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Kohrman NM, Wlodarczyk JR, Ding L, McAndrew NP, Algaze SD, Cologne KG, Lee SW, Koller SE. Rectal Cancer Survival for Residual Carcinoma In Situ Versus Pathologic Complete Response After Neoadjuvant Therapy. Dis Colon Rectum 2024; 67:920-928. [PMID: 38498775 DOI: 10.1097/dcr.0000000000003261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
BACKGROUND Pathologic complete response after neoadjuvant chemoradiotherapy for rectal cancer is associated with improved survival. It is unclear whether residual carcinoma in situ portends a similar outcome. OBJECTIVE To compare the survival of patients with locally advanced rectal cancer who received neoadjuvant therapy and achieved pathologic carcinoma in situ versus pathologic complete response. DESIGN Retrospective cohort study. SETTING National public database. PATIENTS A total of 4594 patients in the National Cancer Database from 2006 to 2016 with locally advanced rectal cancer who received neoadjuvant therapy, underwent surgery, and had node-negative ypTis or ypT0 on final pathology were included. Of these, 4321 patients (94.1%) had ypT0 and 273 (5.9%) had ypTis on final pathology. MAIN OUTCOME MEASURE Overall survival. RESULTS The median age was 60 years, and 1822 patients (39.7%) were women. On initial staging, 54.5% (n = 2503) had stage II disease and 45.5% (n = 2091) had stage III disease. The ypTis group had decreased overall survival compared to the ypT0 group (HR 1.42; 95% CI, 1.04-1.95; p = 0.028). Other factors associated with decreased overall survival were older age at diagnosis, increasing Charlson-Deyo score, and poorly differentiated tumor grade. Variables associated with improved survival were female sex, private insurance, and receipt of both neoadjuvant and adjuvant chemotherapy. For the total cohort, there was no difference in survival between clinical stage II and stage III. LIMITATIONS Standard therapy versus total neoadjuvant therapy could not be abstracted. Overall survival was defined as the time from surgery to death from any cause or last contact, allowing for some erroneously misclassified deaths. CONCLUSIONS ypTis is associated with worse overall survival than ypT0 for patients with locally advanced rectal cancer who receive neoadjuvant chemoradiotherapy followed by surgery. For this cohort, clinical stage was not a significant predictor of survival. Prospective trials comparing survival for these pathologic outcomes are needed. See Video Abstract . SUPERVIVENCIA DEL CNCER DE RECTO PARA EL CARCINOMA RESIDUAL IN SITU VS RESPUESTA PATOLGICA COMPLETA DESPUS DE LA TERAPIA NEOADYUVANTE ANTECEDENTESLa respuesta patológica completa después de la quimiorradioterapia neoadyuvante para el cáncer de recto se asocia con una mayor supervivencia. No está claro si el carcinoma residual in situ presagia un resultado similar.OBJETIVOComparar la supervivencia de pacientes con cáncer de recto localmente avanzado que recibieron terapia neoadyuvante y lograron un carcinoma patológico in situ versus una respuesta patológica completa.DISEÑOEstudio de cohorte retrospectivo.ESCENARIOBase de datos pública nacional.PACIENTESSe incluyeron 4,594 pacientes de la Base de Datos Nacional de Cáncer de 2006 a 2016 con cáncer de recto localmente avanzado que recibieron terapia neoadyuvante, fueron sometidos a cirugía y tuvieron ganglios negativos, ypTis o ypT0 en el reporte patológico final. 4.321 (94,1%) tuvieron ypT0 y 273 (5,9%) tuvieron ypTis en el reporte final.PRINCIPALES MEDIDAS DE RESULTADOSupervivencia general.RESULTADOSLa mediana de edad fue de 60 años. 1.822 pacientes (39,7%) fueron mujeres. El 54,5% (n = 2.503) tuvo la enfermedad en estadio II y el 45,5% (n = 2.091) tuvo la enfermedad en estadio III según la estadificación inicial. El grupo ypTis tuvo una supervivencia general reducida en comparación con el grupo ypT0 (HR 1,42, IC 95 % 1,04-1,95, p = 0,028). Otros factores asociados con una menor supervivencia general fueron una edad más avanzada al momento del diagnóstico, un aumento de la puntuación de Charlson-Deyo y un grado tumoral poco diferenciado. Las variables asociadas con una mejor supervivencia fueron el sexo femenino, el seguro privado y la recepción de quimioterapia neoadyuvante y adyuvante. Para la cohorte total, no hubo diferencias en la supervivencia entre el estadio clínico 2 y el estadio 3.LIMITACIONESNo se pudo resumir el tratamiento estándar versus el tratamiento neoadyuvante total. La supervivencia general se definió como el tiempo transcurrido desde la cirugía hasta la muerte por cualquier causa o último contacto, lo que permite algunas muertes erróneamente clasificadas.CONCLUSIONESypTis se asocia con una peor supervivencia general que ypT0 en pacientes con cáncer de recto localmente avanzado que reciben quimiorradioterapia neoadyuvante seguida de cirugía. Para esta cohorte, el estadio clínico no fue un predictor significativo de supervivencia. Se necesitan ensayos prospectivos que comparen la supervivencia de estos resultados patológicos. ( Traducción-Dr Osvaldo Gauto ).
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Affiliation(s)
- Nathan M Kohrman
- University of Southern California Keck School of Medicine, Los Angeles, California
| | - Jordan R Wlodarczyk
- Department of Surgery, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Li Ding
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Nicholas P McAndrew
- Division of Hematology/Oncology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California
| | - Sandra D Algaze
- Division of Medical Oncology, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Kyle G Cologne
- Division of Colorectal Surgery, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Sang W Lee
- Division of Colorectal Surgery, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Sarah E Koller
- Division of Colorectal Surgery, University of Southern California Keck School of Medicine, Los Angeles, California
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de Moraes FCA, Kelly FA, Souza MEC, Burbano RMR. Impact of adjuvant chemotherapy on survival after pathological complete response in rectal cancer: a meta-analysis of 31,558 patients. Int J Colorectal Dis 2024; 39:96. [PMID: 38913175 PMCID: PMC11196358 DOI: 10.1007/s00384-024-04668-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/12/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND Locally advanced rectal cancer (LARC) typically involves neoadjuvant chemoradiotherapy (nCRT) followed by surgery (total mesorectal excision, TME). While achieving a complete pathological response (pCR) is a strong indicator of a positive prognosis, the specific benefits of adjuvant chemotherapy after pCR remain unclear. To address this knowledge gap, we conducted a systematic review and meta-analysis to assess the potential advantages of adjuvant therapy in patients who achieve pCR. METHODS In this study, we searched Medline, Embase, and Web of Science databases for relevant research. We focused on binary outcomes, analyzing them using odds ratios (ORs) with 95% confidence intervals (CIs). To account for potential variability between studies, all endpoints were analyzed with DerSimonian and Laird random-effects models. We assessed heterogeneity using the I2 statistic and employed the R statistical software (version 4.2.3) for all analyses. RESULTS Thirty-four studies, comprising 31,558 patients, were included. The outcomes demonstrated a significant difference favoring the AC group in terms of overall survival (OS) (HR 0.75; 95% CI 0.60-0.94; p = 0.015; I2 = 0%), and OS in 5 years (OR 1.65; 95% CI 1.21-2.24; p = 0.001; I2 = 39%). There was no significant difference between the groups for disease-free survival (DFS) (HR 0.94; 95% CI 0.76-1.17; p = 0.61; I2 = 17%), DFS in 5 years (OR 1.19; 95% CI 0.82-1.74; p = 0.36; I2 = 43%), recurrence-free survival (RFS) (HR 1.10; 95% CI 0.87-1.40; p = 0.39; I2 = 0%), and relapse-free survival (OR 1.08; 95% CI 0.78-1.51; p = 0.62; I2 = 0%). CONCLUSION This systematic review and meta-analysis found a significant difference in favor of the ACT group in terms of survival after pCR. Therefore, the administration of this treatment as adjuvant therapy should be encouraged in clinical practice.
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Affiliation(s)
| | - Francinny Alves Kelly
- Department of Hypertension, Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil
| | | | - Rommel Mario Rodríguez Burbano
- Federal University of Pará, Rua Augusto Corrêa, nº 01, Guamá, Belém, Pará, 66073-000, Brazil
- Ophir Loyola Hospital, Belém, Pará, Brazil
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Kim S, Huh JW, Lee WY, Yun SH, Kim HC, Cho YB, Park Y, Shin JK. Predicting survival in locally advanced rectal cancer with effective chemoradiotherapy response. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108361. [PMID: 38657375 DOI: 10.1016/j.ejso.2024.108361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/07/2024] [Accepted: 04/19/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Locally advanced rectal cancer patients often display favorable responses and favorable oncologic outcomes. Due to the low recurrence rate, there is scarcity of studies investigating the prognostic factors influencing their survival. Therefore, our study sought to assess the prognostic factors associated with survival in rectal cancer patients who achieved either a pathologic complete response or a pathologic stage I after neoadjuvant chemoradiotherapy combined with radical resection. METHODS In this retrospective study, we analyzed data from cohort of 1394 patients diagnosed with locally advanced rectal cancer who underwent neoadjuvant chemoradiotherapy combined with total mesorectal excision from January 2008 to April 2017. Finally, we selected 474 (34.2 %) who exhibited either a pathologic complete response or attained pathologic stage I following the treatment. Subsequently, we analyzed the prognostic factors influencing disease-free and overall survival. RESULTS A total of 161 (34 %) achieved a pathologic complete response. Our analysis revealed that circumferential resection margin and the administration of adjuvant chemotherapy were prognostic factors for disease-free survival (p = 0.011, p = 0.022). Furthermore, factors influencing overall survival included the clinical N stage and administration of adjuvant chemotherapy (p = 0.035, p = 0.015). CONCLUSION In conclusion, the circumferential resection margin, clinical N stage, and administration of adjuvant chemotherapy were prognostic factors for survival in patients showing good response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer. For patients with a positive circumferential resection margin and clinical N (+) stage, intensive follow-up might be needed to achieve favorable oncologic outcomes. Also, we recommend considering adjuvant chemotherapy as a beneficial treatment approach for these patients.
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Affiliation(s)
- Seijong Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung Wook Huh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Woo Yong Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seong Hyeon Yun
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hee Cheol Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yong Beom Cho
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yoonah Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung Kyong Shin
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Ochiai K, Bhutiani N, Ikeda A, Uppal A, White MG, Peacock O, Messick CA, Bednarski BK, You YQN, Skibber JM, Chang GJ, Konishi T. Total Neoadjuvant Therapy for Rectal Cancer: Which Regimens to Use? Cancers (Basel) 2024; 16:2093. [PMID: 38893212 PMCID: PMC11171181 DOI: 10.3390/cancers16112093] [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: 04/11/2024] [Revised: 05/21/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
Total neoadjuvant therapy (TNT) is a novel strategy for rectal cancer that administers both (chemo)radiotherapy and systemic chemotherapy before surgery. TNT is expected to improve treatment compliance, tumor regression, organ preservation, and oncologic outcomes. Multiple TNT regimens are currently available with various combinations of the treatments including induction or consolidation chemotherapy, triplet or doublet chemotherapy, and long-course chemoradiotherapy or short-course radiotherapy. Evidence on TNT is rapidly evolving with new data on clinical trials, and no definitive consensus has been established on which regimens to use for improving outcomes. Clinicians need to understand the advantages and limitations of the available regimens for multidisciplinary decision making. This article reviews currently available evidence on TNT for rectal cancer. A decision making flow chart is provided for tailor-made use of TNT regimens based on tumor location and local and systemic risk.
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Affiliation(s)
- Kentaro Ochiai
- Department of Colon and Rectal Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA; (K.O.); (N.B.); (A.I.); (A.U.); (O.P.); (C.A.M.); (B.K.B.); (Y.-Q.N.Y.); (J.M.S.); (G.J.C.)
- Department of Colon and Rectal Surgery, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Neal Bhutiani
- Department of Colon and Rectal Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA; (K.O.); (N.B.); (A.I.); (A.U.); (O.P.); (C.A.M.); (B.K.B.); (Y.-Q.N.Y.); (J.M.S.); (G.J.C.)
| | - Atsushi Ikeda
- Department of Colon and Rectal Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA; (K.O.); (N.B.); (A.I.); (A.U.); (O.P.); (C.A.M.); (B.K.B.); (Y.-Q.N.Y.); (J.M.S.); (G.J.C.)
| | - Abhineet Uppal
- Department of Colon and Rectal Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA; (K.O.); (N.B.); (A.I.); (A.U.); (O.P.); (C.A.M.); (B.K.B.); (Y.-Q.N.Y.); (J.M.S.); (G.J.C.)
| | - Michael G. White
- Department of Colon and Rectal Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA; (K.O.); (N.B.); (A.I.); (A.U.); (O.P.); (C.A.M.); (B.K.B.); (Y.-Q.N.Y.); (J.M.S.); (G.J.C.)
| | - Oliver Peacock
- Department of Colon and Rectal Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA; (K.O.); (N.B.); (A.I.); (A.U.); (O.P.); (C.A.M.); (B.K.B.); (Y.-Q.N.Y.); (J.M.S.); (G.J.C.)
| | - Craig A. Messick
- Department of Colon and Rectal Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA; (K.O.); (N.B.); (A.I.); (A.U.); (O.P.); (C.A.M.); (B.K.B.); (Y.-Q.N.Y.); (J.M.S.); (G.J.C.)
| | - Brian K. Bednarski
- Department of Colon and Rectal Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA; (K.O.); (N.B.); (A.I.); (A.U.); (O.P.); (C.A.M.); (B.K.B.); (Y.-Q.N.Y.); (J.M.S.); (G.J.C.)
| | - Yi-Qian Nancy You
- Department of Colon and Rectal Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA; (K.O.); (N.B.); (A.I.); (A.U.); (O.P.); (C.A.M.); (B.K.B.); (Y.-Q.N.Y.); (J.M.S.); (G.J.C.)
| | - John M. Skibber
- Department of Colon and Rectal Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA; (K.O.); (N.B.); (A.I.); (A.U.); (O.P.); (C.A.M.); (B.K.B.); (Y.-Q.N.Y.); (J.M.S.); (G.J.C.)
| | - George J. Chang
- Department of Colon and Rectal Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA; (K.O.); (N.B.); (A.I.); (A.U.); (O.P.); (C.A.M.); (B.K.B.); (Y.-Q.N.Y.); (J.M.S.); (G.J.C.)
| | - Tsuyoshi Konishi
- Department of Colon and Rectal Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA; (K.O.); (N.B.); (A.I.); (A.U.); (O.P.); (C.A.M.); (B.K.B.); (Y.-Q.N.Y.); (J.M.S.); (G.J.C.)
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Yu Y, Wu H, Qiu J, Wu S, Gan Y, Shao L, Lin C, Hong L, Wu J. Analysis of risk characteristics for early progression and late progression in locally advanced rectal cancer patients: a large population-based and validated study. Support Care Cancer 2024; 32:340. [PMID: 38733415 DOI: 10.1007/s00520-024-08546-8] [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: 01/24/2024] [Accepted: 05/03/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND AND OBJECTIVE The current study aimed to explore the factors influencing early progression (EP) and late progression (LP) in locally advanced rectal cancer (LARC) patients. METHODS The patients were classified into EP and LP groups using one year as a cutoff. The random survival forest model was utilized to calculate the probability of time-to-progression. Besides, inverse probability of treatment weighting (IPTW) analysis and the Surveillance, Epidemiology, and End Results (SEER) were conducted to validate our results. RESULTS Our study revealed that PNI, CEA level, and pathological stage were independent prognostic factors for PFS both in EP group and LP group. For EP group patients, Group 1 had the highest probability of progression at the 9th month of follow-up, while Group 2 exhibited the highest probability at the 6th month. Group 3, on the other hand, showed two peaks of progression at the 4th and 8th months of follow-up. As for LP group patients, Groups 4, 5, and 6 all exhibited peaks of progression between the 18th and 24th months of follow-up. Furthermore, our results suggested that PNI was also an independent prognostic factor affecting OS in both EP group and LP group. Finally, the analysis of IPTW and SEER database further confirmed our findings. CONCLUSIONS Our results indicated a significant correlation between immune and nutritional status with PFS and OS in both EP and LP groups. These insights can aid healthcare professionals in effectively identifying and evaluating patients' nutritional status, enabling them to develop tailored nutrition plans and interventions.
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Affiliation(s)
- Yilin Yu
- Department of Radiation Oncology, Fujian Cancer Hospital, Clinical Oncology School of Fujian Medical University, Fuzhou, Fujian, China
| | - Haixia Wu
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Jianjian Qiu
- Department of Radiation Oncology, Fujian Cancer Hospital, Clinical Oncology School of Fujian Medical University, Fuzhou, Fujian, China
| | - Shiji Wu
- Department of Radiation Oncology, Fujian Cancer Hospital, Clinical Oncology School of Fujian Medical University, Fuzhou, Fujian, China
| | - Yixiu Gan
- Department of Radiation Oncology, Fujian Cancer Hospital, Clinical Oncology School of Fujian Medical University, Fuzhou, Fujian, China
| | - Lingdong Shao
- Department of Radiation Oncology, Fujian Cancer Hospital, Clinical Oncology School of Fujian Medical University, Fuzhou, Fujian, China
| | - Cheng Lin
- Department of Radiation Oncology, Fujian Cancer Hospital, Clinical Oncology School of Fujian Medical University, Fuzhou, Fujian, China.
| | - Liang Hong
- Department of Radiation Oncology, Fujian Cancer Hospital, Clinical Oncology School of Fujian Medical University, Fuzhou, Fujian, China.
| | - Junxin Wu
- Department of Radiation Oncology, Fujian Cancer Hospital, Clinical Oncology School of Fujian Medical University, Fuzhou, Fujian, China.
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Yang J, Deng Q, Chen Z, Chen Y, Fu Z. The role of adjuvant chemotherapy in rectal cancer patients with ypT0-2N0 after neoadjuvant chemoradiotherapy. Front Oncol 2024; 14:1338098. [PMID: 38406812 PMCID: PMC10889113 DOI: 10.3389/fonc.2024.1338098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/29/2024] [Indexed: 02/27/2024] Open
Abstract
Background Neoadjuvant chemoradiotherapy has emerged as the established treatment for locally advanced rectal cancer. Nevertheless, there remains a debate regarding the necessity of adjuvant chemotherapy for patients with locally advanced rectal cancer who exhibit a favorable tumor response (ypT0-2N0) after neoadjuvant chemoradiotherapy and surgery. Thus, the objective of this study is to investigate the impact of adjuvant chemotherapy on the oncological prognosis of rectal cancer patients who have a good response to neoadjuvant chemoradiotherapy. Materials and methods The study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. Articles were searched in the Web of Science, PubMed, and Cochrane Library databases. The primary outcomes assessed were 5-year overall survival, disease-free survival, cancer-specific survival, recurrence-free survival, local recurrence, and distant metastasis. The data was summarized using a random effects model. Results A meta-analysis was conducted using 18 retrospective studies published between 2009 and 2023. The studies included 9 from China and 5 from Korea, involving a total of 6566 patients with ypT0-2N0 rectal cancer after neoadjuvant chemoradiotherapy. The pooled data revealed that adjuvant chemotherapy significantly improved 5-year overall survival (OR=1.75, 95% CI: 1.15-2.65, P=0.008), recurrence-free survival (OR=1.73, 95% CI: 1.20-2.48, P=0.003), and reduced distant metastasis (OR=0.68, 95% CI: 0.51-0.92, P=0.011). However, adjuvant chemotherapy did not have a significant effect on disease-free survival, cancer-specific survival, and local recurrence in ypT0-2N0 rectal cancer. Subgroup analysis indicated that adjuvant chemotherapy was beneficial in improving overall survival for ypT1-2N0 rectal cancer (OR=1.89, 95% CI: 1.13-3.19, P=0.003). Conclusion The findings of the meta-analysis suggest that adjuvant chemotherapy may provide benefits in terms of oncological outcomes for rectal cancer patients with ypT0-2N0 after neoadjuvant chemoradiotherapy and radical surgery. However, further prospective clinical studies are needed to confirm these findings.
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Affiliation(s)
- Jianguo Yang
- Department of General Surgery, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qican Deng
- Department of General Surgery, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhenzhou Chen
- Department of General Surgery, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yajun Chen
- Department of General Surgery, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhongxue Fu
- Department of General Surgery, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Yang J, Deng Q, Cheng Y, Fu Z, Wu X. Effect of adjuvant chemotherapy on the oncological outcome of rectal cancer patients with pathological complete response. World J Surg Oncol 2024; 22:31. [PMID: 38273352 PMCID: PMC10809453 DOI: 10.1186/s12957-024-03300-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 01/13/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Locally advanced rectal cancer is typically treated using a combination of neoadjuvant chemoradiotherapy and total mesorectal resection. While achieving pathological complete response following neoadjuvant chemoradiotherapy has been recognized as a positive prognostic factor in oncology, the necessity of adjuvant chemotherapy for locally advanced rectal cancer patients with pathological complete response after surgery remains uncertain. The objective of this meta-analysis was to examine the impact of adjuvant chemotherapy on the oncological outcomes of rectal cancer patients who attain pathological complete response after neoadjuvant chemoradiotherapy. METHODS This meta-analysis followed the guidelines outlined in the preferred reporting items for systematic review and meta-analysis (PRISMA). The Web of Science, PubMed, and Cochrane Library databases were systematically searched to identify relevant literature. RESULTS A total of 34 retrospective studies, including 9 studies from the NCBD database, involving 31,558 patients with pathological complete response rectal cancer, were included in the meta-analysis. The included studies were published between 2008 and 2023. The pooled analysis demonstrated that adjuvant chemotherapy significantly improved overall survival (HR = 0.803, 95% CI 0.678-0.952, P = 0.011), and no heterogeneity was observed (I2 = 0%). Locally advanced rectal cancer patients with pathological complete response who underwent adjuvant chemotherapy exhibited a higher 5-year overall survival rate compared to those who did not receive adjuvant chemotherapy (OR = 1.605, 95% CI 1.183-2.177, P = 0.002). However, the analysis also revealed that postoperative ACT did not lead to improvements in disease-free survival and recurrence-free survival within the same patient population. Subgroup analysis indicated that pathological complete response patients with clinical stage T3/T4, lymph node positivity, and younger than 70 years of age may benefit from adjuvant chemotherapy in terms of overall survival. CONCLUSIONS The findings of this meta-analysis suggest that adjuvant chemotherapy has a beneficial effect on improving overall survival among rectal cancer patients with pathological complete response. However, no such association was observed in terms of disease-free survival and recurrence-free survival.
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Affiliation(s)
- Jianguo Yang
- Department of General Surgery, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, 401120, China
| | - Qican Deng
- Department of General Surgery, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, 401120, China
| | - Yong Cheng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Zhongxue Fu
- Department of General Surgery, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, 401120, China
| | - Xin Wu
- Department of General Surgery, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, 401120, China.
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Xue W, Wang T, Yao J, Wu W, Chen D, Yan B, Dong X, Tang Y, Zeng Y, He Y, Cao P, Shao F, Huang W, Deng C, Yan J. Use of patient-derived tumor organoid platform to predict the benefit of postoperative adjuvant chemotherapy for poor responders to neoadjuvant chemoradiotherapy in locally advanced rectal cancer. Bioeng Transl Med 2023; 8:e10586. [PMID: 38023722 PMCID: PMC10658544 DOI: 10.1002/btm2.10586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/28/2023] [Accepted: 07/21/2023] [Indexed: 12/01/2023] Open
Abstract
Postoperative adjuvant chemotherapy (AC) for poor responders to neoadjuvant chemoradiotherapy (nCRT) remains debatable among patients with locally advanced rectal cancer (LARC), necessitating biomarkers to accurately predict the benefits of AC. This study aimed to develop a patient-derived tumor organoid (PDTO) platform to predict the benefit of AC in LARC patients showing poor nCRT response. PDTOs were established using irradiated rectal cancer specimens with poor nCRT responses, and their sensitivity to chemotherapy regimens was tested. The half-maximal inhibitory concentration (IC50) value for the PDTO drug test was defined based on the clinical outcomes, and the accuracy of the PDTO prognostic predictions was calculated. Predictive models were developed and validated using the PDTO drug test results. Between October 2018 and December 2021, 86 PDTOs were successfully constructed from 138 specimens (success rate 62.3%). The optimal IC50 cut-off value for the organoid drug test was 39.31 μmol/L, with a sensitivity of 84.75%, a specificity of 85.19%, and an accuracy of 84.88%. Multivariate Cox regression analysis revealed that the PDTO drug test was an independent predictor of prognosis. A nomogram based on the PDTO drug test was developed, showing good prognostic ability in predicting the 2-year and 3-year disease-free survivals (AUC of 0.826 [95% CI, 0.721-0.931] and 0.902 [95% CI, 0.823-0.982], respectively) and overall survivals (AUC of 0.859 [95% CI, 0.745-0.973] and 0.885 [95% CI, 0.792-0.978], respectively). The PDTO drug test can predict the benefit of postoperative AC in poor responders with LARC to nCRT.
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Affiliation(s)
- Weisong Xue
- Department of General Surgery, Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal CancerNanfang Hospital, The First School of Clinical Medicine, Southern Medical UniversityGuangzhouGuangdongPeople's Republic of China
- Department of Gastrointestinal SurgeryShenzhen People's Hospital, The Second Clinical Medical College, Jinan UniversityShenzhenGuangdongChina
- Department of Gastrointestinal SurgeryShenzhen People's Hospital, The First Affiliated Hospital, Southern University of Science and TechnologyShenzhenGuangdongChina
| | - Ting Wang
- Department of General Surgery, Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal CancerNanfang Hospital, The First School of Clinical Medicine, Southern Medical UniversityGuangzhouGuangdongPeople's Republic of China
| | - Jiaxin Yao
- Department of General Surgery, Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal CancerNanfang Hospital, The First School of Clinical Medicine, Southern Medical UniversityGuangzhouGuangdongPeople's Republic of China
| | - Wei Wu
- Department of General Surgery, Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal CancerNanfang Hospital, The First School of Clinical Medicine, Southern Medical UniversityGuangzhouGuangdongPeople's Republic of China
| | - Dexin Chen
- Department of General Surgery, Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal CancerNanfang Hospital, The First School of Clinical Medicine, Southern Medical UniversityGuangzhouGuangdongPeople's Republic of China
| | - Botao Yan
- Department of General Surgery, Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal CancerNanfang Hospital, The First School of Clinical Medicine, Southern Medical UniversityGuangzhouGuangdongPeople's Republic of China
| | - Xiaoyu Dong
- Department of General Surgery, Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal CancerNanfang Hospital, The First School of Clinical Medicine, Southern Medical UniversityGuangzhouGuangdongPeople's Republic of China
| | - Yuting Tang
- Department of General Surgery, Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal CancerNanfang Hospital, The First School of Clinical Medicine, Southern Medical UniversityGuangzhouGuangdongPeople's Republic of China
| | - Yunli Zeng
- Department of General Surgery, Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal CancerNanfang Hospital, The First School of Clinical Medicine, Southern Medical UniversityGuangzhouGuangdongPeople's Republic of China
| | - Yueyu He
- Department of General Surgery, Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal CancerNanfang Hospital, The First School of Clinical Medicine, Southern Medical UniversityGuangzhouGuangdongPeople's Republic of China
| | - Peihua Cao
- Clinical Research Center, Zhujiang Hospital, Department of BiostatisticsSchool of Public Health, Southern Medical UniversityGuangzhouGuangdongPeople's Republic of China
| | - Fangyuan Shao
- Cancer Center, Faculty of Health SciencesUniversity of MacauMacauPeople's Republic of China
| | - Wenhua Huang
- Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics, National Key Discipline of Human AnatomySchool of Basic Medical Sciences, Southern Medical UniversityGuangzhouGuangdongPeople's Republic of China
| | - Chuxia Deng
- Cancer Center, Faculty of Health SciencesUniversity of MacauMacauPeople's Republic of China
| | - Jun Yan
- Department of General Surgery, Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal CancerNanfang Hospital, The First School of Clinical Medicine, Southern Medical UniversityGuangzhouGuangdongPeople's Republic of China
- Department of Gastrointestinal SurgeryShenzhen People's Hospital, The Second Clinical Medical College, Jinan UniversityShenzhenGuangdongChina
- Department of Gastrointestinal SurgeryShenzhen People's Hospital, The First Affiliated Hospital, Southern University of Science and TechnologyShenzhenGuangdongChina
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Kim S, Huh JW, Lee WY, Yun SH, Kim HC, Cho YB, Park YA, Shin JK. Prognostic Impact of Lymphatic Invasion, Venous Invasion, Perineural Invasion, and Tumor Budding in Rectal Cancer Treated With Neoadjuvant Chemoradiotherapy Followed by Total Mesorectal Excision. Dis Colon Rectum 2023; 66:905-913. [PMID: 35195558 DOI: 10.1097/dcr.0000000000002266] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The diagnostic implications of lymphatic invasion, venous invasion, perineural invasion, and tumor budding in rectal cancer treated with neoadjuvant chemoradiotherapy are unknown. OBJECTIVE This study aimed to identify the prognostic impact of lymphatic invasion, venous invasion, perineural invasion, and tumor budding in locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy. DESIGN This was a retrospective cohort study. SETTINGS This study was conducted at the Samsung Medical Center. Grouping was performed on the basis of lymphatic invasion, venous invasion, perineural invasion, and tumor budding status: no-risk group with 0 factor (n = 299), low-risk group with any 1 factor (n = 131), intermediate-risk group with any 2 factors (n = 75), and high-risk group with 3 or 4 risk factors (n = 32). PATIENTS Patients who underwent neoadjuvant chemoradiotherapy, followed by radical operation for locally advanced rectal cancer, from January 2010 to December 2015 were included. MAIN OUTCOME MEASURES The main outcome measures were disease-free and overall survival. RESULTS Disease-free and overall survival varied significantly between the groups in stage III ( p < 0.001 and p < 0.001). Disease-free survival in stage I differed between the no-risk group and the intermediate-risk group ( p = 0.026). In stage II, disease-free and overall survival differed between the no-risk group and the intermediate-risk group ( p = 0.010 and p = 0.045). In multivariable analysis, risk grouping was an independent prognostic factor for both disease-free (p <0.001) and overall survival ( p < 0.001). LIMITATIONS The inherent limitations are associated with the retrospective single-center study design. CONCLUSIONS Lymphatic invasion, venous invasion, perineural invasion, and tumor budding are strong prognostic factors for disease-free and overall survival in locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy. Therefore, adjuvant chemotherapy is strongly recommended in patients with positive lymphatic invasion, venous invasion, perineural invasion, and tumor budding. See Video Abstract at http://links.lww.com/DCR/B919 . IMPACTO PRONSTICO DE LA INVASIN LINFTICA, LA INVASIN VENOSA, LA INVASIN PERINEURAL Y LA GEMACIN TUMORAL EN EL CNCER DE RECTO TRATADO CON QUIMIORRADIOTERAPIA NEOADYUVANTE SEGUIDA DE ESCISIN TOTAL DEL MESORRECTO ANTECEDENTES:Se desconocen las implicaciones diagnósticas de la invasión linfática, la invasión venosa, la invasión perineural y el crecimiento tumoral en el cáncer de recto tratado con quimiorradioterapia neoadyuvante.OBJETIVO:Este estudio fue diseñado para identificar el impacto pronóstico de la invasión linfática, la invasión venosa, la invasión perineural y la gemación tumoral en el cáncer de recto localmente avanzado tratado con quimiorradioterapia neoadyuvante.DISEÑO:Este estudio fue un estudio de cohorte retrospectivo.AJUSTES:Este estudio se realizó en el Centro Médico Samsung. La agrupación se realizó en función de la invasión linfática, la invasión venosa, la invasión perineural y el estado de crecimiento del tumor: grupo sin riesgo con 0 factores (n = 299), grupo de bajo riesgo con cualquier factor 1 (n = 131), grupo de riesgo intermedio con 2 factores cualquiera (n = 75), y un grupo de alto riesgo con 3 o 4 factores de riesgo (n = 32).PACIENTES:Se incluyeron un total de 537 pacientes que se sometieron a quimiorradioterapia neoadyuvante seguida de operación radical por cáncer de recto localmente avanzado desde enero de 2010 hasta diciembre de 2015.PRINCIPALES MEDIDAS DE RESULTADO:Las principales medidas de resultado fueron la supervivencia libre de enfermedad y la supervivencia general.RESULTADOS:La mediana del período de seguimiento fue de 77 meses, y la supervivencia libre de enfermedad a los 5 años y la supervivencia general a los 5 años variaron significativamente entre los grupos en el estadio III (p < 0,001, p < 0,001). La supervivencia libre de enfermedad a los 5 años en el estadio I difirió entre el grupo sin riesgo y el grupo de riesgo intermedio (p = 0,026). En el estadio II, la supervivencia libre de enfermedad a 5 años y la supervivencia global a 5 años difirieron entre el grupo sin riesgo y el grupo de riesgo intermedio p = 0,010, p = 0,045). En el análisis multivariable, la agrupación de riesgo fue un factor pronóstico independiente tanto para la supervivencia libre de enfermedad (p < 0,001) como para la supervivencia global (p < 0,001).LIMITACIÓN:Las limitaciones inherentes están asociadas con el diseño de estudio retrospectivo de un solo centro..CONCLUSIÓN:La invasión linfática, la invasión venosa, la invasión perineural y la gemación tumoral son fuertes factores pronósticos para la supervivencia libre de enfermedad y la supervivencia general en el cáncer de recto localmente avanzado tratado con quimiorradioterapia neoadyuvante. Por lo tanto, se recomienda fuertemente la quimioterapia adyuvante en pacientes con invasión linfática positiva, invasión venosa, invasión perineural y tumor en en formacion. Consulte Video Resumen en http://links.lww.com/DCR/B919 . (Traducción-Dr Yolanda Colorado ).
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Affiliation(s)
- Seijong Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Lu S, Chen Z, Peng R, Zhang Q, Wang Y, Li X, Qu R, Zhou X, Fu W, Sun T, Wang H. Prognostic effect of preoperative Controlling Nutritional Status score in patients with locally advanced rectal cancer: A two-center, retrospective study. Nutrition 2023; 112:112078. [PMID: 37267656 DOI: 10.1016/j.nut.2023.112078] [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: 01/09/2023] [Revised: 04/25/2023] [Accepted: 05/08/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVES This study aimed to identify the prognosis relevant to the Controlling Nutritional Status (CONUT) score in locally advanced rectal cancer patients who were treated with neoadjuvant chemoradiotherapy before radical surgery. METHODS From a retrospective database of 568 patients undergoing radical surgery for rectal cancer at two Chinese institutions between 2012 and 2022, data for 300 patients with locally advanced rectal cancer were identified. The optimal cutoff value for the CONUT score in predicting overall survival (OS) was determined using X-tile software. The associations of the CONUT score with the recurrent metastasis and clinicopathologic parameters were analyzed. The CONUT score's ability to predict OS was also compared with other prognostic markers. Univariate and multivariate Cox regression analysis for OS was performed. Subgroup analysis was conducted to evaluate further the CONUT score's predicting value. RESULTS The optimal CONUT score cutoff value was determined as 5 according to X-tile. Patients were divided into CONUT-high (CONUT score ≥ 5) and CONUT-low (CONUT score < 5) groups. CONUT score is significantly correlated with hemoglobin, globulin, and platelets. Time-dependent receiver operating characteristic of the CONUT score predicting OS outperformed all common prognostic markers. Multivariate Cox regression analysis identified CONUT score as an independent prognostic factor for OS (hazard ratio = 5.701; 95% CI, 2.336-13.914; P < 0.001). In the subgroups of age, sex, carcinoembryonic antigen, ypTNM, and tumor response status, significant statistical differences can be observed between CONUT-high and -low. CONCLUSIONS The present study finds that the preoperative CONUT score may be a useful prognostic indicator in clinical scenarios.
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Affiliation(s)
- Siyi Lu
- Cancer Center, Peking University Third Hospital, Beijing, China; Department of General Surgery, Peking University Third Hospital, Beijing, China
| | - Zhaoyu Chen
- Department of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Ran Peng
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Qiuxiang Zhang
- Department of Clinical Nutrition, Peking University Third Hospital, Beijing, China
| | - Yuxia Wang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Xuemin Li
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Ruize Qu
- Cancer Center, Peking University Third Hospital, Beijing, China; Department of General Surgery, Peking University Third Hospital, Beijing, China
| | - Xin Zhou
- Cancer Center, Peking University Third Hospital, Beijing, China; Department of General Surgery, Peking University Third Hospital, Beijing, China
| | - Wei Fu
- Cancer Center, Peking University Third Hospital, Beijing, China; Department of General Surgery, Peking University Third Hospital, Beijing, China
| | - Tao Sun
- Cancer Center, Peking University Third Hospital, Beijing, China; Department of General Surgery, Peking University Third Hospital, Beijing, China
| | - Hao Wang
- Cancer Center, Peking University Third Hospital, Beijing, China; Department of Radiation Oncology, Peking University Third Hospital, Beijing, China.
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Zhang S, Chen S, Wang R, Wang Z, Zhou J, Li C. Clinical efficacy and safety analysis of CT-guided 125I implantation in the treatment of recurrent or metastatic pelvic malignant tumor. Brachytherapy 2023; 22:132-138. [PMID: 36586808 DOI: 10.1016/j.brachy.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 10/07/2022] [Accepted: 10/21/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE This study was conducted to evaluate the clinical efficacy and safety of computed tomography (CT)-guided 125I implantation in the treatment of recurrent or metastatic pelvic malignant tumor. METHODS AND MATERIALS This retrospective study analyzed the data of 30 patients with recurrent and metastatic pelvic malignant tumor who were treated with CT-guided 125I implantation between January 2016 and December 2020. Disease control rate, objective remission rate, overall survival (OS), pain relief rate, quality of life score, and complications were evaluated after the followup. RESULTS Median followup was 20.1 (7-30) months. Disease control rate was 86.67% at 6 months. Objective response rates at 1, 3, and 6 months were 36.67%, 60%, and 56.67%, respectively. OS rates at 12 and 24 months were 76.67% (23/30) and 33.33% (10/30), respectively. Progression-free survival rates at 12 and 24 months were 63.33% (19/30) and 33.33% (10/30), respectively. Postoperative pain relief rate was 86.67% (26/30). There were no major bleeding, pelvic abscess, intestinal fistula, intestinal perforation, and other serious complications. CONCLUSIONS CT-guided 125I seed implantation in the treatment of patients with pelvic malignant tumor is a simple operation and less traumatic and can improve patients' quality of life and reduce tumor load.
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Affiliation(s)
- Shenghe Zhang
- Department of Intervention, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Songbai Chen
- Department of Intervention, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Ruoyu Wang
- Department of Medical Oncology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China.
| | - Zhe Wang
- Department of Medical Oncology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Jun Zhou
- Department of Intervention, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Chuang Li
- Department of Intervention, Affiliated Zhongshan Hospital of Dalian University, Dalian, China.
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Diefenhardt M, Fleischmann M, Martin D, Hofheinz RD, Piso P, Germer CT, Hambsch P, Grützmann R, Kirste S, Schlenska-Lange A, Ghadimi M, Rödel C, Fokas E. Clinical outcome after total neoadjuvant treatment (CAO/ARO/AIO-12) versus intensified neoadjuvant and adjuvant treatment (CAO/ARO/AIO-04) a comparison between two multicenter randomized phase II/III trials. Radiother Oncol 2023; 179:109455. [PMID: 36572280 DOI: 10.1016/j.radonc.2022.109455] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/16/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Total neoadjuvant therapy (TNT) can enhance local tumor regression, but its survival benefits compared to intensified chemoradiotherapy (CRT) followed by adjuvant chemotherapy (CT) remain unclear. METHODS This is a secondary comparison between 607 patients treated with intensified 5-FU/Oxaliplatin neoadjuvant CRT and adjuvant CT within the experimental arm of the CAO/ARO/AIO-04 phase III trial, and 306 patients treated with TNT within the CAO/ARO/AIO-12 phase II trial. Comparison between clinical-pathological characteristics, surgical quality, and post-surgical complications were analyzed using the Pearson's Chi-squared or Mann-Whitney U test. Oncological outcome was examined with log-rank, Gray's test, and multivariate cox regression. In addition, further subgroup analyses and propensity score matching were performed to optimize the balance of baseline covariates. FINDINGS Patients treated with CRT followed by consolidation CT had a significantly higher rate of pathological complete remission (pCR) compared to patients treated within the experimental arm of the CAO/ARO/AIO-04 trial (25.3 % vs 17.3 %, P = 0.04). Post-surgical complications were less common in the CAO/ARO/AIO-12 trial. After a median follow-up of 46 months, clinical outcome did not differ significantly in the overall cohort, in any subgroup or after propensity score matching. In multivariate analysis, disease-free survival (DFS) was similar between the experimental arm of the CAO/ARO/AIO-04 trial and treatments arms of the CAO/ARO/AIO-12 trial (vs arm A: HR 0.92 [95 % CI 0.62-1.37], P = 0.69; vs arm B: HR 1.06 [95 % CI 0.72-1.58], P = 0.76). INTERPRETATION Notwithstanding the limitations of intertrial comparison, TNT did not improve long term oncological outcome in our study compared to the intensified neoadjuvant CRT and adjuvant CT treatment in the CAO/ARO/AIO-04 trial. Improved response rates after TNT offers an attractive option to explore organ preservation in selective patients with locally advanced rectal cancer.
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Affiliation(s)
- Markus Diefenhardt
- Department of Radiotherapy and Oncology, University of Frankfurt, 60596 Frankfurt am Main, Germany; Frankfurt Cancer Institute, 60596 Frankfurt am Main, Germany.
| | - Maximillian Fleischmann
- Department of Radiotherapy and Oncology, University of Frankfurt, 60596 Frankfurt am Main, Germany
| | - Daniel Martin
- Department of Radiotherapy and Oncology, University of Frankfurt, 60596 Frankfurt am Main, Germany; German Cancer Research Center (DKFZ), Heidelberg, German Cancer Consortium (DKTK), Partner Site Frankfurt am Main, 60596 Frankfurt am Main, Germany
| | - Ralf-Dieter Hofheinz
- Department of Medical Oncology, University Hospital Mannheim, 68135 Mannheim, Germany
| | - Pompiliu Piso
- Department of General and Visceral Surgery, Hospital Barmherzige Brüder Regensburg, 93049 Regensburg, Germany
| | | | - Peter Hambsch
- Department of Radiation Therapy, University of Leipzig, 04103 Leipzig, Germany
| | - Robert Grützmann
- Department of General and Visceral Surgery, University of Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Simon Kirste
- Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, 79098 Freiburg, Germany
| | - Anke Schlenska-Lange
- Department of Hematology and Medical Oncology, Hospital Barmherzige Brüder Regensburg, 93049 Regensburg, Germany
| | - Michael Ghadimi
- Department of General, Visceral and Pediatric Surgery, University Medical Center, 37075 Göttingen, Germany
| | - Claus Rödel
- Department of Radiotherapy and Oncology, University of Frankfurt, 60596 Frankfurt am Main, Germany; German Cancer Research Center (DKFZ), Heidelberg, German Cancer Consortium (DKTK), Partner Site Frankfurt am Main, 60596 Frankfurt am Main, Germany; Frankfurt Cancer Institute, 60596 Frankfurt am Main, Germany
| | - Emmanouil Fokas
- Department of Radiotherapy and Oncology, University of Frankfurt, 60596 Frankfurt am Main, Germany; German Cancer Research Center (DKFZ), Heidelberg, German Cancer Consortium (DKTK), Partner Site Frankfurt am Main, 60596 Frankfurt am Main, Germany; Frankfurt Cancer Institute, 60596 Frankfurt am Main, Germany
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13
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Lu S, Li X, Li X, Zhang Q, Wang Y, Peng R, Fu W, Wang H. The preoperative geriatric nutritional risk index predicts long-term prognosis in elderly locally advanced rectal cancer patients: a two-center retrospective cohort study. Aging Clin Exp Res 2023; 35:311-321. [PMID: 36399323 DOI: 10.1007/s40520-022-02297-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/31/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The objective is to explore the value of preoperative geriatric nutritional risk index (GNRI) in evaluating long-term prognosis in elderly locally advanced rectal cancer (LARC) patients who accepted neoadjuvant chemoradiotherapy (NCRT) and to compare GNRI with established nutritional markers, including prognostic nutritional index (PNI) and controlling nutritional status (CONUT) score. METHODS Preoperative GNRI was retrospectively assessed in 172 LARC patients aged ≥ 60 years who underwent radical resection after NCRT at two centers. Optimal cutoff value of GNRI was determined by X-tile program. The association of GNRI with clinicopathological parameters and nutritional markers was analyzed. The survival ability of markers was evaluated using time-dependent receiver-operating characteristic (ROC) curve analysis. Finally, survival analysis was performed using Kaplan-Meier and Cox regression analysis. RESULTS GNRI was highly correlated with nutritional markers. An optimal cutoff value for the GNRI was 96. In the time-dependent ROC curve, GNRI demonstrated a stable predictive ability for both disease-free survival (DFS) and overall survival (OS). Multivariate analysis showed that GNRI was the only nutritional marker that independently predicted DFS (HR 2.457, 95% CI 1.066-5.665, P = 0.035) and OS (HR 9.002, 95% CI 3.100-26.146, P < 0.001). As an additional benefit, GNRI was able to stratify survival in subgroups of ypTNM and tumor response. CONCLUSION Preoperative GNRI is a promising predictor of long-term survival for elderly LARC patients undergoing NCRT, superior to the established nutritional markers.
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Affiliation(s)
- Siyi Lu
- Cancer Center, Peking University Third Hospital, Beijing, 100191, China
- Department of General Surgery, Cancer Center, Peking University Third Hospital, Beijing, 100191, China
| | - Xianan Li
- Department of Radiation Oncology, Peking University People's Hospital, Beijing, 100044, China
| | - Xuemin Li
- Department of Radiation Oncology, Cancer Center, Peking University Third Hospital, Beijing, 100191, China
| | - Qiuxiang Zhang
- Department of Clinical Nutrition, Peking University Third Hospital, Beijing, 100191, China
| | - Yuxia Wang
- Department of Radiation Oncology, Cancer Center, Peking University Third Hospital, Beijing, 100191, China
| | - Ran Peng
- Department of Radiation Oncology, Cancer Center, Peking University Third Hospital, Beijing, 100191, China
| | - Wei Fu
- Cancer Center, Peking University Third Hospital, Beijing, 100191, China.
- Department of General Surgery, Cancer Center, Peking University Third Hospital, Beijing, 100191, China.
| | - Hao Wang
- Cancer Center, Peking University Third Hospital, Beijing, 100191, China.
- Department of Radiation Oncology, Cancer Center, Peking University Third Hospital, Beijing, 100191, China.
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Diefenhardt M, Schlenska-Lange A, Kuhnt T, Kirste S, Piso P, Bechstein WO, Hildebrandt G, Ghadimi M, Hofheinz RD, Rödel C, Fokas E. Total Neoadjuvant Therapy for Rectal Cancer in the CAO/ARO/AIO-12 Randomized Phase 2 Trial: Early Surrogate Endpoints Revisited. Cancers (Basel) 2022; 14:cancers14153658. [PMID: 35954320 PMCID: PMC9367426 DOI: 10.3390/cancers14153658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/03/2022] [Accepted: 07/19/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Early efficacy outcome measures in rectal cancer after total neoadjuvant treatment are increasingly investigated. We examined the prognostic role of pathological complete response (pCR), tumor regression grading (TRG) and neoadjuvant rectal (NAR) score for disease-free survival (DFS) in patients with rectal carcinoma treated within the CAO/ARO/AIO-12 randomized phase 2 trial. Methods: Distribution of pCR, TRG and NAR score was analyzed using the Pearson’s chi-squared test. Univariable analyses were performed using the log-rank test, stratified by treatment arm. Discrimination ability of non-pCR for DFS was assessed by analyzing the ROC curve as a function of time. Results: Of the 311 patients enrolled, 306 patients were evaluable (Arm A:156, Arm B:150). After a median follow-up of 43 months, the 3-year DFS was 73% in both groups (HR, 0.95, 95% CI, 0.63–1.45, p = 0.82). pCR tended to be higher in Arm B (17% vs. 25%, p = 0.086). In both treatment arms, pCR, TRG and NAR were significant prognostic factors for DFS, whereas survival in subgroups defined by pCR, TRG or NAR did not significantly differ between the treatment arms. The discrimination ability of non-pCR for DFS remained constant over time (C-Index 0.58) but was slightly better in Arm B (0.61 vs. 0.56). Conclusion: Although pCR, TRG and NAR were strong prognostic factors for DFS in the CAO/ARO/AIO-12 trial, their value in selecting one TNT approach over another could not be confirmed. Hence, the conclusion of a long-term survival benefit of one treatment arm based on early surrogate endpoints should be stated with caution.
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Affiliation(s)
- Markus Diefenhardt
- Department of Radiotherapy and Oncology, University of Frankfurt, 60596 Frankfurt, Germany; (C.R.); (E.F.)
- Frankfurt Cancer Institute, 60596 Frankfurt, Germany
- Correspondence: ; Tel.: +49-(0)69-63015130; Fax: +49-(0)69-63015091
| | - Anke Schlenska-Lange
- Department of Haematology and Oncology, Barmherzige Brüder Hospital Regensburg, 93049 Regensburg, Germany;
| | - Thomas Kuhnt
- Department of Radiation Oncology, University Hospital Leipzig, 04103 Leipzig, Germany;
| | - Simon Kirste
- Department of Radiation Oncology, Faculty of Medicine, Medical Center University of Freiburg, 79098 Freiburg, Germany;
- German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Partner Site: Freiburg, 69120 Heidelberg, Germany
| | - Pompiliu Piso
- Department of General and Visceral Surgery, Barmherzige Brüder Hospital, 93049 Regensburg, Germany;
| | - Wolf O. Bechstein
- Department of General and Visceral Surgery, University of Frankfurt, 60596 Frankfurt, Germany;
| | - Guido Hildebrandt
- Department of Radiotherapy, University of Rostock, 18051 Rostock, Germany;
| | - Michael Ghadimi
- Department of General and Visceral Surgery, University Medical Center Göttingen, 37075 Göttingen, Germany;
| | - Ralf-Dieter Hofheinz
- Department of Medical Oncology, University Hospital Mannheim, 68167 Mannheim, Germany;
| | - Claus Rödel
- Department of Radiotherapy and Oncology, University of Frankfurt, 60596 Frankfurt, Germany; (C.R.); (E.F.)
- Frankfurt Cancer Institute, 60596 Frankfurt, Germany
- German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Partner Site: Frankfurt, 69120 Heidelberg, Germany
| | - Emmanouil Fokas
- Department of Radiotherapy and Oncology, University of Frankfurt, 60596 Frankfurt, Germany; (C.R.); (E.F.)
- Frankfurt Cancer Institute, 60596 Frankfurt, Germany
- German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Partner Site: Frankfurt, 69120 Heidelberg, Germany
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15
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Kim JK, Marco MR, Roxburgh CSD, Chen CT, Cercek A, Strombom P, Temple LKF, Nash GM, Guillem JG, Paty PB, Yaeger R, Stadler ZK, Gonen M, Segal NH, Reidy DL, Varghese A, Shia J, Vakiani E, Wu AJ, Romesser PB, Crane CH, Gollub MJ, Saltz L, Smith JJ, Weiser MR, Patil S, Garcia-Aguilar J. Survival After Induction Chemotherapy and Chemoradiation Versus Chemoradiation and Adjuvant Chemotherapy for Locally Advanced Rectal Cancer. Oncologist 2022; 27:380-388. [PMID: 35278070 PMCID: PMC9074984 DOI: 10.1093/oncolo/oyac025] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 12/07/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Total neoadjuvant therapy (TNT) improves tumor response in locally advanced rectal cancer (LARC) patients compared to neoadjuvant chemoradiotherapy alone. The effect of TNT on patient survival has not been fully investigated. MATERIALS AND METHODS This was a retrospective case series of patients with LARC at a comprehensive cancer center. Three hundred and eleven patients received chemoradiotherapy (chemoRT) as the sole neoadjuvant treatment and planned adjuvant chemotherapy, and 313 received TNT (induction fluorouracil and oxaliplatin-based chemotherapy followed by chemoradiotherapy in the neoadjuvant setting). These patients then underwent total mesorectal excision or were entered in a watch-and-wait protocol. The proportion of patients with complete response (CR) after neoadjuvant therapy (defined as pathological CR or clinical CR sustained for 2 years) was compared by the χ2 test. Disease-free survival (DFS), local recurrence-free survival, distant metastasis-free survival, and overall survival were assessed by Kaplan-Meier analysis and log-rank test. Cox regression models were used to further evaluate DFS. RESULTS The rate of CR was 20% for chemoRT and 27% for TNT (P=.05). DFS, local recurrence-free survival, metastasis-free survival, and overall survival were no different. Disease-free survival was not associated with the type of neoadjuvant treatment (hazard ratio [HR] 1.3; 95% confidence interval [CI] 0.93-1.80; P = .12). CONCLUSIONS Although TNT does not prolong survival than neoadjuvant chemoradiotherapy plus intended postoperative chemotherapy, the higher response rate associated with TNT may create opportunities to preserve the rectum in more patients with LARC.
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Affiliation(s)
- Jin K Kim
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael R Marco
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Chin-Tung Chen
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrea Cercek
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Paul Strombom
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Larissa K F Temple
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Garrett M Nash
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jose G Guillem
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Philip B Paty
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rona Yaeger
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Zsofia K Stadler
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mithat Gonen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Neil H Segal
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Diane L Reidy
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anna Varghese
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jinru Shia
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Efsevia Vakiani
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Abraham J Wu
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Paul B Romesser
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christopher H Crane
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marc J Gollub
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Leonard Saltz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - J Joshua Smith
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Martin R Weiser
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sujata Patil
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Julio Garcia-Aguilar
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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16
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Lin Z, Li X, Song J, Zheng R, Chen C, Li A, Xu B. The Effect of Lymph Node Harvest on Prognosis in Locally Advanced Middle-Low Rectal Cancer After Neoadjuvant Chemoradiotherapy. Front Oncol 2022; 12:816485. [PMID: 35242710 PMCID: PMC8886163 DOI: 10.3389/fonc.2022.816485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/24/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE The purpose of this study was to investigate the relationship between lymph node harvest and the prognosis in locally advanced rectal cancer (LARC) patients after neoadjuvant chemoradiotherapy (nCRT). METHODS Patients who were diagnosed with clinical LARC and treated with nCRT and radical surgery between June 2008 and July 2017 were included in this study. The relationship between lymph node retrieval and prognosis was analyzed. Other lymph node-related indicators were explored. RESULTS A total of 837 patients with a median follow-up of 61 (7-139) months were included in the study. The five-year DFS and OS rates of all patients were 74.9% and 82.3%, respectively. Multivariate survival analysis suggested that dissection of ≥ 12 lymph nodes did not improve OS or DFS. 7 was selected as the best cutoff value for the total number of lymph nodes retrieved by Cox multivariate analysis (χ2 = 10.072, HR: 0.503, P=0.002). Dissection of ≥ 5 positive lymph nodes (PLNs) was an independent prognostic factor for poorer DFS (HR: 2.104, P=0.004) and OS (HR: 3.471, p<0.001). A positive lymph node ratio (LNR) of more than 0.29 was also an independent prognostic factor for poorer DFS (HR: 1.951, P=0.002) and OS (HR: 2.434, p<0.001). CONCLUSION The recommends that at least 7 harvested lymph nodes may be more appropriate for LARC patients with nCRT. PLN and LNR may be prognostic factors for LARC patients with ypN+ after nCRT.
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Affiliation(s)
- Zhuangbin Lin
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China.,The Graduate School, Fujian Medical University, Fuzhou, China.,Department of Radiation Oncology, Fujian Branch of Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Fuzhou, China.,Department of Radiation Oncology, Fujian Children's Hospital, Fuzhou, China
| | - Xiaobo Li
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China.,Department of Medical Imaging Technology, College of Medical Technology and Engineering, Fujian Medical University, Fuzhou, China.,Union Clinical Medicine College, Fujian Medical University, Fuzhou, China
| | - Jianyuan Song
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China.,Department of Medical Imaging Technology, College of Medical Technology and Engineering, Fujian Medical University, Fuzhou, China.,Union Clinical Medicine College, Fujian Medical University, Fuzhou, China
| | - Rong Zheng
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China.,Department of Medical Imaging Technology, College of Medical Technology and Engineering, Fujian Medical University, Fuzhou, China.,Union Clinical Medicine College, Fujian Medical University, Fuzhou, China.,School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Cheng Chen
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China.,Department of Medical Imaging Technology, College of Medical Technology and Engineering, Fujian Medical University, Fuzhou, China.,Union Clinical Medicine College, Fujian Medical University, Fuzhou, China
| | - Anchuan Li
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China.,Union Clinical Medicine College, Fujian Medical University, Fuzhou, China.,School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Benhua Xu
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China.,Department of Medical Imaging Technology, College of Medical Technology and Engineering, Fujian Medical University, Fuzhou, China.,Union Clinical Medicine College, Fujian Medical University, Fuzhou, China.,School of Clinical Medicine, Fujian Medical University, Fuzhou, China
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17
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Liu Z, Lu S, Wang Y, Lin X, Ran P, Zhou X, Fu W, Wang H. Impact of Body Composition During Neoadjuvant Chemoradiotherapy on Complications, Survival and Tumor Response in Patients With Locally Advanced Rectal Cancer. Front Nutr 2022; 9:796601. [PMID: 35155538 PMCID: PMC8830534 DOI: 10.3389/fnut.2022.796601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 01/06/2022] [Indexed: 01/05/2023] Open
Abstract
Background To explore the impact of body composition before neoadjuvant chemoradiotherapy (pre-NCRT) and after neoadjuvant chemoradiotherapy (post-NCRT) on complications, survival, and tumor response in patients with locally advanced rectal cancer (LARC). Methods Patients with LARC who underwent radical surgery after NCRT between Ja 22nuary 2012 and March 2019 were studied. Body composition parameters, including skeletal muscle area (SMA), muscle density (MD), visceral fat area (VFA), total abdominal fat area (TAFA), and subcutaneous fat area (SFA), was identified at the third lumbar vertebra level on computed tomography (CT). The patients were divided into two groups based on the sex-specific quartile values of SMA, MD, VFA, TAFA, SFA, and body composition change. Patient characteristics, short- and long-term postoperative complications, survival, and tumor response were analyzed. Results A total of 122 eligible patients were enrolled. Body composition parameters, except MD, were strongly correlated with BMI (p < 0.001). Pre-NCRT low MD (p = 0.04) and TAFA loss (p = 0.02) were significantly correlated with short- and long-term ileus, respectively. Pre-NCRT low SMA was a significant prognostic factor for both disease-free survival (DFS) (HR 2.611, 95% CI 1.129–6.040, p = 0.025) and cancer-specific survival (CSS) (HR 3.124, 95% CI 1.030–9.472, p = 0.044) in the Cox regression multivariate analysis. Multivariate logistic regression analysis identified post-NCRT SFA (OR 3.425, 95% CI 1.392–8.427, p = 0.007) and SFA loss (OR 3.358, 95% CI 1.214–9.289, p = 0.02) as independent risk factors for tumor regression grade (TRG) and downstaging, respectively. Conclusion Pre-NCRT low MD and TAFA loss were related to a high incidence of short- and long-term ileus, respectively. Pre-NCRT low SMA was a significant prognostic factor for CSS and DFS. Post-NCRT SFA and SFA loss were independent risk factors for TRG and downstaging, respectively.
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Affiliation(s)
- Zhenzhen Liu
- Department of General Surgery, Peking University Third Hospital, Beijing, China
| | - Siyi Lu
- Department of General Surgery, Peking University Third Hospital, Beijing, China
| | - Yuxia Wang
- Department of Radiotherapy, Peking University Third Hospital, Beijing, China
| | - Xinyi Lin
- Department of General Surgery, Peking University Third Hospital, Beijing, China
| | - Peng Ran
- Department of Radiotherapy, Peking University Third Hospital, Beijing, China
| | - Xin Zhou
- Department of General Surgery, Peking University Third Hospital, Beijing, China
- *Correspondence: Xin Zhou
| | - Wei Fu
- Department of General Surgery, Peking University Third Hospital, Beijing, China
- Wei Fu
| | - Hao Wang
- Department of Radiotherapy, Peking University Third Hospital, Beijing, China
- Hao Wang
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18
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Agrawal A, Bhattacharya S. Cutting-edge Nanotechnological Approaches for Lung Cancer Therapy. Curr Drug Res Rev 2022; 14:171-187. [PMID: 35440332 DOI: 10.2174/2589977514666220418085658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 01/17/2022] [Accepted: 02/22/2022] [Indexed: 06/14/2023]
Abstract
Lung cancer is the second leading cancer with a high rate of mortality. It can be treated using different intervention techniques such as chemotherapy, radiation therapy, surgical removal, and photodynamic therapy. All of these interventions lack specificity, implying that it harms the normal cells adjacent to the infected ones. Nanotechnology provides a promising solution that increases the bioavailability of anticancer drugs at the tumor site with reduced toxicity and improved therapeutic efficacy. Nanotechnology also improves the way lung cancer is diagnosed and treated. Various nanocarriers like liposomes, polymeric nanoparticles, magnetic nanoparticles, and different theranostic approaches are already approved for medical use, while various are under clinical and preclinical stages. This review article covers the details about lung cancer, types of overexpressed receptors, and cutting-edge nanocarriers used for treating lung cancer at its specific target.
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Affiliation(s)
- Amaiyya Agrawal
- Department of Pharmaceutics, School of Pharmacy & Technology Management, SVKM\'S NMIMS Deemed-to-be University, Shirpur 425405, Maharashtra, India
| | - Sankha Bhattacharya
- Department of Pharmaceutics, School of Pharmacy & Technology Management, SVKM\'S NMIMS Deemed-to-be University, Shirpur 425405, Maharashtra, India
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19
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Feng W, Yu B, Zhang Z, Li J, Wang Y. Current status of total neoadjuvant therapy for locally advanced rectal cancer. Asia Pac J Clin Oncol 2021; 18:546-559. [PMID: 34818447 DOI: 10.1111/ajco.13640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 07/05/2021] [Indexed: 12/21/2022]
Abstract
Neoadjuvant chemoradiotherapy (nCRT) plus total mesorectal excision (TME) has been the standard regimen for treatment of patients with locally advanced rectal cancer (LARC), because it significantly reduces the rate of local recurrence and enables sphincter preservation. However, distant metastasis remains the major reason for treatment failure, and the value of postoperative chemotherapy is still controversial. Recent studies have examined the use of total neoadjuvant therapy (TNT), defined as induction and/or consolidation chemotherapy (CONCT) with radiotherapy (RT) or nCRT prior to surgery. The results indicated that TNT may increase the rates of chemotherapy compliance and pathological complete response (pCR), and probably improve the success rate of sphincter preservation surgery. TNT may also improve disease-free survival and overall survival, and even reduce the rate of relapse. Here, we critically appraise the existing literature on three different TNT schemes used for LARC patients.
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Affiliation(s)
- Wei Feng
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences, Hangzhou, China.,Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Bin Yu
- The Second Department of Surgery, Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital, Shijiazhuang, China
| | - Zhenya Zhang
- The Second Department of Surgery, Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital, Shijiazhuang, China
| | - Juan Li
- Department of Radiation Oncology, Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital & Hebei Clinical Research Center for Radiation Oncology, Shijiazhuang, China
| | - Yuxiang Wang
- Department of Radiation Oncology, Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital & Hebei Clinical Research Center for Radiation Oncology, Shijiazhuang, China
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20
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Jeon YW, Park IJ, Kim JE, Park JH, Lim SB, Kim CW, Yoon YS, Lee JL, Yu CS, Kim JC. Evaluating the benefit of adjuvant chemotherapy in patients with ypT0–1 rectal cancer treated with preoperative chemoradiotherapy. World J Gastrointest Surg 2021; 13:1000-1011. [PMID: 34621476 PMCID: PMC8462088 DOI: 10.4240/wjgs.v13.i9.1000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/22/2021] [Accepted: 08/02/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Adjuvant chemotherapy (ACTx) is recommended in rectal cancer patients after preoperative chemoradiotherapy (PCRT), but its efficacy in patients in the early post-surgical stage who have a favorable prognosis is controversial.
AIM To evaluate the long-term survival benefit of ACTx in patients with ypT0–1 rectal cancer after PCRT and surgical resection.
METHODS We identified rectal cancer patients who underwent PCRT followed by surgical resection at the Asan Medical Center from 2005 to 2014. Patients with ypT0–1 disease and those who received ACTx were included. The 5-year overall survival (OS) and 5-year recurrence-free survival (RFS) were analyzed according to the status of the ACTx.
RESULTS Of 520 included patients, 413 received ACTx (ACTx group) and 107 did not (no ACTx group). No significant difference was observed in 5-year RFS (ACTx group, 87.9% vs no ACTx group, 91.4%, P = 0.457) and 5-year OS (ACTx group, 90.5% vs no ACTx group, 86.2%, P = 0.304) between the groups. cT stage was associated with RFS and OS in multivariate analysis [hazard ratio (HR): 2.57, 95% confidence interval (CI): 1.07–6.16, P = 0.04 and HR: 2.27, 95%CI: 1.09–4.74, P = 0.03, respectively]. Furthermore, ypN stage was associated with RFS and OS (HR: 4.74, 95%CI: 2.39–9.42, P < 0.00 and HR: 4.33, 95%CI: 2.20–8.53, P < 0.00, respectively), but only in the radical resection group.
CONCLUSION Oncological outcomes of patients with ypT0–1 rectal cancer who received ACTx after PCRT showed no improvement, regardless of the radicality of resection. Further trials are needed to evaluate the efficacy of ACTx in these group of patients.
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Affiliation(s)
- Ye Won Jeon
- Department of Surgery, Asan Medical Center and University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - In Ja Park
- Department of Colon and Rectal Surgery, Asan Medical Center and University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Jeong Eun Kim
- Department of Oncology, Asan Medical Center and University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Jin-Hong Park
- Department of Radiation Oncology, Asan Medical Center and University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Seok-Byung Lim
- Department of Colon and Rectal Surgery, Asan Medical Center and University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Chan Wook Kim
- Department of Colon and Rectal Surgery, Asan Medical Center and University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Yong Sik Yoon
- Department of Colon and Rectal Surgery, Asan Medical Center and University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Jong Lyul Lee
- Department of Colon and Rectal Surgery, Asan Medical Center and University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Chang Sik Yu
- Department of Colon and Rectal Surgery, Asan Medical Center and University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Jin Cheon Kim
- Department of Colon and Rectal Surgery, Asan Medical Center and University of Ulsan College of Medicine, Seoul 05505, South Korea
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21
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Lu S, Liu Z, Wang B, Li F, Meng Y, Wang J, Wang Y, Wang H, Zhou X, Fu W. High CFP score indicates poor prognosis and chemoradiotherapy response in LARC patients. Cancer Cell Int 2021; 21:205. [PMID: 33849545 PMCID: PMC8045186 DOI: 10.1186/s12935-021-01903-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 03/30/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Preoperative tumor markers, inflammation, and nutritional status are considered important predictors of prognosis and tumor response in locally advanced rectal cancer (LARC) patients. This study aims to explore the prognostic and predictive role of carcinoembryonic antigen (CEA), the Fibrinogen-Albumin Ratio Index (FARI), the Prognostic Nutritional Index (PNI) in LARC patients and compared them with a novel combined CEA-FARI-PNI (CFP) scoring system. METHODS A total of 138 LARC patients undergoing radical surgery following neoadjuvant chemoradiotherapy (NCRT) between January 2012 and March 2019 were enrolled. The X-tile program was used to determine the optimal cut-off values of CEA, FARI, and PNI, and CFP scoring system was constructed accordingly. The prognostic ability of these factors was assessed by the time-dependent receiver operating characteristic (ROC) curve, Kaplan-Meier, Cox regression, and logistic regression. Nomogram was established to evaluate the predictive role of these factors in tumor response. RESULTS The optimal cut-off values of CEA, FARI, and PNI were 5.15 ng/l, 10.56%, and 42.25 g/L, respectively. The time-dependent ROC curve showed that compared to CEA, FARI, and PNI, CFP showed stable predictive efficacy for overall survival (OS) and disease-free survival (DFS). In multivariate analysis, CFP was the only factor that could independently predict OS (HR = 8.117, p = 0.001) and DFS (HR = 4.994, p < 0.001). Moreover, high CFP (OR = 3.693, p = 0.002) was also an independent risk factor of poor response. The area under the ROC curve (AUC) of the nomograms for predicting tumor response was better including CFP (0.717) than without CFP (0.656) (p < 0.05). CONCLUSIONS The CFP score was a more reliable marker for predicting OS, DFS, and NCRT efficacy in LARC patients, and the score could apparently improve predicted efficacy of the nomogram.
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Affiliation(s)
- Siyi Lu
- Department of General Surgery, Peking University Third Hospital, Beijing, 100191, China
| | - Zhenzhen Liu
- Department of General Surgery, Peking University Third Hospital, Beijing, 100191, China
| | - Bingyan Wang
- Department of General Surgery, Peking University Third Hospital, Beijing, 100191, China
| | - Fei Li
- Department of General Surgery, Peking University Third Hospital, Beijing, 100191, China
| | - Yan Meng
- Department of General Surgery, Peking University Third Hospital, Beijing, 100191, China
| | - Junwei Wang
- Department of General Surgery, Peking University Third Hospital, Beijing, 100191, China
| | - Yuxia Wang
- Department of Radiotherapy, Peking University Third Hospital, Beijing, 100191, China
| | - Hao Wang
- Department of Radiotherapy, Peking University Third Hospital, Beijing, 100191, China.
| | - Xin Zhou
- Department of General Surgery, Peking University Third Hospital, Beijing, 100191, China.
| | - Wei Fu
- Department of General Surgery, Peking University Third Hospital, Beijing, 100191, China.
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22
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No benefit of more intense follow-up after surgery for colorectal cancer in the risk group with elevated CEA levels - An analysis within the COLOFOL randomized clinical trial. Eur J Surg Oncol 2021; 47:2053-2059. [PMID: 33846037 DOI: 10.1016/j.ejso.2021.03.235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 03/09/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Patients with colorectal cancer were examined to determine (1) whether elevated carcinoembryonic antigen (CEA) levels, either before treatment or after surgery, was associated with an increased risk of overall or colorectal cancer-specific mortality or recurrence, and (2) whether high intensity follow-up would benefit those patients. MATERIALS AND METHODS Post-hoc analysis based on 2509 patients that underwent surgery for colorectal cancer, stage II or III, in the COLOFOL randomized trial with 5-year follow-up. Serum CEA levels were ascertained before treatment and one month after surgery. Follow-up examinations included computed tomography of the thorax and abdomen and serum CEA sampling. Patients were randomized to examinations at either 6, 12, 18, 24, and 36 months (high-intensity group) or at 12 and 36 months after surgery (low-intensity group). Levels of CEA >5 μg/l were defined as elevated. RESULTS Elevated CEA levels before treatment were associated with increased risk of recurrence (hazard ratio [HR], 1.49; 95% confidence interval [CI]: 1.22-1.83), colorectal cancer-specific mortality (HR, 1.44; 95% CI: 1.08-1.91), and overall mortality (HR, 1.38; 95% CI: 1.07-1.78). Elevated CEA levels after surgery were associated with increased colorectal cancer-specific mortality (HR, 1.68; 95% CI: 1.08-2.61) and overall mortality (HR, 1.79; 95% CI: 1.22-2.63). The intensity of the follow-up regimen had no effect on 5-year outcomes in patients with elevated CEA levels. CONCLUSION Both pre-treatment and post-surgery elevated serum CEA levels were associated with increased overall and cancer-specific mortality. Intensified follow-up showed no benefit over low-intensity follow-up in this high-risk group of patients with elevated CEA levels.
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23
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Morris MC, Winer LK, Lee TC, Shah SA, Rafferty JF, Paquette IM. Omission of Adjuvant Chemotherapy in Rectal Cancer Patients with Pathologic Complete Response: a National Analysis. J Gastrointest Surg 2021; 25:1857-1865. [PMID: 32728821 PMCID: PMC7388436 DOI: 10.1007/s11605-020-04749-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/16/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND An increasing number of patients achieve a pathologic complete response (pCR) after neoadjuvant chemoradiation for locally advanced rectal cancer. Consensus guidelines continue to recommend oncologic resection followed by adjuvant chemotherapy in these patients. We hypothesize that there is significant variability in compliance with this recommendation. METHODS The National Cancer Database was queried from 2006 to 2015 for patients with locally advanced rectal cancer who underwent neoadjuvant chemoradiation followed by oncologic resection with a pCR (ypT0N0). Hierarchical logistic regression models were used to generate risk and reliability-adjusted rates of adjuvant chemotherapy utilization in patients with pCR at each hospital. RESULTS In total, 2421 pCR patients were identified. Five-year overall survival was improved in pCR patients who received adjuvant chemotherapy compared with those who did not (92 vs. 85%, p < 0.01). Multivariate analysis indicated that improvement in overall survival remained associated with adjuvant chemotherapy (HR 0.60, 95% CI 0.44-0.82, p < 0.01). The mean adjuvant chemotherapy utilization rate among hospitals was 32%. There was an upward trend in use over the past decade, but two-thirds still do not receive the recommended therapy. High chemotherapy utilizer hospitals were more likely to be academic centers (54.9 vs. 45.9%, p < 0.01) when compared with low chemotherapy utilizers. CONCLUSION Adjuvant chemotherapy is associated with improved survival in rectal cancer patients with pCR following neoadjuvant chemoradiation and oncologic resection. However, utilization among centers in the USA was only 32% with significant variability across centers. National efforts are needed to standardize treatment patterns according to national guidelines.
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Affiliation(s)
- Mackenzie C. Morris
- grid.24827.3b0000 0001 2179 9593Department of Surgery, College of Medicine, University of Cincinnati, 2123 Auburn Ave #524, Cincinnati, OH 45219 USA
| | - Leah K. Winer
- grid.24827.3b0000 0001 2179 9593Department of Surgery, College of Medicine, University of Cincinnati, 2123 Auburn Ave #524, Cincinnati, OH 45219 USA
| | - Tiffany C. Lee
- grid.24827.3b0000 0001 2179 9593Department of Surgery, College of Medicine, University of Cincinnati, 2123 Auburn Ave #524, Cincinnati, OH 45219 USA
| | - Shimul A. Shah
- grid.24827.3b0000 0001 2179 9593Department of Surgery, College of Medicine, University of Cincinnati, 2123 Auburn Ave #524, Cincinnati, OH 45219 USA
| | - Janice F. Rafferty
- grid.24827.3b0000 0001 2179 9593Department of Surgery, College of Medicine, University of Cincinnati, 2123 Auburn Ave #524, Cincinnati, OH 45219 USA
| | - Ian M. Paquette
- grid.24827.3b0000 0001 2179 9593Department of Surgery, College of Medicine, University of Cincinnati, 2123 Auburn Ave #524, Cincinnati, OH 45219 USA
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Voltage-gated sodium channel Na v1.5 promotes tumor progression and enhances chemosensitivity to 5-fluorouracil in colorectal cancer. Cancer Lett 2020; 500:119-131. [PMID: 33338532 DOI: 10.1016/j.canlet.2020.12.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/30/2020] [Accepted: 12/09/2020] [Indexed: 12/24/2022]
Abstract
Nav1.5, encoded by SCN5A, has been associated with metastasis in colorectal cancer (CRC). Here, we investigated the mechanism by which Nav1.5 regulates tumor progression and whether Nav1.5 influences chemosensitivity to 5-fluorouracil (5-FU) in CRCs. CRC cases were evaluated for Nav1.5 expression. Elevated Nav1.5 expression was associated with poor prognosis in CRCs, whereas stage II/III patients with upregulated SCN5A expression could have better survival after receiving 5-FU-based adjuvant chemotherapy. In CRC cells, SCN5A knockdown reduced the proliferation, migration and invasion. According to RNA sequencing, SCN5A knockdown inhibited both the cell cycle and epithelial-mesenchymal transition. In addition, Nav1.5 stabilized the KRas-calmodulin complex to modulate Ras signaling, promoting Ca2+ influx through the Na+-Ca2+ exchanger and Ca2+ release-activated calcium channel. Meanwhile, SCN5A knockdown increased the 50% inhibitory concentration to 5-FU by upregulating 5-FU-stimulated apoptosis in CRCs. In conclusion, Nav1.5 could progress to proliferation and metastasis through Ca2+/calmodulin-dependent Ras signaling in CRC, and it could also enhance 5-FU-stimulated apoptosis. Clinically, patients with stage II/III CRCs with elevated SCN5A expression demonstrated poor prognosis, yet those patients could benefit more from 5-FU-based chemotherapy than patients with lower SCN5A expression.
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