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Sonal S, Qwaider YZ, Boudreau C, Kunitake H, Goldstone RN, Bordeianou LG, Cauley CE, Francone TD, Ricciardi R, Berger DL. Association of age with outcomes in locally advanced rectal cancer treated with neoadjuvant therapy followed by surgery. Am J Surg 2023; 225:1029-1035. [PMID: 36535854 DOI: 10.1016/j.amjsurg.2022.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/15/2022] [Accepted: 12/04/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION We aimed to assess the association of age with outcomes in patients with Locally Advanced Rectal Cancer (LARC) who received neoadjuvant therapy followed by major surgery. METHODS Retrospective review of 328 patients with LARC, N = 99 < 70 years (younger) versus N = 229 ≥ 70 years (elderly) from 2004 to 2018. RESULTS Elderly patients had a higher American Society of Anesthesiologists (ASA) score, Charlson Comorbidity Index (CCI), length of stay and 30-day readmissions (p < 0.05). They also had worse overall survival (OS) & disease-free survival (DFS) (p < 0.001), but similar disease-specific survival (DSS) compared to younger group. Age was not associated with hazard of death (HR 1.01, 0.98-1.03). Rather, CCI (HR 1.29, 1.01-1.5), extramural vascular invasion (HR 4.98, 2.84-8.74), and adjuvant therapy (0.37, 0.21-0.64) were significantly associated with the hazard of death; when controlled for stage, tumor distance from anal verge, and neoadjuvant completion. CONCLUSION Comorbidities and lower rates of adjuvant therapy, and not chronologic age, are associated with poor OS of elderly patients with LARC treated with neoadjuvant therapy and major surgery.
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Affiliation(s)
- Swati Sonal
- Division of Gastrointestinal & Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, 02114, USA; Department of Surgery, Harvard Medical School, Boston, MA, 02115, USA
| | - Yasmeen Z Qwaider
- Division of Gastrointestinal & Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, 02114, USA; Department of Surgery, Harvard Medical School, Boston, MA, 02115, USA
| | - Chloe Boudreau
- Division of Gastrointestinal & Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, 02114, USA; Department of Surgery, Harvard Medical School, Boston, MA, 02115, USA
| | - Hiroko Kunitake
- Division of Gastrointestinal & Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, 02114, USA; Department of Surgery, Harvard Medical School, Boston, MA, 02115, USA
| | - Robert N Goldstone
- Division of Gastrointestinal & Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, 02114, USA; Department of Surgery, Harvard Medical School, Boston, MA, 02115, USA
| | - Liliana G Bordeianou
- Division of Gastrointestinal & Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, 02114, USA; Department of Surgery, Harvard Medical School, Boston, MA, 02115, USA
| | - Christy E Cauley
- Division of Gastrointestinal & Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, 02114, USA; Department of Surgery, Harvard Medical School, Boston, MA, 02115, USA
| | - Todd D Francone
- Department of Colorectal Surgery, Newton-Wellesley Hospital, MA, 02462, USA
| | - Rocco Ricciardi
- Division of Gastrointestinal & Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, 02114, USA; Department of Surgery, Harvard Medical School, Boston, MA, 02115, USA
| | - David L Berger
- Division of Gastrointestinal & Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, 02114, USA; Department of Surgery, Harvard Medical School, Boston, MA, 02115, USA.
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Li SF, Wei R, Yu GH, Jiang Z. Predictive value of indirect bilirubin before neoadjuvant chemoradiotherapy in evaluating prognosis of local advanced rectal cancer patients. World J Gastrointest Oncol 2022; 14:2224-2237. [PMID: 36438711 PMCID: PMC9694265 DOI: 10.4251/wjgo.v14.i11.2224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/25/2022] [Accepted: 10/03/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Many biomarkers have predictive value for overall survival (OS) and disease-free survival (DFS) in tumor patients. However, the role of indirect bilirubin (IBIL) in local advanced rectal cancer (LARC) patients treated with neoadjuvant chemoradiotherapy (nCRT) has not been studied.
AIM To explore the predictive value of IBIL before nCRT (pre-IBIL) for the OS and DFS of LARC patients treated with nCRT.
METHODS A total of 324 LARC patients undergoing nCRT with total mesorectal excision (TME) were enrolled. Preoperative clinical features and postoperative pathological characteristics were collected. Cox regression analysis was performed, and a Cox-based nomogram was developed to predict OS and DFS. We also assessed the predictive performance of the nomogram with calibration plots and receiver operating characteristic (ROC) curves.
RESULTS Among 324 patients, the median pre-IBIL was 6.2 μmol/L (interquartile range: 4.6 μmol/L-8.4 μmol/L). In the Cox multivariate regression analysis, we found that pre-IBIL, smoking history, tumor regression grade (TRG), vascular invasion, and carbohydrate antigen 19-9 before nCRT (pre-CA19-9) were predictors of OS. Additionally, pre-IBIL, body mass index (BMI), nCRT with surgery interval, TRG, and vascular invasion were predictors of DFS. Predictive nomograms were developed to predict 5-year OS and 5-year DFS with area under the ROC curve values of 0.7518 and 0.7355, respectively. Good statistical performance on internal validation was shown by calibration plots and ROC curves.
CONCLUSION This study demonstrated that pre-IBIL was an independent prognostic factor for OS and DFS in LARC patients treated with nCRT followed by TME. Nomograms incorporating pre-IBIL, BMI, smoking history, nCRT with surgery interval, TRG, vascular invasion, and pre-CA19-9 could be helpful to predict OS and DFS.
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Affiliation(s)
- Shuo-Feng Li
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Ran Wei
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Guan-Hua Yu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Zheng Jiang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Neoadjuvant Chemotherapy plus Bevacizumab Combined with Total Mesorectal Excision in Treating Locally Advanced Rectal Cancer Patients with BRAF Mutation: Clinical Benefit and Safety. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:4227650. [PMID: 34925539 PMCID: PMC8677386 DOI: 10.1155/2021/4227650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 11/08/2021] [Accepted: 11/18/2021] [Indexed: 11/29/2022]
Abstract
Objective To investigate clinical benefit and safety of neoadjuvant chemotherapy (NAC) plus bevacizumab combined with total mesorectal excision (TME) in treating patients with BRAF-mutated locally advanced rectal cancer (LARC). Methods This study included LARC patients with BRAF mutation admitted to the Oncology Department of Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, between June 2013 and December 2018. Patients in the control group received a standard treatment regimen of TME combined with NAC (n = 45), and patients in the observation group received NAC plus bevacizumab combined with TME (n = 55). The short-term clinical efficacy of the two groups after NAC treatment was observed and compared, including differences in the pathological downstaging rate. The incidence of perioperative complications and adverse reactions during neoadjuvant therapy was compared to evaluate the safety of the treatment. Besides, the relapse-free survival (RFS) and overall survival (OS) of patients were analyzed to evaluate the long-term clinical benefit of the treatment. Results Compared with the control group, the ypT staging rate (p = 0.014) in the observation group was markedly lower. In addition, patients in the observation group had a prominently lower overall incidence of complications (p < 0.001) during the perioperative period and a remarkably lower incidence of leukopenia (p = 0.037) during neoadjuvant therapy. In terms of long-term clinical benefit, the RFS of patients in the observation group was evidently longer (p = 0.037) than that in the control group. Conclusion Compared with TME plus NAC treatment, the short-term and long-term clinical benefits are higher and safety is more favorable of NAC plus bevacizumab combined with TME in treating LARC patients.
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