - Dong Wang
- Cancer Center, Daping Hospital, Army Medical University, Chongqing, China
| | - He Xiao
- Cancer Center, Daping Hospital, Army Medical University, Chongqing, China
| | - Jia-Min Luo
- Cancer Center, Daping Hospital, Army Medical University, Chongqing, China
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Shao Z, Xu Y, Zhang X, Zou C, Xie R. Changes in serum uric acid, serum uric acid/serum creatinine ratio, and gamma-glutamyltransferase might predict the efficacy of neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer. Strahlenther Onkol 2024; 200:523-534. [PMID: 37286741 DOI: 10.1007/s00066-023-02096-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 04/23/2023] [Indexed: 06/09/2023]
Abstract
PURPOSE The purpose of this study was to investigate the predictive value of changes in serum uric acid (SUA), the ratio of serum uric acid to serum creatinine (SUA/SCr), and serum gamma-glutamyltransferase (GGT) from before to after therapy in patients with locally advanced rectal cancer (LARC). METHODS Data from 114 LARC patients from January 2016 to December 2021 were included in this retrospective study. All patients received neoadjuvant chemoradiotherapy (nCRT) and total mesorectal excision (TME). The change in SUA was calculated as a ratio: (SUA level after nCRT-SUA level before nCRT)/SUA level before nCRT. The change ratios of SUA/SCr and GGT were calculated in the same way. The efficacy of nCRT was evaluated by magnetic resonance (MR) and postoperative pathological response. A nonlinear model was used to evaluate whether the change ratios of SUA, SUA/SCr, and GGT were associated with the efficacy of nCRT. The predictive power of the change ratios of SUA, SUA/SCr, and GGT was assessed by receiver operating characteristic (ROC) curves. Univariate and multivariate Cox regression analyses were employed to measure the associations between disease-free survival (DFS) and other predictive indicators. The Kaplan-Meier method was used to further compare DFS between groups. RESULTS The nonlinear model indicated that the change ratios of SUA, SUA/SCr, and GGT were associated with the efficacy of nCRT. The change ratios of SUA, SUA/SCr, and GGT were used to predict the area under the ROC curve of efficacy for nCRT (0.95, 0.91-0.99), which was better than the prediction by the change ratio of SUA (0.94, 0.89-0.99), SUA/SCr (0.90, 0.84-0.96), or GGT alone (0.86, 0.79-0.93; p < 0.05). The optimal cut-off values of SUA, SUA/SCr, and GGT change were 0.02, 0.01, and 0.04, respectively. The Kaplan-Meier method indicated that patients with SUA, SUA/SCr, or GGT changes greater than the cut-off values had shorter DFS (p < 0.05). CONCLUSION Change ratios of SUA, SUA/SCr, or GGT greater than the cut-off values implied a risk of poor pathological response after nCRT and shorter DFS in LARC patients.
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Affiliation(s)
- Zhenyong Shao
- Department of Radiotherapy, The First Affiliated Hospital of Wenzhou Medical University, 325000, Wenzhou, China
| | - Yuyan Xu
- Department of Radiotherapy, The First Affiliated Hospital of Wenzhou Medical University, 325000, Wenzhou, China
| | - Xuebang Zhang
- Department of Radiotherapy, The First Affiliated Hospital of Wenzhou Medical University, 325000, Wenzhou, China
| | - Changlin Zou
- Department of Radiotherapy, The First Affiliated Hospital of Wenzhou Medical University, 325000, Wenzhou, China.
| | - Raoying Xie
- Department of Radiotherapy, The First Affiliated Hospital of Wenzhou Medical University, 325000, Wenzhou, China.
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Lai YH, Chang YT, Chang YJ, Tsai JT, Li MH, Lin JC. Predictive Value of the Interaction between CEA and Hemoglobin in Neoadjuvant CCRT Outcomes in Rectal Cancer Patients. J Clin Med 2023; 12:7690. [PMID: 38137759 PMCID: PMC10744245 DOI: 10.3390/jcm12247690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/01/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
The adoption of neoadjuvant concurrent chemoradiotherapy (CCRT) has reshaped the therapeutic landscape, but response prediction remains challenging. This study investigates the interaction between pre-CCRT carcinoembryonic antigen (CEA) and post-CCRT hemoglobin (Hb) levels in predicting the response of locally advanced rectal cancer (LARC) to CCRT. Retrospective data from 93 rectal cancer patients receiving neoadjuvant CCRT were analyzed. Univariate analyses assessed clinical factors associated with tumor regression grade (TRG) and T-stage outcomes. Machine learning identified predictive biomarkers. Interaction effects between CEA and Hb were explored through subgroup analyses. Post-CCRT Hb varied between pre-CCRT CEA groups. The interaction between pre-CCRT CEA and post-CCRT Hb influenced TRG. Males with normal pre-CCRT CEA and anemia showed better treatment responses. Females with elevated pre-CCRT CEA and post-CCRT anemia exhibited poorer responses. The interaction effect between them was significant, indicating that their relationship with TRG was not additive. Inflammatory biomarkers, WBC, neutrophil count, and post-CCRT platelet level correlated with CCRT response. Contrasting with previous findings, anemia was a predictor of better treatment response in males with normal pre-CCRT CEA. The interaction between pre-CCRT CEA and post-CCRT Hb levels predicts the response of LARC to CCRT. CEA, Hb, and sex should be considered when assessing treatment response. Inflammatory biomarkers contribute to response prediction. Understanding these complex relationships can enhance personalized treatment approaches in rectal cancer patients.
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Affiliation(s)
- Yi-Hsuan Lai
- Department of Radiation Oncology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan; (Y.-H.L.); (J.-T.T.); (M.-H.L.)
| | - Yu-Tien Chang
- School of Public Health, National Defense Medical Center, Taipei 114201, Taiwan;
| | - Yu-Jia Chang
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan;
| | - Jo-Ting Tsai
- Department of Radiation Oncology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan; (Y.-H.L.); (J.-T.T.); (M.-H.L.)
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan;
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
| | - Ming-Hsien Li
- Department of Radiation Oncology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan; (Y.-H.L.); (J.-T.T.); (M.-H.L.)
| | - Jang-Chun Lin
- Department of Radiation Oncology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan; (Y.-H.L.); (J.-T.T.); (M.-H.L.)
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
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Davies AT, Devlin PM, Dugan C, Richards T, Miles LF. Non-erythropoiesis stimulating agent, non-iron therapies for the management of anemia: A scoping review. Transfusion 2023; 63:849-860. [PMID: 36810729 DOI: 10.1111/trf.17274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 12/21/2022] [Accepted: 12/27/2022] [Indexed: 02/24/2023]
Affiliation(s)
- Amelia T Davies
- Division of Surgery, University of Western Australia, Perth, Western Australia, Australia
| | - Paula M Devlin
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - Cory Dugan
- Division of Surgery, University of Western Australia, Perth, Western Australia, Australia
| | - Toby Richards
- Division of Surgery, University of Western Australia, Perth, Western Australia, Australia
| | - Lachlan F Miles
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
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Drami I, Lord AC, Sarmah P, Baker RP, Daniels IR, Boyle K, Griffiths B, Mohan HM, Jenkins JT. Preoperative assessment and optimisation for pelvic exenteration in locally advanced and recurrent rectal cancer: A review. Eur J Surg Oncol 2021; 48:2250-2257. [PMID: 34922810 DOI: 10.1016/j.ejso.2021.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/03/2021] [Indexed: 01/06/2023] Open
Abstract
The pre-operative phase in planning a pelvic exenteration or extended resections is critical to optimising patient outcomes. This review summarises the key components of preoperative assessment and planning in patients with locally advanced rectal cancer (LARC) and locally recurrent rectal cancer (LLRC) being considered for potential curative resection. The preoperative period can be considered in 5 key phases: 1) Multidisciplinary meeting (MDT) review and recommendation for neoadjuvant therapy and surgery, 2) Anaesthetic preoperative assessment of fitness for surgery and quantification of risk, 3) Shared decision making with the patient and the process of informed consent, 4) Prehabilitation and physiological optimisation 5) Technical aspects of surgical planning. This review will focus on patients who have been recommended for surgery by the MDT and have completed neoadjuvant therapy. Other important considerations beyond the scope of this review are the various neoadjuvant strategies employed which in this patient group include Total Neo-adjuvant Therapy and reirradiation. Critical to improving perioperative outcomes is the dual aim of achieving a negative resection margin in a patient fit enough for extended surgery. Advanced, realistic communication is required pre-operatively and should be maintained throughout recovery. Optimising patient's physiological and psychological reserve with a preoperative prehabilitation programme is important, with physiotherapy, psychological and nutritional input. From a surgical perspective, image based technical preoperative planning is important to identify risk points and ensure correct surgical strategy. Careful attention to the entire patient journey through these 5 preoperative phases can optimise outcomes with the accumulation of marginal gains at multiple timepoints.
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Affiliation(s)
- I Drami
- Dukes' Club, Association of Coloproctology of Great Britain and Ireland, Royal College of Surgeons of England, London, UK.
| | - A C Lord
- Dukes' Club, Association of Coloproctology of Great Britain and Ireland, Royal College of Surgeons of England, London, UK
| | - P Sarmah
- Dukes' Club, Association of Coloproctology of Great Britain and Ireland, Royal College of Surgeons of England, London, UK
| | - R P Baker
- Advanced Malignancy Subcommittee, Association of Coloproctology of Great Britain and Ireland, Royal College of Surgeons of England, London, UK
| | - I R Daniels
- Advanced Malignancy Subcommittee, Association of Coloproctology of Great Britain and Ireland, Royal College of Surgeons of England, London, UK
| | - K Boyle
- Advanced Malignancy Subcommittee, Association of Coloproctology of Great Britain and Ireland, Royal College of Surgeons of England, London, UK
| | - B Griffiths
- Advanced Malignancy Subcommittee, Association of Coloproctology of Great Britain and Ireland, Royal College of Surgeons of England, London, UK
| | - H M Mohan
- Dukes' Club, Association of Coloproctology of Great Britain and Ireland, Royal College of Surgeons of England, London, UK
| | - J T Jenkins
- Advanced Malignancy Subcommittee, Association of Coloproctology of Great Britain and Ireland, Royal College of Surgeons of England, London, UK
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