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He J, Wang SX, Liu P. Machine learning in predicting pathological complete response to neoadjuvant chemoradiotherapy in rectal cancer using MRI: a systematic review and meta-analysis. Br J Radiol 2024; 97:1243-1254. [PMID: 38730550 PMCID: PMC11186567 DOI: 10.1093/bjr/tqae098] [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: 09/13/2023] [Revised: 01/15/2024] [Accepted: 05/07/2024] [Indexed: 05/13/2024] Open
Abstract
OBJECTIVES To evaluate the performance of machine learning models in predicting pathological complete response (pCR) to neoadjuvant chemoradiotherapy (nCRT) in patients with rectal cancer using magnetic resonance imaging. METHODS We searched PubMed, Embase, Cochrane Library, and Web of Science for studies published before March 2024. The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) was used to assess the methodological quality of the included studies, random-effects models were used to calculate sensitivity and specificity, I2 values were used for heterogeneity measurements, and subgroup analyses were carried out to detect potential sources of heterogeneity. RESULTS A total of 1699 patients from 24 studies were included. For machine learning models in predicting pCR to nCRT, the meta-analysis calculated a pooled area under the curve (AUC) of 0.91 (95% CI, 0.88-0.93), pooled sensitivity of 0.83 (95% CI, 0.74-0.89), and pooled specificity of 0.86 (95% CI, 0.80-0.91). We investigated 6 studies that mainly contributed to heterogeneity. After performing meta-analysis again excluding these 6 studies, the heterogeneity was significantly reduced. In subgroup analysis, the pooled AUC of the deep-learning model was 0.93 and 0.89 for the traditional statistical model; the pooled AUC of studies that used diffusion-weighted imaging (DWI) was 0.90 and 0.92 in studies that did not use DWI; the pooled AUC of studies conducted in China was 0.93, and was 0.83 in studies conducted in other countries. CONCLUSIONS This systematic study showed that machine learning has promising potential in predicting pCR to nCRT in patients with locally advanced rectal cancer. Compared to traditional machine learning models, although deep-learning-based studies are less predominant and more heterogeneous, they are able to obtain higher AUC. ADVANCES IN KNOWLEDGE Compared to traditional machine learning models, deep-learning-based studies are able to obtain higher AUC, although they are less predominant and more heterogeneous. Together with clinical information, machine learning-based models may bring us closer towards precision medicine.
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Affiliation(s)
- Jia He
- Department of Radiology, The First Affiliated Hospital of Hunan Normal University, Hunan Provincial People’s Hospital, Changsha 410002, China
| | | | - Peng Liu
- Department of Radiology, The First Affiliated Hospital of Hunan Normal University, Hunan Provincial People’s Hospital, Changsha 410002, China
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Ramireddy JK, Sathya A, Sasidharan BK, Varghese AJ, Sathyamurthy A, John NO, Chandramohan A, Singh A, Joel A, Mittal R, Masih D, Varghese K, Rebekah G, Ram TS, Thomas HMT. Can Pretreatment MRI and Planning CT Radiomics Improve Prediction of Complete Pathological Response in Locally Advanced Rectal Cancer Following Neoadjuvant Treatment? J Gastrointest Cancer 2024:10.1007/s12029-024-01073-z. [PMID: 38856797 DOI: 10.1007/s12029-024-01073-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2024] [Indexed: 06/11/2024]
Abstract
OBJECTIVE(S) The treatment response to neoadjuvant chemoradiation (nCRT) differs largely in individuals treated for rectal cancer. In this study, we investigated the role of radiomics to predict the pathological response in locally advanced rectal cancers at different treatment time points: (1) before the start of any treatment using baseline T2-weighted MRI (T2W-MR) and (2) at the start of radiation treatment using planning CT. METHODS Patients on nCRT followed by surgery between June 2017 to December 2019 were included in the study. Histopathological tumour response grading (TRG) was used for classification, and gross tumour volume was defined by the radiation oncologists. Following resampling, 100 and 103 pyradiomic features were extracted from T2W-MR and planning CT images, respectively. Synthetic minority oversampling technique (SMOTE) was used to address class imbalance. Four machine learning classifiers built clinical, radiomic, and merged models. Model performances were evaluated on a held-out test dataset following 3-fold cross-validation using area under the receiver operator characteristic curves (AUC) with bootstrap 95% confidence intervals. RESULTS One hundred and fifty patients were included; 58/150 with TRG 1 were classified as complete responders, and rest were incomplete responders (IR). Clinical models performed better (AUC = 0.68) compared to radiomics models (AUC = 0.62). Overall, the clinical + T2W-MR model showed best performance (AUC = 0.72) in predicting the pathological response prior to therapy. Clinical + Planning CT-merged models could only achieve the highest AUC of 0.66. CONCLUSION Merging clinical and baseline T2W-MR radiomics enhances predicting pathological response in rectal cancer. Validation in larger cohorts is warranted, especially for watch and wait strategies.
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Grants
- Fluid research major grant Christian Medical College, Vellore
- Fluid research major grant Christian Medical College, Vellore
- Fluid research major grant Christian Medical College, Vellore
- Fluid research major grant Christian Medical College, Vellore
- Fluid research major grant Christian Medical College, Vellore
- Fluid research major grant Christian Medical College, Vellore
- Fluid research major grant Christian Medical College, Vellore
- Fluid research major grant Christian Medical College, Vellore
- Fluid research major grant Christian Medical College, Vellore
- Fluid research major grant Christian Medical College, Vellore
- Fluid research major grant Christian Medical College, Vellore
- Fluid research major grant Christian Medical College, Vellore
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Affiliation(s)
- Jeba Karunya Ramireddy
- Quantitative Imaging Research and Artificial Intelligence Lab, Department of Radiation Oncology, Unit 2, Dr Ida B Scudder Cancer Centre, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - A Sathya
- Quantitative Imaging Research and Artificial Intelligence Lab, Department of Radiation Oncology, Unit 2, Dr Ida B Scudder Cancer Centre, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Balu Krishna Sasidharan
- Quantitative Imaging Research and Artificial Intelligence Lab, Department of Radiation Oncology, Unit 2, Dr Ida B Scudder Cancer Centre, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Amal Joseph Varghese
- Quantitative Imaging Research and Artificial Intelligence Lab, Department of Radiation Oncology, Unit 2, Dr Ida B Scudder Cancer Centre, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Arvind Sathyamurthy
- Quantitative Imaging Research and Artificial Intelligence Lab, Department of Radiation Oncology, Unit 2, Dr Ida B Scudder Cancer Centre, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Neenu Oliver John
- Quantitative Imaging Research and Artificial Intelligence Lab, Department of Radiation Oncology, Unit 2, Dr Ida B Scudder Cancer Centre, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | | | - Ashish Singh
- Department of Medical Oncology, Christian Medical College, Vellore, India
| | - Anjana Joel
- Department of Medical Oncology, Christian Medical College, Vellore, India
| | - Rohin Mittal
- Department of General Surgery, Christian Medical College, Vellore, India
| | - Dipti Masih
- Department of Pathology, Christian Medical College, Vellore, India
| | - Kripa Varghese
- Department of Pathology, Christian Medical College, Vellore, India
| | - Grace Rebekah
- Department of Biostatistics, Christian Medical College, Vellore, India
| | - Thomas Samuel Ram
- Quantitative Imaging Research and Artificial Intelligence Lab, Department of Radiation Oncology, Unit 2, Dr Ida B Scudder Cancer Centre, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Hannah Mary T Thomas
- Quantitative Imaging Research and Artificial Intelligence Lab, Department of Radiation Oncology, Unit 2, Dr Ida B Scudder Cancer Centre, Christian Medical College, Vellore, Tamil Nadu, 632004, India.
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Abedizadeh R, Majidi F, Khorasani HR, Abedi H, Sabour D. Colorectal cancer: a comprehensive review of carcinogenesis, diagnosis, and novel strategies for classified treatments. Cancer Metastasis Rev 2024; 43:729-753. [PMID: 38112903 DOI: 10.1007/s10555-023-10158-3] [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] [Received: 08/08/2023] [Accepted: 11/27/2023] [Indexed: 12/21/2023]
Abstract
Colorectal cancer is the third most common and the second deadliest cancer worldwide. To date, colorectal cancer becomes one of the most important challenges of the health system in many countries. Since the clinical symptoms of this cancer appear in the final stages of the disease and there is a significant golden time between the formation of polyps and the onset of cancer, early diagnosis can play a significant role in reducing mortality. Today, in addition to colonoscopy, minimally invasive methods such as liquid biopsy have received much attention. The treatment of this complex disease has been mostly based on traditional treatments including surgery, radiotherapy, and chemotherapy; the high mortality rate indicates a lack of success for current treatment methods. Moreover, disease recurrence is another problem of traditional treatments. Recently, new approaches such as targeted therapy, immunotherapy, and nanomedicine have opened new doors for cancer treatment, some of which have already entered the market, and many methods have shown promising results in clinical trials. The success of immunotherapy in the treatment of refractory disease, the introduction of these methods into neoadjuvant therapy, and the successful results in tumor shrinkage without surgery have made immunotherapy a tough competitor for conventional treatments. It seems that the combination of those methods with such targeted therapies will go through promising changes in the future of colorectal cancer treatment.
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Affiliation(s)
- Roya Abedizadeh
- Department of Cancer Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Isar 11, Babol, 47138-18983, Iran
- Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Bani-Hashem Square, Tehran, 16635-148, Iran
| | - Fateme Majidi
- Department of Cancer Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Isar 11, Babol, 47138-18983, Iran
- Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Bani-Hashem Square, Tehran, 16635-148, Iran
| | - Hamid Reza Khorasani
- Department of Cancer Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Isar 11, Babol, 47138-18983, Iran
- Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Bani-Hashem Square, Tehran, 16635-148, Iran
| | - Hassan Abedi
- Department of Internal Medicine, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran.
| | - Davood Sabour
- Department of Cancer Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Isar 11, Babol, 47138-18983, Iran.
- Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Bani-Hashem Square, Tehran, 16635-148, Iran.
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Matallana C, Pera M, Espin-Basany E, Biondo S, Badia JM, Limon E, Pujol M, de Lacy B, Aliste L, Borràs JM, Manchon-Walsh P. Quality check: concordance between two monitoring systems for postoperative organ/space-surgical site infections in rectal cancer surgery. Linkage of data from the Catalan Cancer Plan and the VINCat infection surveillance programme. World J Surg Oncol 2024; 22:138. [PMID: 38789966 PMCID: PMC11127316 DOI: 10.1186/s12957-024-03410-9] [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: 04/03/2024] [Accepted: 05/11/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND The Catalan Cancer Plan (CCP) undertakes periodic audits of cancer treatment outcomes, including organ/space surgical site infections (O/S-SSI) rates, while the Catalan Healthcare-associated Infections Surveillance Programme (VINCat) carries out standardized prospective surveillance of surgical site infections (SSI) in colorectal surgery. This cohort study aimed to assess the concordance between these two monitoring systems for O/S-SSI following primary rectal cancer surgery. METHODS The study compared O/S-SSI incidence data from CCP clinical audits versus the VINCat Programme in patients undergoing surgery for primary rectal cancer, in 2011-12 and 2015-16, in publicly funded centres in Spain. The main outcome variable was the incidence of O/S-SSI in the first 30 days after surgery. Concordance between the two registers was analysed using Cohen's kappa. Discordant cases were reviewed by an expert, and the main reasons for discrepancies evaluated. RESULTS Pooling data from both databases generated a sample of 2867 patients. Of these, O/S-SSI was detected in 414 patients-235 were common to both registry systems, with satisfactory concordance (κ = 0.69, 95% confidence interval 0.65-0.73). The rate of discordance from the CCP (positive cases in VINCat and negative in CCP) was 2.7%, and from VINCat (positive in CCP and negative in VINCat) was 3.6%. External review confirmed O/S-SSI in 66.2% of the cases in the CCP registry and 52.9% in VINCat. CONCLUSIONS This type of synergy shows the potential of pooling data from two different information sources with a satisfactory level of agreement as a means to improving O/S-SSI detection. CLINICALTRIALS gov Identifier: NCT06104579. Registered 30 November 2023.
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Affiliation(s)
- Carlota Matallana
- Catalonian Cancer Strategy, Health Department, Hospital Duran i Reynals Hospital, Av. Gran Via de l'Hospitalet, 199-203- 1ª planta,08908 L'Hospitalet de Llobregat, Barcelona, Spain
- Universitat Autònoma de Barcelona. Plaça Cívica, Bellaterra, Barcelona, 08193, Spain
- Department of General and Digestive Surgery, Hospital del Mar, Passeig Marítim 25-29, Barcelona, 08003, Spain
| | - Miguel Pera
- Department of General and Digestive Surgery Department, Institute of Digestive and Metabolic Diseases (ICMDM), Biomedical Research Centre (CIBERehd), Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Eloy Espin-Basany
- Colorectal Surgery Unit, Vall d'Hebrón University Hospital, Pº de la Vall d'Hebron, 119-129, Barcelona, 08035, Spain
| | - Sebastiano Biondo
- Department of General and Digestive Surgery-Colorectal Unit, Bellvitge University Hospital, C/Feixa Llarga, s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
- Biomedical Research Institute of Bellvitge (IDIBELL), Universitat de Barcelona, C/Feixa Llarga, s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Josep M Badia
- Department of Surgery, Hospital General de Granollers, Av Francesc Ribas 1, Barcelona, 08402, Granollers, Spain.
- School of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain.
| | - Enric Limon
- Departament de Salut, VINCat Programme - Surveillance of Healthcare Related Infections in Catalonia, Barcelona, Spain
- Department of Public Health, Mental Health and Mother-Infant Nursing, Faculty of Nursing, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas CIBERINFEC, Instituto Carlos III, Madrid, Spain
| | - Miquel Pujol
- Departament de Salut, VINCat Programme - Surveillance of Healthcare Related Infections in Catalonia, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas CIBERINFEC, Instituto Carlos III, Madrid, Spain
| | - Borja de Lacy
- Department of General and Digestive Surgery Department, Institute of Digestive and Metabolic Diseases (ICMDM), Biomedical Research Centre (CIBERehd), Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Luisa Aliste
- Catalonian Cancer Strategy, Health Department, Hospital Duran i Reynals Hospital, Av. Gran Via de l'Hospitalet, 199-203- 1ª planta,08908 L'Hospitalet de Llobregat, Barcelona, Spain
- Biomedical Research Institute of Bellvitge (IDIBELL), Universitat de Barcelona, C/Feixa Llarga, s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Josep M Borràs
- Catalonian Cancer Strategy, Health Department, Hospital Duran i Reynals Hospital, Av. Gran Via de l'Hospitalet, 199-203- 1ª planta,08908 L'Hospitalet de Llobregat, Barcelona, Spain
- Biomedical Research Institute of Bellvitge (IDIBELL), Universitat de Barcelona, C/Feixa Llarga, s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Paula Manchon-Walsh
- Catalonian Cancer Strategy, Health Department, Hospital Duran i Reynals Hospital, Av. Gran Via de l'Hospitalet, 199-203- 1ª planta,08908 L'Hospitalet de Llobregat, Barcelona, Spain
- Biomedical Research Institute of Bellvitge (IDIBELL), Universitat de Barcelona, C/Feixa Llarga, s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
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Shannon AH, Sarna A, Bressler L, Monsour C, Palettas M, Huang E, D'Souza DM, Kneuertz PJ, Ejaz A, Pawlik TM, Santry H, Cloyd JM. Quality of Life and Real-time Patient Experience During Neoadjuvant Therapy: A Prospective Cohort Study. Ann Surg 2024; 279:850-856. [PMID: 37641957 DOI: 10.1097/sla.0000000000006090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
OBJECTIVE To use a customized smartphone application to prospectively measure QOL and the real-time patient experience during neoadjuvant therapy (NT). BACKGROUND NT is increasingly used for patients with localized gastrointestinal (GI) cancers. There is little data assessing patient experience and quality of life (QOL) during NT for GI cancers. METHODS Patients with GI cancers receiving NT were instructed on using a customized smartphone application through which the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire, a validated measure of health-related QOL, was administered at baseline, every 30 days, and at the completion of NT. Participants also tracked their moods and symptoms and used free-text journaling functionalities in the application. Mean overall and subsection health-related QOL scores were calculated during NT. RESULTS Among 104 enrolled patients, the mean age was 60.5 ± 11.5 years and 55% were males. Common cancer diagnoses were colorectal (40%), pancreatic (37%), and esophageal (15%). Mean overall FACT-G scores did not change during NT ( P = 0.987). While functional well-being scores were consistently the lowest and social well-being scores the highest, FACT subscores similarly did not change during NT (all P > 0.01). The most common symptoms reported during NT were fatigue, insomnia, and anxiety (39.3%, 34.5%, and 28.3% of patient entries, respectively). Qualitative analysis of free-text journaling entries identified anxiety, fear, and frustration as the most common themes, but also the importance of social support systems and confidence in health care providers. CONCLUSIONS While patient symptom burden remains high, results of this prospective cohort study suggest QOL is maintained during NT for localized GI cancers.
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Affiliation(s)
- Alexander H Shannon
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
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Li J, Wang Y, Shen W, Zhang Z, Su Z, Guo X, Pei P, Hu L, Liu T, Yang K, Guo L. Mitochondria-Modulating Liposomes Reverse Radio-Resistance for Colorectal Cancer. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2400845. [PMID: 38520732 PMCID: PMC11095197 DOI: 10.1002/advs.202400845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/28/2024] [Indexed: 03/25/2024]
Abstract
Complete remission of colorectal cancer (CRC) is still unachievable in the majority of patients by common fractionated radiotherapy, leaving risks of tumor metastasis and recurrence. Herein, clinical CRC samples demonstrated a difference in the phosphorylation of translation initiation factor eIF2α (p-eIF2α) and the activating transcription factor 4 (ATF4), whose increased expression by initial X-ray irradiation led to the resistance to subsequent radiotherapy. The underlying mechanism is studied in radio-resistant CT26 cells, revealing that the incomplete mitochondrial outer membrane permeabilization (iMOMP) triggered by X-ray irradiation is key for the elevated expression of p-eIF2α and ATF4, and therefore radio-resistance. This finding guided to discover that metformin and 2-DG are synergistic in reversing radio resistance by inhibiting p-eIF2α and ATF4. Liposomes loaded with metformin and 2-DG (M/D-Lipo) are thus prepared for enhancing fractionated radiotherapy of CRC, which achieved satisfactory therapeutic efficacy in both local and metastatic CRC tumors by reversing radio-resistance and preventing T lymphocyte exhaustion.
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Affiliation(s)
- Junmei Li
- Department of Pathologythe First Affiliated Hospital of Soochow UniversitySoochow UniversitySuzhouJiangsu215123China
| | - Yuhong Wang
- Department of Pathologythe First Affiliated Hospital of Soochow UniversitySoochow UniversitySuzhouJiangsu215123China
| | - Wenhao Shen
- Department of OncologyTaizhou People's Hospital Affiliated to Nanjing Medical UniversityTaizhou225300China
| | - Ziyu Zhang
- State Key Laboratory of Radiation Medicine and ProtectionSchool of Radiation Medicine and Protection & School for Radiological and Interdisciplinary Sciences (RAD‐X)Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education InstitutionsSuzhou Medical CollegeSoochow UniversitySuzhouJiangsu215123China
| | - Zhiyue Su
- Department of Pathologythe First Affiliated Hospital of Soochow UniversitySoochow UniversitySuzhouJiangsu215123China
| | - Xia Guo
- Department of Pathologythe First Affiliated Hospital of Soochow UniversitySoochow UniversitySuzhouJiangsu215123China
| | - Pei Pei
- State Key Laboratory of Radiation Medicine and ProtectionSchool of Radiation Medicine and Protection & School for Radiological and Interdisciplinary Sciences (RAD‐X)Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education InstitutionsSuzhou Medical CollegeSoochow UniversitySuzhouJiangsu215123China
| | - Lin Hu
- State Key Laboratory of Radiation Medicine and ProtectionSchool of Radiation Medicine and Protection & School for Radiological and Interdisciplinary Sciences (RAD‐X)Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education InstitutionsSuzhou Medical CollegeSoochow UniversitySuzhouJiangsu215123China
| | - Teng Liu
- State Key Laboratory of Radiation Medicine and ProtectionSchool of Radiation Medicine and Protection & School for Radiological and Interdisciplinary Sciences (RAD‐X)Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education InstitutionsSuzhou Medical CollegeSoochow UniversitySuzhouJiangsu215123China
| | - Kai Yang
- Department of Pathologythe First Affiliated Hospital of Soochow UniversitySoochow UniversitySuzhouJiangsu215123China
- State Key Laboratory of Radiation Medicine and ProtectionSchool of Radiation Medicine and Protection & School for Radiological and Interdisciplinary Sciences (RAD‐X)Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education InstitutionsSuzhou Medical CollegeSoochow UniversitySuzhouJiangsu215123China
| | - Lingchuan Guo
- Department of Pathologythe First Affiliated Hospital of Soochow UniversitySoochow UniversitySuzhouJiangsu215123China
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Castagnoli F, Mencel J, Ap Dafydd D, Gough J, Drake B, Mcaddy NC, Withey SJ, Riddell AM, Koh DM, Shur JD. Response Evaluation Criteria in Gastrointestinal and Abdominal Cancers: Which to Use and How to Measure. Radiographics 2024; 44:e230047. [PMID: 38662587 DOI: 10.1148/rg.230047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
As the management of gastrointestinal malignancy has evolved, tumor response assessment has expanded from size-based assessments to those that include tumor enhancement, in addition to functional data such as those derived from PET and diffusion-weighted imaging. Accurate interpretation of tumor response therefore requires knowledge of imaging modalities used in gastrointestinal malignancy, anticancer therapies, and tumor biology. Targeted therapies such as immunotherapy pose additional considerations due to unique imaging response patterns and drug toxicity; as a consequence, immunotherapy response criteria have been developed. Some gastrointestinal malignancies require assessment with tumor-specific criteria when assessing response, often to guide clinical management (such as watchful waiting in rectal cancer or suitability for surgery in pancreatic cancer). Moreover, anatomic measurements can underestimate therapeutic response when applied to molecular-targeted therapies or locoregional therapies in hypervascular malignancies such as hepatocellular carcinoma. In these cases, responding tumors may exhibit morphologic changes including cystic degeneration, necrosis, and hemorrhage, often without significant reduction in size. Awareness of pitfalls when interpreting gastrointestinal tumor response is required to correctly interpret response assessment imaging and guide appropriate oncologic management. Data-driven image analyses such as radiomics have been investigated in a variety of gastrointestinal tumors, such as identifying those more likely to respond to therapy or recur, with the aim of delivering precision medicine. Multimedia-enhanced radiology reports can facilitate communication of gastrointestinal tumor response by automatically embedding response categories, key data, and representative images. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.
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Affiliation(s)
- Francesca Castagnoli
- From the Departments of Radiology (F.C., D.a.D., N.C.M., S.J.W., A.M.R., D.M.K., J.D.S.), Oncology (J.M.), Radiotherapy (J.G.), and Nuclear Medicine (B.D.), Royal Marsden Hospital, Downs Road, Sutton SM2 5PT, UK; and Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK (F.C., D.M.K.)
| | - Justin Mencel
- From the Departments of Radiology (F.C., D.a.D., N.C.M., S.J.W., A.M.R., D.M.K., J.D.S.), Oncology (J.M.), Radiotherapy (J.G.), and Nuclear Medicine (B.D.), Royal Marsden Hospital, Downs Road, Sutton SM2 5PT, UK; and Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK (F.C., D.M.K.)
| | - Derfel Ap Dafydd
- From the Departments of Radiology (F.C., D.a.D., N.C.M., S.J.W., A.M.R., D.M.K., J.D.S.), Oncology (J.M.), Radiotherapy (J.G.), and Nuclear Medicine (B.D.), Royal Marsden Hospital, Downs Road, Sutton SM2 5PT, UK; and Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK (F.C., D.M.K.)
| | - Jessica Gough
- From the Departments of Radiology (F.C., D.a.D., N.C.M., S.J.W., A.M.R., D.M.K., J.D.S.), Oncology (J.M.), Radiotherapy (J.G.), and Nuclear Medicine (B.D.), Royal Marsden Hospital, Downs Road, Sutton SM2 5PT, UK; and Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK (F.C., D.M.K.)
| | - Brent Drake
- From the Departments of Radiology (F.C., D.a.D., N.C.M., S.J.W., A.M.R., D.M.K., J.D.S.), Oncology (J.M.), Radiotherapy (J.G.), and Nuclear Medicine (B.D.), Royal Marsden Hospital, Downs Road, Sutton SM2 5PT, UK; and Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK (F.C., D.M.K.)
| | - Naami Charlotte Mcaddy
- From the Departments of Radiology (F.C., D.a.D., N.C.M., S.J.W., A.M.R., D.M.K., J.D.S.), Oncology (J.M.), Radiotherapy (J.G.), and Nuclear Medicine (B.D.), Royal Marsden Hospital, Downs Road, Sutton SM2 5PT, UK; and Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK (F.C., D.M.K.)
| | - Samuel Joseph Withey
- From the Departments of Radiology (F.C., D.a.D., N.C.M., S.J.W., A.M.R., D.M.K., J.D.S.), Oncology (J.M.), Radiotherapy (J.G.), and Nuclear Medicine (B.D.), Royal Marsden Hospital, Downs Road, Sutton SM2 5PT, UK; and Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK (F.C., D.M.K.)
| | - Angela Mary Riddell
- From the Departments of Radiology (F.C., D.a.D., N.C.M., S.J.W., A.M.R., D.M.K., J.D.S.), Oncology (J.M.), Radiotherapy (J.G.), and Nuclear Medicine (B.D.), Royal Marsden Hospital, Downs Road, Sutton SM2 5PT, UK; and Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK (F.C., D.M.K.)
| | - Dow-Mu Koh
- From the Departments of Radiology (F.C., D.a.D., N.C.M., S.J.W., A.M.R., D.M.K., J.D.S.), Oncology (J.M.), Radiotherapy (J.G.), and Nuclear Medicine (B.D.), Royal Marsden Hospital, Downs Road, Sutton SM2 5PT, UK; and Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK (F.C., D.M.K.)
| | - Joshua David Shur
- From the Departments of Radiology (F.C., D.a.D., N.C.M., S.J.W., A.M.R., D.M.K., J.D.S.), Oncology (J.M.), Radiotherapy (J.G.), and Nuclear Medicine (B.D.), Royal Marsden Hospital, Downs Road, Sutton SM2 5PT, UK; and Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK (F.C., D.M.K.)
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Bratu LD, Schenker M, Stovicek PO, Schenker RA, Mehedințeanu AM, Berisha TC, Donoiu A, Mogoantă SȘ. Retrospective Evaluation of the Efficacy of Total Neoadjuvant Therapy and Chemoradiotherapy Neoadjuvant Treatment in Relation to Surgery in Patients with Rectal Cancer. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:656. [PMID: 38674302 PMCID: PMC11052151 DOI: 10.3390/medicina60040656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 04/14/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024]
Abstract
Background and Objective: In the therapeutic strategy of rectal cancer, radiotherapy has consolidated its important position and frequent use in current practice due to its indications as neoadjuvant, adjuvant, definitive, or palliative treatment. In recent years, total neoadjuvant therapy (TNT) has been established as the preferred regimen compared to concurrent neoadjuvant chemoradiotherapy (CRT). In relation to better outcomes, the percentage of patients who achieved pathological complete response (pCR) after neoadjuvant treatment is higher in the case of TNT. This study aimed to analyze the response to TNT compared to neoadjuvant CRT regarding pCR rate and the change in staging after surgical intervention. Materials and Methods: We performed a retrospective study on 323 patients with rectal cancer and finally analyzed the data of 201 patients with neoadjuvant treatment, selected based on the inclusion and exclusion criteria. Patients received CRT neoadjuvant therapy or TNT neoadjuvant therapy with FOLFOX or CAPEOX. Results: Out of 157 patients who underwent TNT treatment, 19.74% had pathological complete response, whereas in the group with CRT (n = 44), those with pCR were 13.64%. After neoadjuvant treatment, the most frequent TNM classifications were ypT2 (40.30%) and ypN0 (79.10%). The statistical analysis of the postoperative disease stage, after neoadjuvant therapy, showed that the most frequent changes were downstaging (71.14%) and complete response (18.41%). Only four patients (1.99%) had an upstaging change. The majority of patients (88.56%) initially presented clinical evidence of nodal involvement whereas only 20.9% of the patients still presented regional disease at the time of surgical intervention. Conclusions: By using TNT, a higher rate of stage reduction is obtained compared to the neoadjuvant CRT treatment. The post-neoadjuvant-treatment imagistic evaluation fails to accurately evaluate the response. A better response to TNT was observed in young patients.
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Affiliation(s)
- Lucian Dragoș Bratu
- Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania (T.C.B.); (A.D.)
- Sf. Nectarie Oncology Center, 200347 Craiova, Romania; (R.A.S.); (A.M.M.)
| | - Michael Schenker
- Sf. Nectarie Oncology Center, 200347 Craiova, Romania; (R.A.S.); (A.M.M.)
- Department of Oncology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Puiu Olivian Stovicek
- Sf. Nectarie Oncology Center, 200347 Craiova, Romania; (R.A.S.); (A.M.M.)
- Department of Pharmacology, Faculty of Nursing, Târgu Jiu Subsidiary, Titu Maiorescu University, 040441 Bucharest, Romania
| | | | | | - Tradian Ciprian Berisha
- Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania (T.C.B.); (A.D.)
- Sf. Nectarie Oncology Center, 200347 Craiova, Romania; (R.A.S.); (A.M.M.)
| | - Andreas Donoiu
- Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania (T.C.B.); (A.D.)
- 3rd General Surgery Clinic, Emergency County Hospital, 200642 Craiova, Romania;
| | - Stelian Ștefăniță Mogoantă
- 3rd General Surgery Clinic, Emergency County Hospital, 200642 Craiova, Romania;
- Department of Surgery, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
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Liu Z, Xu M, Yu Q, Song J, Lin Q, Huang S, Chen Z, Huang Y, Chi P. Fibrosis signature of anastomotic margins for predicting anastomotic stenosis in rectal cancer with neoadjuvant chemoradiotherapy and sphincter-preserving surgery. Gastroenterol Rep (Oxf) 2024; 12:goae012. [PMID: 38510669 PMCID: PMC10950477 DOI: 10.1093/gastro/goae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 11/27/2023] [Accepted: 12/31/2023] [Indexed: 03/22/2024] Open
Abstract
Background Radiation-induced colorectal fibrosis (RICF) is a common pathological alteration among patients with rectal cancer undergoing neoadjuvant chemoradiotherapy (nCRT). Anastomotic stenosis (AS) causes symptoms and negatively impacts patients' quality of life and long-term survival. In this study, we aimed to evaluate the fibrosis signature of RICF and develop a nomogram to predict the risk of AS in patients with rectal cancer undergoing nCRT. Methods Overall, 335 pairs of proximal and distal margins were collected and randomly assigned at a 7:3 ratio to the training and testing cohorts. The RICF score was established to evaluate the fibrosis signature in the anastomotic margins. A nomogram based on the RICF score for AS was developed and evaluated by using the area under the curve, decision curve analysis, and the DeLong test. Results The training cohort included 235 patients (161 males [68.51%]; mean age, 59.61 years) with an occurrence rate of AS of 17.4%, whereas the testing cohort included 100 patients (72 males [72.00%]; mean age, 57.17 years) with an occurrence rate of AS of 11%. The RICF total score of proximal and distal margins was significantly associated with AS (odds ratio, 3.064; 95% confidence interval [CI], 2.200-4.268; P < 0.001). Multivariable analysis revealed that the RICF total score, neoadjuvant radiotherapy, and surgical approach were independent predictors for AS. The nomogram demonstrated good discrimination in the training cohort (area under the receiver-operating characteristic curve, 0.876; 95% CI, 0.816-0.937), with a sensitivity of 68.3% (95% CI, 51.9%-81.9%) and a specificity of 85.5% (95% CI, 78.7%-89.3%). Similar results were observed in the testing cohort. Conclusions This study results suggest that the RICF total score of anastomotic margins is an independent predictor for AS. The prediction model developed based on the RICF total score may be useful for individualized AS risk prediction in patients with rectal cancer undergoing nCRT and sphincter-preserving surgery.
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Affiliation(s)
- Zhun Liu
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, P. R. China
| | - Meifang Xu
- Department of Pathology, Fujian Medical University Union Hospital, Fuzhou, Fujian, P. R. China
| | - Qian Yu
- Department of Pathology, Fujian Medical University Union Hospital, Fuzhou, Fujian, P. R. China
| | - Jianyuan Song
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, Fujian, P. R. China
| | - Qili Lin
- Department of Pathology, Fujian Medical University Union Hospital, Fuzhou, Fujian, P. R. China
| | - Shenghui Huang
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, P. R. China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, P. R. China
| | - Zhifen Chen
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, P. R. China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, P. R. China
| | - Ying Huang
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, P. R. China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, P. R. China
| | - Pan Chi
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, P. R. China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, P. R. China
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10
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Yazici H, Eren Kayaci A, Sevindi HI, Attaallah W. Should we consider Systemic Inflammatory Response Index (SIRI) as a new diagnostic marker for rectal cancer? Discov Oncol 2024; 15:44. [PMID: 38381179 PMCID: PMC10881451 DOI: 10.1007/s12672-024-00895-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 02/16/2024] [Indexed: 02/22/2024] Open
Abstract
PURPOSE The Systemic Inflammatory Response Index (SIRI), which depends on peripheral neutrophil, monocyte, and lymphocyte count, was found to be an effective prognostic indicator for various malignancies. In this study, we aimed to investigate the diagnostic value and the prognostic impact of SIRI on rectal cancer patients. METHOD The medical records of patients underwent sphincter-sparing rectal cancer surgery at general surgery between 2017 and 2022 were examined retrospectively. Patient demographics, operation types, neoadjuvant chemo/radiotherapies, pathological results, and complications were recorded. A total number of 99 patients who operated with diagnoses other than cancer were conducted as a control group. SIRI was calculated from preoperative peripheral blood samples' neutrophil, lymphocyte, and monocyte count. The optimal cut-off value for SIRI was found to be 1.38. The clinicopathological outcomes and Overall Survival (OS) were analyzed under two groups according to the SIRI values lower or higher than 1.38. RESULTS The number of eligible patients was 104. The median age of the entire cohort was 62 (31-89). The median follow-up time was 33 (1-62) months. The median SIRI value in the study group was significantly higher compared with the control group. The study group was examined under two groups: SIRI 1.38 and SIRI > 1.38. The male gender was significantly more frequent in the high SIRI group. The remaining patient demographics and operation types were similar between the groups. The pathological outcomes were similar between the two groups. Overall Survival rate was better in the low SIRI group than those higher. The higher group had significantly higher complication rates than the lower SIRI group (p: 0.004). CONCLUSION SIRI may be a valuable diagnostic marker in rectal cancer patients. Higher SIRI levels were also associated with poorer prognosis and increased complication rates. Still, further prospective studies with a larger number of patients are needed.
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Affiliation(s)
- Hilmi Yazici
- Marmara Universitesi Pendik Eğitim Ve Araştırma Hastanesi, Istanbul, Turkey.
| | - Ayse Eren Kayaci
- Marmara Universitesi Pendik Eğitim Ve Araştırma Hastanesi, Istanbul, Turkey
| | | | - Wafi Attaallah
- Marmara Universitesi Pendik Eğitim Ve Araştırma Hastanesi, Istanbul, Turkey
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11
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Jiang W, Wang H, Dong X, Zhao Y, Long C, Chen D, Yan B, Cheng J, Lin Z, Zhuo S, Wang H, Yan J. Association of the pathomics-collagen signature with lymph node metastasis in colorectal cancer: a retrospective multicenter study. J Transl Med 2024; 22:103. [PMID: 38273371 PMCID: PMC10811897 DOI: 10.1186/s12967-024-04851-2] [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: 07/30/2023] [Accepted: 01/02/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Lymph node metastasis (LNM) is a prognostic biomarker and affects therapeutic selection in colorectal cancer (CRC). Current evaluation methods are not adequate for estimating LNM in CRC. H&E images contain much pathological information, and collagen also affects the biological behavior of tumor cells. Hence, the objective of the study is to investigate whether a fully quantitative pathomics-collagen signature (PCS) in the tumor microenvironment can be used to predict LNM. METHODS Patients with histologically confirmed stage I-III CRC who underwent radical surgery were included in the training cohort (n = 329), the internal validation cohort (n = 329), and the external validation cohort (n = 315). Fully quantitative pathomics features and collagen features were extracted from digital H&E images and multiphoton images of specimens, respectively. LASSO regression was utilized to develop the PCS. Then, a PCS-nomogram was constructed incorporating the PCS and clinicopathological predictors for estimating LNM in the training cohort. The performance of the PCS-nomogram was evaluated via calibration, discrimination, and clinical usefulness. Furthermore, the PCS-nomogram was tested in internal and external validation cohorts. RESULTS By LASSO regression, the PCS was developed based on 11 pathomics and 9 collagen features. A significant association was found between the PCS and LNM in the three cohorts (P < 0.001). Then, the PCS-nomogram based on PCS, preoperative CEA level, lymphadenectasis on CT, venous emboli and/or lymphatic invasion and/or perineural invasion (VELIPI), and pT stage achieved AUROCs of 0.939, 0.895, and 0.893 in the three cohorts. The calibration curves identified good agreement between the nomogram-predicted and actual outcomes. Decision curve analysis indicated that the PCS-nomogram was clinically useful. Moreover, the PCS was still an independent predictor of LNM at station Nos. 1, 2, and 3. The PCS nomogram displayed AUROCs of 0.849-0.939 for the training cohort, 0.837-0.902 for the internal validation cohort, and 0.851-0.895 for the external validation cohorts in the three nodal stations. CONCLUSIONS This study proposed that PCS integrating pathomics and collagen features was significantly associated with LNM, and the PCS-nomogram has the potential to be a useful tool for predicting individual LNM in CRC patients.
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Affiliation(s)
- Wei Jiang
- Department of General Surgery, Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, 510515, People's Republic of China
- School of Science, Jimei University, Xiamen, Fujian, 361021, People's Republic of China
| | - Huaiming Wang
- Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, 510655, People's Republic of China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, 510655, People's Republic of China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, 510655, People's Republic of China
| | - Xiaoyu Dong
- Department of General Surgery, Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, 510515, People's Republic of China
| | - Yandong Zhao
- Department of Pathology, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, 510655, People's Republic of China
| | - Chenyan Long
- Department of General Surgery, Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, 510515, People's Republic of China
- Division of Colorectal and Anal Surgery, Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, 530000, People's Republic of China
| | - Dexin Chen
- Department of General Surgery, Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, 510515, People's Republic of China
| | - Botao Yan
- Department of General Surgery, Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, 510515, People's Republic of China
| | - Jiaxin Cheng
- Department of General Surgery, Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, 510515, People's Republic of China
| | - Zexi Lin
- School of Science, Jimei University, Xiamen, Fujian, 361021, People's Republic of China
| | - Shuangmu Zhuo
- School of Science, Jimei University, Xiamen, Fujian, 361021, People's Republic of China.
| | - Hui Wang
- Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, 510655, People's Republic of China.
| | - Jun Yan
- Department of General Surgery, Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, 510515, People's Republic of China.
- Department of Gastrointestinal Surgery, Shenzhen People's Hospital, Second Clinical Medical College of Jinan University, First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, Guangdong, 518020, People's Republic of China.
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12
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Bai G, Wang C, Sun Y, Li J, Shi X, Zhang W, Yang Y, Yang R. Quantitative analysis of contrast-enhanced ultrasound in neoadjuvant treatment of locally advanced rectal cancer: a retrospective study. Front Oncol 2024; 13:1340060. [PMID: 38322290 PMCID: PMC10844946 DOI: 10.3389/fonc.2023.1340060] [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: 12/05/2023] [Accepted: 12/26/2023] [Indexed: 02/08/2024] Open
Abstract
Purpose To explore the clinical value of contrast-enhanced ultrasound (CEUS) quantitative analysis in the evaluation and prognosis of neoadjuvant chemoradiotherapy for locally advanced rectal cancer (LARC). Methods Eighty-three consecutive patients undergoing neoadjuvant chemoradiotherapy and total mesorectal excision for LARC were retrospectively included. According to pathological results, patients were categorized into complete or incomplete response groups. Differences in ultrasonic parameters, pathological results, and clinical data between groups were evaluated. The cutoff point for a complete response as determined by quantitative analysis of CEUS was assessed using a receiver operating characteristic curve; additionally, overall survival (OS) and progression-free survival (PFS) were analyzed. Results Of the 83 patients, 12 (14.5%) achieved a complete response and 71 (85.5%) did not. There were significant between-group differences in carcinoembryonic antigen (CEA) levels, differentiation degree, proportion of tumor occupying the lumen, anterior-posterior and superior-inferior diameters of the lesion, and intensity of enhancement (P<0.05). CEUS quantitative analysis showed significant between-group differences in peak intensity (PI) and area under the curve (AUC) values (P<0.05). The OS and PFS of patients with high PI, high AUC value, and poorly differentiated cancer were significantly worse than those with low PI, low AUC values, and moderately to highly differentiated cancer (P<0.05). High CEA levels (hazard ratio: 1.02, 95% confidence interval: 1.01-1.04; P=0.002) and low differentiation (2.72, 1.12-6.62; P=0.028) were independent risk factors for PFS and OS. Conclusions CEUS can predict the response to neoadjuvant treatment in patients with LARC. CEUS quantitative analysis is helpful for clinical prognosis.
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Affiliation(s)
- Gouyang Bai
- Department of Ultrasound, Tang Du Hospital, Xi’an, China
| | - Congying Wang
- Department of Clinical Laboratory, Tang Du Hospital, Xi’an, China
| | - Yi Sun
- Department of Ultrasound, Tang Du Hospital, Xi’an, China
| | - Jinghua Li
- Department of Ultrasound, Tang Du Hospital, Xi’an, China
| | - Xiangzhou Shi
- Department of Ultrasound, Tang Du Hospital, Xi’an, China
| | - Wei Zhang
- Department of Pathology, Tang Du Hospital, Xi’an, China
| | - Yilin Yang
- Department of Ultrasound, Tang Du Hospital, Xi’an, China
| | - Ruijing Yang
- Department of Ultrasound, Tang Du Hospital, Xi’an, China
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Ahmad A, Tiwari RK, Siddiqui S, Chadha M, Shukla R, Srivastava V. Emerging trends in gastrointestinal cancers: Targeting developmental pathways in carcinogenesis and tumor progression. INTERNATIONAL REVIEW OF CELL AND MOLECULAR BIOLOGY 2024; 385:41-99. [PMID: 38663962 DOI: 10.1016/bs.ircmb.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Gastrointestinal carcinomas are a group of cancers associated with the digestive system and its accessory organs. The most prevalent cancers related to the gastrointestinal tract are colorectal, gall bladder, gastric, hepatocellular, and esophageal cancers, respectively. Molecular aberrations in different signaling pathways, such as signal transduction systems or developmental pathways are the chief triggering mechanisms in different cancers Though a massive advancement in diagnostic and therapeutic interventions results in improved survival of patients with gastrointestinal cancer; the lower malignancy stages of these carcinomas are comparatively asymptomatic. Various gastrointestinal-related cancers are detected at advanced stages, leading to deplorable prognoses and increased rates of recurrence. Recent molecular studies have elucidated the imperative roles of several signaling pathways, namely Wnt, Hedgehog, and Notch signaling pathways, play in the progression, therapeutic responsiveness, and metastasis of gastrointestinal-related cancers. This book chapter gives an interesting update on recent findings on the involvement of developmental signaling pathways their mechanistic insight in gastrointestinalcancer. Subsequently, evidences supporting the exploration of gastrointestinal cancer related molecular mechanisms have also been discussed for developing novel therapeutic strategies against these debilitating carcinomas.
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Affiliation(s)
- Afza Ahmad
- Department of Biosciences, Integral University, Lucknow, Uttar Pradesh, India
| | - Rohit Kumar Tiwari
- Department of Clinical Research, Sharda School of Allied Health Sciences, Sharda University, Greater Noida, Uttar Pradesh, India
| | - Saleha Siddiqui
- Department of Biotechnology, Delhi Technological University, Delhi, India
| | - Muskan Chadha
- Department of Nutrition and Dietetics, Sharda School of Allied Health Sciences, Sharda University, Greater Noida, Uttar Pradesh, India
| | - Ratnakar Shukla
- Department of Clinical Research, Sharda School of Allied Health Sciences, Sharda University, Greater Noida, Uttar Pradesh, India
| | - Vivek Srivastava
- Department of Chemistry & Biochemistry, Sharda School of Basic Sciences & Research, Sharda University, Greater Noida, Uttar Pradesh, India.
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Fok M, Hill R, Fowler H, Clifford R, Kler A, Uzzi-Daniel J, Rocha S, Grundy G, Parsons J, Vimalachandran D. Enhancing radiotherapy outcomes in rectal cancer: A systematic review of targeting hypoxia-induced radioresistance. Clin Transl Radiat Oncol 2024; 44:100695. [PMID: 37961749 PMCID: PMC10637894 DOI: 10.1016/j.ctro.2023.100695] [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: 07/31/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
Introduction Neoadjuvant radiotherapy is successfully used in rectal cancer to improve overall survival. However, treatment response is both unpredictable and variable. There is strong evidence to show that the phenomenon of tumour hypoxia is associated with radioresistance, however the mechanism(s) behind this are poorly understood. Consequently, there have only been a small number of studies evaluating methods targeting hypoxia-induced radioresistance. The purpose of this systematic review is to evaluate the potential effectiveness of targeting hypoxia-induced radioresistance in rectal cancer and provide recommendations for future research in this area. Methods A comprehensive literature search was performed following the PRISMA guidelines. This study was registered on the Prospero database (CRD42023441983). Results Eight articles met the inclusion criteria. All studies identified were in vitro or in vivo studies, there were no clinical trials. Of the 8 studies identified, 5 assessed the efficacy of drugs which directly or indirectly targeted hypoxia and three that identified potential targets. There was conflicting in vivo evidence for the use of metformin to overcome hypoxia induced radioresistance. Vorinostat, atovaquone, and evofosfamide showed promising preclinical evidence that they can overcome hypoxia-induced radioresistance. Discussion The importance of investigating hypoxia-induced radioresistance in rectal cancer is crucial. However, to date, only a small number of preclinical studies exist evaluating this phenomenon. This systematic review highlights the importance of further research to fully understand the mechanism behind this radioresistance. There are promising targets identified in this systematic review however, substantially more pre-clinical and clinical research as a priority for future research is needed.
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Affiliation(s)
- Matthew Fok
- Institute of Systems, Molecular and Integrative Biology University of Liverpool, UK
| | - Rhianna Hill
- Institute of Systems, Molecular and Integrative Biology University of Liverpool, UK
| | - Hayley Fowler
- Institute of Systems, Molecular and Integrative Biology University of Liverpool, UK
| | - Rachael Clifford
- Institute of Systems, Molecular and Integrative Biology University of Liverpool, UK
| | - Aaron Kler
- Institute of Systems, Molecular and Integrative Biology University of Liverpool, UK
| | - Jayanma Uzzi-Daniel
- Institute of Systems, Molecular and Integrative Biology University of Liverpool, UK
| | - Sonia Rocha
- Institute of Systems, Molecular and Integrative Biology University of Liverpool, UK
| | - Gabrielle Grundy
- Institute of Systems, Molecular and Integrative Biology University of Liverpool, UK
| | - Jason Parsons
- Institute of Cancer and Genomic Sciences, University of Birmingham, UK
| | - Dale Vimalachandran
- Institute of Systems, Molecular and Integrative Biology University of Liverpool, UK
- Countess of Chester Hospital, Colorectal Surgery Department, Chester, UK
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15
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Zeng H, Zhang F, Sun Y, Li S, Zhang W. Treatment options for neoadjuvant strategies of esophageal squamous cell carcinoma (Review). Mol Clin Oncol 2024; 20:4. [PMID: 38223404 PMCID: PMC10784769 DOI: 10.3892/mco.2023.2702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 10/26/2023] [Indexed: 01/16/2024] Open
Abstract
Compared with postoperative adjuvant therapy, neoadjuvant therapy has more potential advantages, such as decreasing tumor stage, killing micrometastatic cells. Because of these advantages, neoadjuvant therapy is recommended for numerous types of tumor, such as breast, lung and rectal cancer. To determine the role of neoadjuvant therapy on overall survival and adverse for patients with resectable esophageal carcinoma. we summarized clinical studies on 7 types of neoadjuvant therapies in this review. Currently, patients with esophageal cancer (EC) in China mainly receive postoperative treatment with <30% of patients receiving neoadjuvant therapy. One reason for the limited use of neoadjuvant therapy in China is inaccurate staging based on imaging and neoadjuvant treatment may increase difficulties in surgery. After neoadjuvant therapy, there may be tissue edema, blurry surgical field of view and unclear tissue gaps, resulting in greater difficulty in surgical procedures. However, oncologists are interested in neoadjuvant treatment, especially neoadjuvant immunotherapy to treat EC. Concurrent chemoradiotherapy for esophageal squamous cell carcinoma (ESCC) is the most common neoadjuvant treatment regimen and increases the pathological complete response (pCR) and 5- and 10-year survival rates. Preoperative induction chemotherapy and sequential concurrent chemoradiotherapy are currently the most widely treatments used in clinical practice in China. However, this treatment strategy does not yield long-term survival. The pCR rate of neoadjuvant immunotherapy is greater than that of concurrent chemoradiotherapy but, to the best of our knowledge, no evidence of long-term survival benefit has been found in phase I and II clinical trials. Neoadjuvant treatment should be considered for patients with locally advanced ESCC.
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Affiliation(s)
- Hai Zeng
- Department of Oncology, First Affiliated Hospital of Yangtze University, Jingzhou, Hubei 434000, P.R. China
| | - Fan Zhang
- Department of Oncology, First Affiliated Hospital of Yangtze University, Jingzhou, Hubei 434000, P.R. China
| | - Yujiao Sun
- Department of Clinical Medicine, Medical School of Yangtze University, Jingzhou, Hubei 434000, P.R. China
| | - Shuang Li
- Department of Oncology, First Affiliated Hospital of Yangtze University, Jingzhou, Hubei 434000, P.R. China
| | - Weijia Zhang
- Department of Oncology, First Affiliated Hospital of Yangtze University, Jingzhou, Hubei 434000, P.R. China
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Zeng Z, Ma D, Zhu P, Niu K, Fu S, Di X, Zhu J, Xie P. Prognostic value of the ratio of pretreatment carcinoembryonic antigen to tumor volume in rectal cancer. J Gastrointest Oncol 2023; 14:2395-2408. [PMID: 38196531 PMCID: PMC10772672 DOI: 10.21037/jgo-23-683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/10/2023] [Indexed: 01/11/2024] Open
Abstract
Background As a commonly used biomarker in rectal cancer (RC), the prognostic value of carcinoembryonic antigen (CEA) remains underexplored. This study aims to evaluate the prognostic value of pretreatment CEA/tumor volume in RC. Methods This retrospective study included patients who underwent pretreatment magnetic resonance imaging (MRI) with histologically confirmed primary rectal adenocarcinoma from November 2012 to April 2018. Patients were divided into high-risk and low-risk groups according to the median values of CEA/Diapath (CEA to pathological diameter), CEA/DiaMRI (CEA to MRI tumor diameter), and CEA/VolMRI (CEA to MRI tumor volume). Cox regression analysis was utilized to determine the prognostic value of CEA, CEA/Diapath, CEA/DiaMRI, and CEA/VolMRI. Stepwise regression was used to establish nomograms for predicting disease-free survival (DFS) and overall survival (OS). Predictive performance was estimated by using the concordance index (C-index) and area under curve receiver operating characteristic (AUC). Results A total of 343 patients [median age 58.99 years, 206 (60.06%) males] were included. After adjusting for patient-related and tumor-related factors, CEA/VolMRI was superior to CEA, CEA/Diapath, and CEA/DiaMRI in distinguishing high-risk from low-risk patients in terms of DFS [hazard ratio (HR) =1.83; P=0.010] and OS (HR =1.67; P=0.048). Subanalysis revealed that CEA/VolMRI stratified high death risk in CEA-negative individuals (HR =2.50; P=0.038), and also stratified low recurrence risk in CEA-positive individuals (HR =2.06; P=0.024). In the subanalysis of stage II or III cases, the highest HRs and the smallest P values were observed in distinguishing high-risk from low-risk patients according to CEA/VolMRI in terms of DFS (HR =2.44; P=0.046 or HR =2.41; P=0.001) and OS (HR =1.96; P=0.130 or HR =2.22; P=0.008). The nomograms incorporating CEA/VolMRI showed good performance, with a C-index of 0.72 [95% confidence interval (CI): 0.68-0.79] for DFS and 0.73 (95% CI: 0.68-0.80) for OS. Conclusions Higher CEA/VolMRI was associated with worse DFS and OS. CEA/VolMRI was superior to CEA, CEA/Diapath, and CEA/DiaMRI in predicting DFS and OS. Pretreatment CEA/VolMRI may facilitate risk stratification and treatment decision-making.
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Affiliation(s)
- Zhiming Zeng
- Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Decai Ma
- Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Pan Zhu
- Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Kexin Niu
- Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shuai Fu
- Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaohui Di
- Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Junying Zhu
- Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Peiyi Xie
- Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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17
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Hui L, Zhang YY, Hu XD. Multidisciplinary diagnosis and treatment nutritional support intervention for gastrointestinal tumor radiotherapy: Impact on nutrition and quality of life. World J Gastrointest Surg 2023; 15:2719-2726. [PMID: 38222015 PMCID: PMC10784837 DOI: 10.4240/wjgs.v15.i12.2719] [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: 08/23/2023] [Revised: 09/19/2023] [Accepted: 11/14/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND Gastrointestinal tumors are a major cause of cancer-related deaths and have become a major public health problem. This study aims to provide a scientific basis for improving clinical treatment effects, quality of life, and prognosis of patients with gastrointestinal tumors. AIM To explore the clinical effect of the multidisciplinary diagnosis and treatment (MDT) nutrition intervention model on patients with gastrointestinal tumors. METHODS This was a case control study which included patients with gastrointestinal tumors who received radiotherapy at the Department of Oncology between January 2021 and January 2023. Using a random number table, 120 patients were randomly divided into MDT and control groups with 60 patients in each group. To analyze the effect of MDT on the nutritional status and quality of life of the patients, the nutritional status and quality of life scores of the patients were measured before and after the treatment. RESULTS Albumin (ALB), transferrin (TRF), hemoglobin (Hb), and total protein (TP) levels significantly decreased after the treatment. The control group had significantly lower ALB, TRF, Hb, and TP levels than the MDT group, and the differences in these levels between the two groups were statistically significant (P < 0.05). After the treatment, the MDT group had significantly more well-nourished patients than the control group (P < 0.05). The quality of life total score, somatic functioning, role functioning, and emotional functioning were higher in the MDT group than in the control group. By contrast, pain, fatigue, nausea, and vomiting scores were lower in the MDT group than in the control group (P < 0.05). CONCLUSION MDT nutritional intervention model effectively improves the nutritional status and quality of life of the patients. The study provides a rigorous theoretical basis for improving the prognosis of cancer patients. In the future, we intend to provide additional treatment methods for improving the quality of life of patients with cancer.
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Affiliation(s)
- Lin Hui
- Head, Neck and Chest Radiotherapy Department 1, Affiliated Hospital of Jiangnan University, Wuxi 214000, Jiangsu Province, China
| | - Ying-Ying Zhang
- Department of Gastroenterology, The People’s Hospital of Danyang, Danyang 212300, Jiangsu Province, China
| | - Xiao-Dan Hu
- Department of Gastroenterology, Affiliated Hospital of Jiangnan University, Wuxi 214000, Jiangsu Province, China
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18
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Arndt KR, Dombek GE, Allar BG, Storino A, Fleishman A, Quinn J, Fabrizio A, Cataldo TE, Messaris E. Impact of National Accreditation Program for Rectal Cancer guidelines on surgical margin status. Surg Oncol 2023; 51:101921. [PMID: 36898906 DOI: 10.1016/j.suronc.2023.101921] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/13/2023] [Accepted: 02/21/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND The American College of Surgeons established the National Accreditation Program for Rectal Cancer (NAPRC) to standardize rectal cancer care. We sought to assess the impact of NAPRC guidelines at a tertiary care center on surgical margin status. MATERIALS AND METHODS The Institutional NSQIP database was queried for patients with rectal adenocarcinoma undergoing surgery for curative intent two years prior to and following implementation of NAPRC guidelines. Primary outcome was surgical margin status before (pre-NAPRC) versus after (post-NAPRC) implementation of NAPRC guidelines. RESULTS Surgical pathology in five (5%) pre-NAPRC and seven (8%) post-NAPRC patients had positive radial margins (p = 0.59); distal margins were positive in three (3%) post-NAPRC and six (7%) post-NAPRC patients (p = 0.37). Local recurrence was observed in seven (6%) pre-NAPRC patients, there were no recurrences to date in post-NAPRC patients (p = 0.15). Metastasis was observed in 18 (17%) pre-NAPRC patients and four (4%) post-NAPRC patients (p = 0.55). CONCLUSION NAPRC implementation was not associated with a change in surgical margin status for rectal cancer at our institution. However, the NAPRC guidelines formalize evidence-based rectal cancer care and we anticipate that improvements will be greatest in low-volume hospitals which may not utilize multidisciplinary collaboration.
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Affiliation(s)
- Kevin R Arndt
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | - Gabrielle E Dombek
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Benjamin G Allar
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Alessandra Storino
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Aaron Fleishman
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jeanne Quinn
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Anne Fabrizio
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Thomas E Cataldo
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Evangelos Messaris
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
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19
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Donnelly SM, Wyatt J, Powell SG, Jones N, Altaf K, Ahmed S. What is the optimal timing of surgery after short-course radiotherapy for rectal cancer? Surg Oncol 2023; 51:101992. [PMID: 37757518 DOI: 10.1016/j.suronc.2023.101992] [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: 05/10/2023] [Revised: 09/08/2023] [Accepted: 09/17/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Short-course neoadjuvant radiotherapy is a valuable tool in managing rectal cancers and has improved local recurrence rates. However, limited and conflicting data has resulted in variable usage and a lack of consensus on the optimal timing of surgery following short-course radiotherapy. This review aims to provide a contemporary summation of the available evidence regarding the optimal time interval between short-course neoadjuvant radiotherapy and surgery. METHODS A focused literature search was undertaken using the PubMed and Embase databases from January 1980 until January 2023. Randomised control trials, large observational studies and systematic reviews focusing on the use of short-course preoperative radiotherapy for localised rectal cancers, with a focus on the timing of surgery, were included. Primary outcomes were overall survival, disease-free survival and perioperative complications. RESULTS Five randomised control trials, two meta-analyses, and two large, population-based studies were included for their eligibility and relevance. Increased downstaging and fewer postoperative complications are demonstrated in patients receiving delayed surgery (> four weeks), but more recent data raise concerns regarding increased rates of local recurrence in this cohort. Studies directly comparing different time intervals to surgery following short-course radiotherapy have failed to demonstrate an effect on overall survival. CONCLUSIONS This review highlights the complexities and relative shortcomings of the available data with few high-quality studies and randomised control trials directly comparing different time intervals to surgery following short-course radiotherapy. Continuing research is needed to confirm existing findings and explore gaps in the current literature.
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Affiliation(s)
| | - James Wyatt
- The University of Liverpool, L69 3BX, United Kingdom; Liverpool University Hospitals NHS Foundation Trust, L7 8XP, United Kingdom.
| | - Simon G Powell
- The University of Liverpool, L69 3BX, United Kingdom; Liverpool University Hospitals NHS Foundation Trust, L7 8XP, United Kingdom
| | - Nia Jones
- Liverpool University Hospitals NHS Foundation Trust, L7 8XP, United Kingdom
| | - Kiran Altaf
- Liverpool University Hospitals NHS Foundation Trust, L7 8XP, United Kingdom
| | - Shakil Ahmed
- Liverpool University Hospitals NHS Foundation Trust, L7 8XP, United Kingdom
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20
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Arndt K, Vigna C, Kaul S, Fabrizio A, Cataldo T, Smith M, Messaris E. Magnetic resonance imaging accuracy in staging early and locally advanced rectal cancer. Surg Oncol 2023; 50:101987. [PMID: 37717374 DOI: 10.1016/j.suronc.2023.101987] [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: 04/01/2023] [Revised: 08/21/2023] [Accepted: 09/07/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION Magnetic Resonance Imaging (MRI) is the standard pretreatment staging in patients with rectal cancer. Accurate tumor staging is paramount to determining the appropriate treatment course for patients diagnosed with rectal cancer. The current study aims to re-evaluate the accuracy of pre-operative MRI in staging of both early and locally advanced rectal cancer following completion of neoadjuvant therapy (NAT) compared to the pathologic stage. METHODS A retrospective review of patients treated for rectal cancer between 2015 and 2020 at a single academic institution. All patients underwent rectal cancer protocol MRIs before surgical resection. Analysis was carried out in two groups: early rectal cancer: T1/2 N0 tumors with upfront surgical resection (N = 40); and locally advanced disease: T3 or greater or N+ disease receiving NAT, with restaging MRI following NAT (n = 63). RESULTS 103 patients were included in analysis. MRI accuracy in early tumors was 35% ICC = 0.52 (95% CI 0.25-0.71) T stage and 66% ICC = 0 (95% CI -0.24, 0.29) for 29 patients with nodal data for N stage. There was 28% understaging of T2 tumors and 34% understaging of N0 stage by MRI. Post NAT MRI had 44% accuracy ICC = 0.57 (95% CI -0.15-0.20) T stage and 60% accuracy ICC = 0.32 (95% CI 0.08-0.52) N stage. Tumor invasion was overstaged on MRI: 40% T2, 29% T3, 90% T4. Nodal inaccuracy was due to overstaging, 61% N1, 90% N2. CONCLUSIONS In locally advanced rectal cancer MRI overstaged tumors, this could be due to the continued effect of NAT from MRI to resection. This overstaging is of little clinical significance as it doesn't alter the treatment plan, except in cases of complete clinical response. In early rectal cancer, MRI had limited accuracy compared to pathology, understaging a quarter of patients who would benefit from NAT before surgery. Other adjunct imaging modalities should be considered to improve accuracy in staging early rectal cancer and consideration of complete response and enrollment in watch and wait protocols.
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Affiliation(s)
- Kevin Arndt
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - Carolina Vigna
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sumedh Kaul
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Anne Fabrizio
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Thomas Cataldo
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Martin Smith
- Department of Diagnostic Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Evangelos Messaris
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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21
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Ho V, Callaghan CM. The Role of Destrin Wnt/β-Catenin Signaling Pathway in Rectal Cancer Oncogenesis. Int J Radiat Oncol Biol Phys 2023; 117:211-213. [PMID: 37574236 DOI: 10.1016/j.ijrobp.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 05/02/2023] [Indexed: 08/15/2023]
Affiliation(s)
- Vincent Ho
- School of Medicine, Western Sydney University, Sydney, Australia.
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22
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Isaic A, Motofelea AC, Costachescu D, Pop GN, Totolici B, Popovici D, Diaconescu RG. What Is the Comparative Efficacy of Surgical, Endoscopic, Transanal Resection, and Radiotherapy Modalities in the Treatment of Rectal Cancer? Healthcare (Basel) 2023; 11:2347. [PMID: 37628544 PMCID: PMC10454130 DOI: 10.3390/healthcare11162347] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/11/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Rectal cancer is a significant healthcare burden, and effective treatment is crucial. This research aims to compare the effectiveness of surgical and endoscopic resection, transanal resection, and radiotherapy. METHODS A literature analysis was conducted in order to identify relevant studies, by comparing the different surgical approaches and variables affecting treatment decisions. The findings were analyzed and synthesized to provide a comprehensive overview. RESULTS Surgical treatment, particularly TME (total mesorectal excision), proved consistent efficacy in achieving complete tumor resection and improving long-term survival. Endoscopic treatment and transanal resection techniques were promising for early-stage tumors but were associated with higher local recurrence rates. Radiotherapy, especially in combination with chemotherapy, played a crucial role in locally advanced cases, improving local control and reducing recurrence risk. Patient data, tumor characteristics, and healthcare system factors were identified as important factors in treatment modality selection. CONCLUSION Surgical treatment, specifically TME, remains the recommended standard approach for rectal cancer, providing excellent oncological outcomes. Endoscopic treatment and transanal resection techniques can be considered for selected early-stage cases, while radiotherapy is beneficial for locally advanced tumors. Treatment decisions should be personalized based on patient and tumor characteristics, considering the available resources and expertise within the healthcare system.
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Affiliation(s)
- Alexandru Isaic
- IInd Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timisoara, Romania;
- Department X of General Surgery, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Alexandru Cătălin Motofelea
- Department of Internal Medicine, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Dan Costachescu
- Department of Orthopedics-Traumatology, Urology, Radiology, and Medical Imaging, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
- Department of Oncology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Gheorghe Nicusor Pop
- Center for Modeling Biological Systems and Data Analysis, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Bogdan Totolici
- 1st Clinic of General Surgery, Arad County Emergency Clinical Hospital, 310158 Arad, Romania;
- Department of General Surgery, Faculty of Medicine, “Victor Babes” Western University of Arad, 310025 Arad, Romania
| | - Dorel Popovici
- Department of Oncology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Razvan Gheorghe Diaconescu
- OncoHelp Hospital, 300239 Timisoara, Romania;
- Department of Surgery, Faculty of Medicine, “Victor Babes” Western University of Arad, 310025 Arad, Romania
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23
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Răileanu M, Bacalum M. Cancer Wars: Revenge of the AMPs (Antimicrobial Peptides), a New Strategy against Colorectal Cancer. Toxins (Basel) 2023; 15:459. [PMID: 37505728 PMCID: PMC10467133 DOI: 10.3390/toxins15070459] [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: 06/13/2023] [Revised: 07/08/2023] [Accepted: 07/12/2023] [Indexed: 07/29/2023] Open
Abstract
Cancer is a multifaceted health issue that affects people globally and it is considered one of the leading causes of death with a high percentage of victims worldwide. In recent years, research studies have uncovered great advances in cancer diagnosis and treatment. But, there are still major drawbacks of the conventional therapies used including severe side effects, toxicity, and drug resistance. That is why it is critical to develop new drugs with advantages like low cytotoxicity and no treatment resistance to the cancer cells. Antimicrobial peptides (AMPs) have recently attracted attention as a novel therapeutic strategy for the treatment of various cancers, targeting tumor cells with less toxicity to normal tissues. The aim of the study was to discover alternate treatments that do not lead to cancer resistance and have fewer side effects. Here, we report the effects induced by several AMPs, Melittin, Cecropin A, and a Cecropin A-Melittin hybrid, against two human colorectal cancer-derived spheroids. To study the effects of the peptides, cell viability was investigated using MTT, LDH, and ATP assays. Furthermore, cellular senescence and cell cycle were investigated. We found that using different concentrations of these peptides affected the spheroids, their structure being highly compromised by reducing cell viability, and the increase in ATP and LDH levels. Also, the cells are arrested in the G2/M phase leading to an increase in senescent cells. We show that Melittin and the hybrid are most effective against the 3D colorectal cancer cells compared to Cecropin A.
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Affiliation(s)
| | - Mihaela Bacalum
- Department of Life and Environmental Physics, Horia Hulubei National Institute of Physics and Nuclear Engineering, 30 Reactorului Street, RO-077125 Magurele, Romania;
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24
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Cao J, Zhou A, Zhou Z, Liu H, Jia S. The role of GPLD1 in chronic diseases. J Cell Physiol 2023. [PMID: 37393554 DOI: 10.1002/jcp.31041] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/07/2023] [Accepted: 04/17/2023] [Indexed: 07/04/2023]
Abstract
Glycosylphosphatidylinositol-specific phospholipase D (GPLD1) is a specific enzyme for glycosylphosphatidylinositol (GPI) anchors, thereby exerting its biological functions by cleaving membrane-associated GPI molecules. GPLD1 is abundant in serum, with a concentration of approximately 5-10 µg/mL. Previous studies have demonstrated that GPLD1 plays a crucial role in the pathogenesis of numerous chronic diseases including disorders of lipid and glucose metabolism, cancer, and neurological disorders. In the present study, we reviewed the structure, functions, and localization of GPLD1 in chronic diseases, as well as exercise-mediated regulation of GPLD1, thus providing a theoretical support to develop GPLD1 as a new therapeutic target for chronic diseases.
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Affiliation(s)
- Jing Cao
- Graduate School of Wuhan Sports University, Wuhan, China
| | - Anni Zhou
- Graduate School of Wuhan Sports University, Wuhan, China
| | - Zhuoyang Zhou
- Graduate School of Wuhan Sports University, Wuhan, China
| | - Hui Liu
- School of Physical Education, Jinan University, Jinan, China
| | - Shaohui Jia
- Hubei Key Laboratory of Sport Training and Monitoring, Tianjiu Research and Development Center for Exercise Nutrition and Foods, College of Health Science, Wuhan Sports University, Wuhan, China
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Mroczkowski P, Dziki Ł, Vosikova T, Otto R, Merecz-Sadowska A, Zajdel R, Zajdel K, Lippert H, Jannasch O. Rectal Cancer: Are 12 Lymph Nodes the Limit? Cancers (Basel) 2023; 15:3447. [PMID: 37444557 DOI: 10.3390/cancers15133447] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/18/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
Lymph node dissection is a crucial element of oncologic rectal surgery. Many guidelines regard the removal of at least 12 lymph nodes as the quality criterion in rectal cancer. However, this recommendation remains controversial. This study examines the factors influencing the lymph node yield and the validity of the 12-lymph node limit. Patients with rectal cancer who underwent low anterior resection or abdominoperineal amputation between 2000 and 2010 were analyzed. In total, 20,966 patients from 381 hospitals were included. Less than 12 lymph nodes were found in 20.53% of men and 19.31% of women (p = 0.03). The number of lymph nodes yielded increased significantly from 2000, 2005 and 2010 within the quality assurance program for all procedures. The univariate analysis indicated a significant (p < 0.001) correlation between lymph node yield and gender, age, pre-therapeutic T-stage, risk factors and neoadjuvant therapy. The multivariate analyses found T3 stage, female sex, the presence of at least one risk factor and neoadjuvant therapy to have a significant influence on yield. The probability of finding a positive lymph node was proportional to the number of examined nodes with no plateau. There is a proportional relationship between the number of examined lymph nodes and the probability of finding an infiltrated node. Optimal surgical technique and pathological evaluation of the specimen cannot be replaced by a numeric cut-off value.
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Affiliation(s)
- Paweł Mroczkowski
- Department for General and Colorectal Surgery, Medical University of Lodz, Pl. Hallera 1, 90-647 Lodz, Poland
- Institute for Quality Assurance in Operative Medicine Ltd., Otto-von-Guericke-University, Leipziger Str. 44, D-39120 Magdeburg, Germany
- Department for Surgery, University Hospital Knappschaftskrankenhaus, Ruhr-University, In der Schornau 23-25, D-44892 Bochum, Germany
| | - Łukasz Dziki
- Department for General and Colorectal Surgery, Medical University of Lodz, Pl. Hallera 1, 90-647 Lodz, Poland
| | - Tereza Vosikova
- Institute for Quality Assurance in Operative Medicine Ltd., Otto-von-Guericke-University, Leipziger Str. 44, D-39120 Magdeburg, Germany
| | - Ronny Otto
- Institute for Quality Assurance in Operative Medicine Ltd., Otto-von-Guericke-University, Leipziger Str. 44, D-39120 Magdeburg, Germany
| | - Anna Merecz-Sadowska
- Department of Economic and Medical Informatics, University of Lodz, 90-214 Lodz, Poland
| | - Radosław Zajdel
- Department of Economic and Medical Informatics, University of Lodz, 90-214 Lodz, Poland
| | - Karolina Zajdel
- Department of Medical Informatics and Statistics, Medical University of Lodz, 90-645 Lodz, Poland
| | - Hans Lippert
- Institute for Quality Assurance in Operative Medicine Ltd., Otto-von-Guericke-University, Leipziger Str. 44, D-39120 Magdeburg, Germany
- Department for General, Visceral and Vascular Surgery, Otto-von-Guericke-University, Leipziger Str. 44, D-39120 Magdeburg, Germany
| | - Olof Jannasch
- Institute for Quality Assurance in Operative Medicine Ltd., Otto-von-Guericke-University, Leipziger Str. 44, D-39120 Magdeburg, Germany
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Ose J, Gigic B, Brezina S, Lin T, Peoples AR, Schobert PP, Baierl A, van Roekel E, Robinot N, Gicquiau A, Achaintre D, Scalbert A, van Duijnhoven FJB, Holowatyj AN, Gumpenberger T, Schrotz-King P, Ulrich AB, Ulvik A, Ueland PM, Weijenberg MP, Habermann N, Keski-Rahkonen P, Gsur A, Kok DE, Ulrich CM. Higher Plasma Creatinine Is Associated with an Increased Risk of Death in Patients with Non-Metastatic Rectal but Not Colon Cancer: Results from an International Cohort Consortium. Cancers (Basel) 2023; 15:3391. [PMID: 37444500 PMCID: PMC10340258 DOI: 10.3390/cancers15133391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/30/2023] [Accepted: 06/13/2023] [Indexed: 07/15/2023] Open
Abstract
Colorectal cancer (CRC) is increasingly recognized as a heterogeneous disease. No studies have prospectively examined associations of blood metabolite concentrations with all-cause mortality in patients with colon and rectal cancer separately. Targeted metabolomics (Biocrates AbsoluteIDQ p180) and pathway analyses (MetaboAnalyst 4.0) were performed on pre-surgery collected plasma from 674 patients with non-metastasized (stage I-III) colon (n = 394) or rectal cancer (n = 283). Metabolomics data and covariate information were received from the international cohort consortium MetaboCCC. Cox proportional hazards models were computed to investigate associations of 148 metabolite levels with all-cause mortality adjusted for age, sex, tumor stage, tumor site (whenever applicable), and cohort; the false discovery rate (FDR) was used to account for multiple testing. A total of 93 patients (14%) were deceased after an average follow-up time of 4.4 years (60 patients with colon cancer and 33 patients with rectal cancer). After FDR adjustment, higher plasma creatinine was associated with a 39% increase in all-cause mortality in patients with rectal cancer. HR: 1.39, 95% CI 1.23-1.72, pFDR = 0.03; but not colon cancer: pFDR = 0.96. Creatinine is a breakdown product of creatine phosphate in muscle and may reflect changes in skeletal muscle mass. The starch and sucrose metabolisms were associated with increased all-cause mortality in colon cancer but not in rectal cancer. Genes in the starch and sucrose metabolism pathways were previously linked to worse clinical outcomes in CRC. In summary, our findings support the hypothesis that colon and rectal cancer have different etiological and clinical outcomes that need to be considered for targeted treatments.
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Affiliation(s)
- Jennifer Ose
- Huntsman Cancer Institute, Salt Lake City, UT 84112, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT 84112, USA
| | - Biljana Gigic
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, 69117 Heidelberg, Germany; (B.G.)
| | - Stefanie Brezina
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, 23, 1090 Vienna, Austria; (S.B.)
| | - Tengda Lin
- Huntsman Cancer Institute, Salt Lake City, UT 84112, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT 84112, USA
| | - Anita R. Peoples
- Huntsman Cancer Institute, Salt Lake City, UT 84112, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT 84112, USA
| | - Pauline P. Schobert
- Huntsman Cancer Institute, Salt Lake City, UT 84112, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT 84112, USA
- School of Medicine, Ludwig-Maximilians University, 80539 Munich, Germany
- School of Medicine, Technical University of Munich, 80333 Munich, Germany
| | - Andreas Baierl
- Department of Statistics and Operations Research, University of Vienna, 1, 1010 Wien, Austria
| | - Eline van Roekel
- Department of Epidemiology, GROW-School of Oncology and Developmental Biology, Maastricht University, 30, 6229 Maastricht, The Netherlands
| | - Nivonirina Robinot
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, WHO, 69366 Lyon, France
| | - Audrey Gicquiau
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, WHO, 69366 Lyon, France
| | - David Achaintre
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, WHO, 69366 Lyon, France
| | - Augustin Scalbert
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, WHO, 69366 Lyon, France
| | | | - Andreana N. Holowatyj
- Huntsman Cancer Institute, Salt Lake City, UT 84112, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT 84112, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Vanderbilt-Ingram Cancer Center, Nashville, TN 37232, USA
| | - Tanja Gumpenberger
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, 23, 1090 Vienna, Austria; (S.B.)
| | - Petra Schrotz-King
- Division of Preventive Oncology, National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Alexis B. Ulrich
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, 69117 Heidelberg, Germany; (B.G.)
- Klinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Städtische Kliniken Neuss, 84, 41464 Neuss, Germany
| | | | | | - Matty P. Weijenberg
- Department of Epidemiology, GROW-School of Oncology and Developmental Biology, Maastricht University, 30, 6229 Maastricht, The Netherlands
| | - Nina Habermann
- Genome Biology, European Molecular Biology Laboratory (EMBL), 69117 Heidelberg, Germany
| | - Pekka Keski-Rahkonen
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, WHO, 69366 Lyon, France
| | - Andrea Gsur
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, 23, 1090 Vienna, Austria; (S.B.)
| | - Dieuwertje E. Kok
- Division of Human Nutrition and Health, Wageningen University & Research, 6708 Wageningen, The Netherlands
| | - Cornelia M. Ulrich
- Huntsman Cancer Institute, Salt Lake City, UT 84112, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT 84112, USA
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27
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Wang KX, Yu J, Xu Q. Histogram analysis of dynamic contrast-enhanced magnetic resonance imaging to predict extramural venous invasion in rectal cancer. BMC Med Imaging 2023; 23:77. [PMID: 37291527 PMCID: PMC10249234 DOI: 10.1186/s12880-023-01027-0] [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: 11/27/2022] [Accepted: 05/23/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND To explore the potential of histogram analysis (HA) of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in the identification of extramural venous invasion (EMVI) in rectal cancer patients. METHODS This retrospective study included preoperative images of 194 rectal cancer patients at our hospital between May 2019 and April 2022. The postoperative histopathological examination served as the reference standard. The mean values of DCE-MRI quantitative perfusion parameters (Ktrans, Kep and Ve) and other HA features calculated from these parameters were compared between the pathological EMVI-positive and EMVI-negative groups. Multivariate logistic regression analysis was performed to establish the prediction model for pathological EMVI-positive status. Diagnostic performance was assessed and compared using the receiver operating characteristic (ROC) curve. The clinical usefulness of the best prediction model was further measured with patients with indeterminate MRI-defined EMVI (mrEMVI) score 2(possibly negative) and score 3 (probably positive). RESULTS The mean values of Ktrans and Ve in the EMVI-positive group were significantly higher than those in the EMVI-negative group (P = 0.013 and 0.025, respectively). Significant differences in Ktrans skewness, Ktrans entropy, Ktrans kurtosis, and Ve maximum were observed between the two groups (P = 0.001,0.002, 0.000, and 0.033, respectively). The Ktrans kurtosis and Ktrans entropy were identified as independent predictors for pathological EMVI. The combined prediction model had the highest area under the curve (AUC) at 0.926 for predicting pathological EMVI status and further reached the AUC of 0.867 in subpopulations with indeterminate mrEMVI scores. CONCLUSIONS Histogram Analysis of DCE-MRI Ktrans maps may be useful in preoperative identification of EMVI in rectal cancer, particularly in patients with indeterminate mrEMVI scores.
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Affiliation(s)
- Ke-Xin Wang
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Gulou District, 300 Guangzhou Rd, Nanjing, 210029, Jiangsu, China
| | - Jing Yu
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Gulou District, 300 Guangzhou Rd, Nanjing, 210029, Jiangsu, China
| | - Qing Xu
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Gulou District, 300 Guangzhou Rd, Nanjing, 210029, Jiangsu, China.
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28
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Cattaneo L, Centonze G, Sabella G, Lagano V, Angerilli V, Pardo C, Bertani E, Spada F, Prinzi N, Pusceddu S, Fassan M, Fazio N, Milione M. Digestive MiNENs: Could histological classification and molecular characterization drive clinical outcome and therapeutic approach? Crit Rev Oncol Hematol 2023:104044. [PMID: 37268174 DOI: 10.1016/j.critrevonc.2023.104044] [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: 03/01/2023] [Revised: 05/19/2023] [Accepted: 05/30/2023] [Indexed: 06/04/2023] Open
Abstract
Mixed neuroendocrine-non-neuroendocrine neoplasms (MiNENs) are epithelial neoplasms in which neuroendocrine and non-neuroendocrine discrete components are combined, each of which constitutes ≥ 30% of the neoplasm. The finding of an additional neuroendocrine component seems to characterize the tumor's biological behavior. Few studies have proved MiNENs histogenetic and molecular characterization, and the development of molecular markers for more accurate classification of MiNENs represents a clinical need. However, a common origin of the neuroendocrine and non-neuroendocrine components from a pluripotent cancer stem cell could be suggested. The optimal clinical management of MiNENS is largely unknown. Whenever feasible, curative-intent resection should be performed for localized disease; in advanced disease, the treatment should be targeted to the component responsible for the metastatic spreading. This paper provides a revision of the current knowledge on MiNENs, focusing on available evidence about their molecular characterization to suggest a prognostic stratification of these rare forms.
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Affiliation(s)
- Laura Cattaneo
- Pathology First Division, Department of Pathology and Laboratory Medicine, Fondazione IRCCS - Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanni Centonze
- Pathology First Division, Department of Pathology and Laboratory Medicine, Fondazione IRCCS - Istituto Nazionale dei Tumori, Milan, Italy; Department of Research, Fondazione IRCCS - Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Sabella
- Pathology First Division, Department of Pathology and Laboratory Medicine, Fondazione IRCCS - Istituto Nazionale dei Tumori, Milan, Italy
| | - Vincenzo Lagano
- Pathology First Division, Department of Pathology and Laboratory Medicine, Fondazione IRCCS - Istituto Nazionale dei Tumori, Milan, Italy
| | - Valentina Angerilli
- Department of Medicine - DIMED, University of Padua, Padua, Italy; Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Carlotta Pardo
- Pathology First Division, Department of Pathology and Laboratory Medicine, Fondazione IRCCS - Istituto Nazionale dei Tumori, Milan, Italy
| | - Emilio Bertani
- Division of Gastrointestinal Surgery, European Institute of Oncology, Milan, Italy
| | - Francesca Spada
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology (IEO) IRCCS, Milan
| | - Natalie Prinzi
- Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Sara Pusceddu
- Medical Oncology and Hematology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Matteo Fassan
- Department of Medicine - DIMED, University of Padua, Padua, Italy; Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Nicola Fazio
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology (IEO) IRCCS, Milan
| | - Massimo Milione
- Pathology First Division, Department of Pathology and Laboratory Medicine, Fondazione IRCCS - Istituto Nazionale dei Tumori, Milan, Italy.
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29
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Huang MY, Huang YJ, Cheng TL, Jhang WY, Ke CC, Chen YT, Kuo SH, Lin IL, Huang YH, Chuang CH. XPF-ERCC1 Blocker Improves the Therapeutic Efficacy of 5-FU- and Oxaliplatin-Based Chemoradiotherapy in Colorectal Cancer. Cells 2023; 12:1475. [PMID: 37296596 PMCID: PMC10252687 DOI: 10.3390/cells12111475] [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: 03/29/2023] [Revised: 05/20/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023] Open
Abstract
5-FU-based chemoradiotherapy (CRT) and oxaliplatin-based CRT are commonly used therapies for advanced colorectal cancer (CRC). However, patients with a high expression of ERCC1 have a worse prognosis than those with a low expression. In this study, we investigated the effect of XPF-ERCC1 blockers on chemotherapy and 5-FU-based CRT and oxaliplatin (OXA)-based CRT in colorectal cancer cell lines. We investigated the half-maximal inhibitory concentration (IC50) of 5-FU, OXA, XPF-ERCC1 blocker, and XPF-ERCC1 blocker, and 5-FU or OXA combined and analyzed the effect of XPF-ERCC1 blocker on 5-FU-based CRT and oxaliplatin-based CRT. Furthermore, the expression of XPF and γ-H2AX in colorectal cells was analyzed. In animal models, we combined the XPF-ERCC1 blocker with 5-FU and OXA to investigate the effects of RC and finally combined the XPF-ERCC1 blocker with 5-FU- and oxaliplatin-based CRT. In the IC50 analysis of each compound, the cytotoxicity of the XPF-ERCC1 blocker was lower than that of 5-FU and OXA. In addition, the XPF-ERCC1 blocker combined with 5-FU or OXA enhanced the cytotoxicity of the chemotherapy drugs in colorectal cells. Furthermore, the XPF-ERCC1 blocker also increased the cytotoxicity of 5-FU-based CRT and OXA -based CRT by inhibiting the XPF product DNA locus. In vivo, the XPF-ERCC1 blocker was confirmed to enhance the therapeutic efficacy of 5-FU, OXA, 5-FU-based CRT, and OXA CRT. These findings show that XPF-ERCC1 blockers not only increase the toxicity of chemotherapy drugs but also increase the efficacy of combined chemoradiotherapy. In the future, the XPF-ERCC1 blocker may be used to improve the efficacy of 5-FU- and oxaliplatin-based CRT.
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Grants
- (KMU-DK(B)110005, KMU-S110002 and KMU-M111011, (KMU-DK(B)110006, KMU-DK(B)110006-2, KMU-DK(B)111001-3, KMU-DK(B)112002-1, KMU-DK(B)112002-3, KMU-KI110004, KMU-DK(B)110005, KMU-S110002, KMU-TC111A03-2 and KMU-M111011) Kaohsiung Medical University
- (KMUH-DK(B)110005-1, KMUH-DK(B)110005-2, KMUH-DK(B)110005-3, KMUH-DK(B)110005-4, KMUH110-0R72, KMUH111-1R69) Kaohsiung Medical University Hospital
- (NSYSUKMU 110-I002, KAFGH_D_112023) NSYSU-KMU joint research project
- (802KB109388) Medical Research Fund of Kaohsiung Armed Forces General Hospital
- (110KK004, NK110I02-2, 110E9010BA11) National Kaohsiung Marine University
- (110KK004) National Sun Yat-sen University
- (MOST108-2314-B-037-021-MY3, MOST110-2320-B-037-027-MY3, MOST110-2314-B-037-075-MY2, MOST103-2314-B-037-010-MY3, MOST106-2314-B-037-019, MOST108-2314-B-037-021-MY3, MOST 110-2628-B-037-010, MOST 110-2320-B-037-027-MY3, MOST 111-2628-B-037-010 and MOST 111 Ministry of Science and Technology, Taiwan
- PT111001, PT111002 Kaohsiung Medical University
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Affiliation(s)
- Ming-Yii Huang
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Radiation Oncology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Center for Cancer Research, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Yi-Jung Huang
- Department of Biochemistry, School of Post Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Drug Development and Value Creation Research Center, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Tian-Lu Cheng
- Drug Development and Value Creation Research Center, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Biomedical Science and Environmental Biology, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Wun-Ya Jhang
- Department of Medical Laboratory Science and Biotechnology, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Chien-Chih Ke
- Drug Development and Value Creation Research Center, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
| | - Yi-Ting Chen
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Pathology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Shih-Hsun Kuo
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - I-Ling Lin
- Department of Medical Laboratory Science and Biotechnology, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Yu-Hsiang Huang
- Post-Graduate Year Training, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Chih-Hung Chuang
- Drug Development and Value Creation Research Center, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Medical Laboratory Science and Biotechnology, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
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30
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Santos A, Cristóbal I, Caramés C, Luque M, Sanz-Álvarez M, Madoz-Gúrpide J, Rojo F, García-Foncillas J. Deregulation of the miR-19b/PPP2R5E Signaling Axis Shows High Functional Impact in Colorectal Cancer Cells. Int J Mol Sci 2023; 24:ijms24097779. [PMID: 37175484 PMCID: PMC10178228 DOI: 10.3390/ijms24097779] [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: 03/03/2023] [Revised: 04/19/2023] [Accepted: 04/22/2023] [Indexed: 05/15/2023] Open
Abstract
MicroRNA (miR)-19b is deregulated in colorectal cancer (CRC) and locally advanced rectal cancer (LARC), predicting worse outcome and disease progression in CRC patients, and acting as a promising prognostic marker of patient recurrence and pathological response to 5-fluorouracil (5-FU)-based neoadjuvant chemoradiotherapy in LARC. Moreover, there is a strong inverse correlation between miR-19b and PPP2R5E in LARC, and both predict the response to neoadjuvant therapy in LARC patients. However, the functional role of the miR-19b/PPP2R5E axis in CRC cells remains to be experimentally evaluated. Here, we confirm with luciferase assays that miR-19b is a direct negative regulator of PPP2R5E in CRC, which is concordant with the observed decreased PP2A activity levels after miR-19b overexpression. Furthermore, PPP2R5E downregulation plays a key role mediating miR-19b-induced oncogenic effects, increasing cell viability, colonosphere formation ability, and the migration of CRC cells. Lastly, we also confirm the role of miR-19b mediating 5-FU sensitivity of CRC cells through negative PPP2R5E regulation. Altogether, our findings demonstrate the functional relevance of the miR-19b/PPP2R5E signaling pathway in disease progression, and its potential therapeutic value determining the 5-FU response of CRC cells.
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Affiliation(s)
- Andrea Santos
- Cancer Unit for Research on Novel Therapeutic Targets, Oncohealth Institute, IIS-Fundación Jiménez Díaz-UAM, 28040 Madrid, Spain
- Translational Oncology Division, Oncohealth Institute, IIS-Fundación Jiménez Díaz-UAM, 28040 Madrid, Spain
| | - Ion Cristóbal
- Cancer Unit for Research on Novel Therapeutic Targets, Oncohealth Institute, IIS-Fundación Jiménez Díaz-UAM, 28040 Madrid, Spain
- Translational Oncology Division, Oncohealth Institute, IIS-Fundación Jiménez Díaz-UAM, 28040 Madrid, Spain
| | - Cristina Caramés
- Cancer Unit for Research on Novel Therapeutic Targets, Oncohealth Institute, IIS-Fundación Jiménez Díaz-UAM, 28040 Madrid, Spain
- Medical Oncology Department, University Hospital "Fundación Jiménez Díaz", UAM, 28040 Madrid, Spain
| | - Melani Luque
- Pathology Department, IIS-Fundación Jiménez Díaz-UAM, 28040 Madrid, Spain
| | - Marta Sanz-Álvarez
- Pathology Department, IIS-Fundación Jiménez Díaz-UAM, 28040 Madrid, Spain
| | - Juan Madoz-Gúrpide
- Pathology Department, IIS-Fundación Jiménez Díaz-UAM, 28040 Madrid, Spain
| | - Federico Rojo
- Pathology Department, IIS-Fundación Jiménez Díaz-UAM, 28040 Madrid, Spain
| | - Jesús García-Foncillas
- Translational Oncology Division, Oncohealth Institute, IIS-Fundación Jiménez Díaz-UAM, 28040 Madrid, Spain
- Medical Oncology Department, University Hospital "Fundación Jiménez Díaz", UAM, 28040 Madrid, Spain
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31
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Keshvari A, Mollamohammadi L, Keramati MR, Behboudi B, Fazeli MS, Kazemeini A, Naseri A, Shahmohammadi E, Foroutani L, Ayati A, Tayebi A, Sajjadian Z, Hadizadeh A, Ahmadi-Tafti SM. Assessment of the efficacy of Handmade Vacuum-Assisted Sponge Drain for Treatment of Anastomotic leakage after Low Anterior Rectal Resection. Updates Surg 2023:10.1007/s13304-023-01518-3. [PMID: 37086350 DOI: 10.1007/s13304-023-01518-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/17/2023] [Indexed: 04/23/2023]
Abstract
Anastomotic leakage is one of the major complications of colorectal surgery, which might lead to reoperation, increased hospital stays, further intervention and mortality. Vacuum-assisted closure by devices such as Endo-SPONGE® produced by (B-Braun Medical B.V.) is currently being used to treat leakage and fistula. In this study, we aimed to assess the handmade vacuum-assisted sponge drain for anastomotic leakage following low anterior resection. This prospective study included 22 patients who had undergone sponge drain placement to treat anastomotic leakage. All patients had anastomotic leaks or defects after left anterior rectal resection (LAR) without ileostomy. They were treated with neo-adjuvant chemotherapy before the surgery and then subjected to rigid recto-sigmoidoscopy for 30 days following the operation. Any sign of leakage, such as perianal and pelvic pain, was immediately identified and followed up with a CT scan and another recto-sigmoidoscopy. Twenty-two patients were enrolled in this study, 12 men (54.5%) and 10 women (47.4%). All patients had received neo-adjuvant chemotherapy with an average follow-up of 22.30 ± 3.81. 75% of patients (15 cases) were successfully treated, and 17 patients (85%) underwent successful ostomy closure. Treatment failed in 5 patients (25%), including three men and two women. This study shows that handmade vacuum-assisted sponge drain is a cost-effective method of anastomotic leakage management with efficacy similar to that of Endo-SPONGE®.
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Affiliation(s)
- Amir Keshvari
- Colorectal Research Center, Imam Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
- Division of Colorectal Surgery, Department of Surgery, Tehran University of Medical Sciences, Tehran, 1419733141, Iran
| | - Leila Mollamohammadi
- Colorectal Research Center, Imam Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
- Division of Colorectal Surgery, Department of Surgery, Tehran University of Medical Sciences, Tehran, 1419733141, Iran
| | - Mohammad Reza Keramati
- Colorectal Research Center, Imam Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
- Division of Colorectal Surgery, Department of Surgery, Tehran University of Medical Sciences, Tehran, 1419733141, Iran
| | - Behnam Behboudi
- Colorectal Research Center, Imam Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
- Division of Colorectal Surgery, Department of Surgery, Tehran University of Medical Sciences, Tehran, 1419733141, Iran
| | - Mohammad Sadegh Fazeli
- Colorectal Research Center, Imam Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
- Division of Colorectal Surgery, Department of Surgery, Tehran University of Medical Sciences, Tehran, 1419733141, Iran
| | - Alireza Kazemeini
- Colorectal Research Center, Imam Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
- Division of Colorectal Surgery, Department of Surgery, Tehran University of Medical Sciences, Tehran, 1419733141, Iran
| | - Amirhossein Naseri
- Colorectal Research Center, Imam Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
- Division of Colorectal Surgery, Department of Surgery, Tehran University of Medical Sciences, Tehran, 1419733141, Iran
| | - Elnaz Shahmohammadi
- Research Center for Advanced Technologies in Cardiovascular Medicine, Cardiovascular Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Laleh Foroutani
- Research Center for Advanced Technologies in Cardiovascular Medicine, Cardiovascular Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Aryan Ayati
- Research Center for Advanced Technologies in Cardiovascular Medicine, Cardiovascular Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Tayebi
- Research Center for Advanced Technologies in Cardiovascular Medicine, Cardiovascular Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Sajjadian
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Alireza Hadizadeh
- Research Center for Advanced Technologies in Cardiovascular Medicine, Cardiovascular Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Seyed-Mohsen Ahmadi-Tafti
- Colorectal Research Center, Imam Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
- Division of Colorectal Surgery, Department of Surgery, Tehran University of Medical Sciences, Tehran, 1419733141, Iran.
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32
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Peng J, Wang W, Jin H, Qin X, Hou J, Yang Z, Shu Z. Develop and validate a radiomics space-time model to predict the pathological complete response in patients undergoing neoadjuvant treatment of rectal cancer: an artificial intelligence model study based on machine learning. BMC Cancer 2023; 23:365. [PMID: 37085830 PMCID: PMC10120125 DOI: 10.1186/s12885-023-10855-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/17/2023] [Indexed: 04/23/2023] Open
Abstract
OBJECTIVE In this study, we aimed to investigate the predictive efficacy of magnetic resonance imaging (MRI) radiomics features at different time points of neoadjuvant therapy for rectal cancer in patients with pathological complete response (pCR). Furthermore, we aimed to develop and validate a radiomics space-time model (RSTM) using machine learning for artificial intelligence interventions in predicting pCR in patients. METHODS Clinical and imaging data of 83 rectal cancer patients were retrospectively analyzed, and the patients were classified as pCR and non-pCR patients according to their postoperative pathological results. All patients received one MRI examination before and after neoadjuvant therapy to extract radiomics features, including pre-treatment, post-treatment, and delta features. Delta features were defined by the ratio of the difference between the pre- and the post-treatment features to the pre-treatment feature. After feature dimensionality reduction based on the above three feature types, the RSTM was constructed using machine learning methods, and its performance was evaluated using the area under the curve (AUC). RESULTS The AUC values of the individual basic models constructed by pre-treatment, post-treatment, and delta features were 0.771, 0.681, and 0.871, respectively. Their sensitivity values were 0.727, 0.864, and 0.909, respectively, and their specificity values were 0.803, 0.492, and 0.656, respectively. The AUC, sensitivity, and specificity values of the combined basic model constructed by combining pre-treatment, post-treatment, and delta features were 0.901, 0.909, and 0.803, respectively. The AUC, sensitivity, and specificity values of the RSTM constructed using the K-Nearest Neighbor (KNN) classifier on the basis of the combined basic model were 0.944, 0.871, and 0.983, respectively. The Delong test showed that the performance of RSTM was significantly different from that of pre-treatment, post-treatment, and delta models (P < 0.05) but not significantly different from the combined basic model of the three (P > 0.05). CONCLUSIONS The RSTM constructed using the KNN classifier based on the combined features of before and after neoadjuvant therapy and delta features had the best predictive efficacy for pCR of neoadjuvant therapy. It may emerge as a new clinical tool to assist with individualized management of rectal cancer patients.
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Affiliation(s)
- Jiaxuan Peng
- Jinzhou medical university, Jinzhou, Liaoning Province, China
| | - Wei Wang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical and Pharmaceutical College, Chongqing, China
| | - Hui Jin
- Bengbu medical college, Bengbu, China
| | - Xue Qin
- Bengbu medical college, Bengbu, China
| | - Jie Hou
- Jinzhou medical university, Jinzhou, Liaoning Province, China
| | - Zhang Yang
- Center for General Practice Medicine, Department of Radiology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Zhenyu Shu
- Center for General Practice Medicine, Department of Radiology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China.
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Popa C, Prunoiu VM, Puia P, Schlanger D, Brătucu MN, Strâmbu V, Brătucu E, Moisă HA, Chiru EG, Ileanu BV, Radu P. Specific Septic Complications after Rectal Cancer Surgery: A Critical Multicentre Study. Cancers (Basel) 2023; 15:cancers15082340. [PMID: 37190267 DOI: 10.3390/cancers15082340] [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: 04/02/2023] [Accepted: 04/15/2023] [Indexed: 05/17/2023] Open
Abstract
The postoperative septic complications in gastrointestinal surgery impact immediate as well as long-term outcomes, which lead to reinterventions and additional costs. The authors presented the experience of three surgery clinics in Romania regarding the specific septic complications occurring in patients operated on for rectal cancer. The study group comprised 2674 patients who underwent surgery over a 5-year period (2017-2021). Neoplasms of the middle and lower rectum (76%) were the majority. There were 85% rectal resections and 15% abdominoperineal excisions of the rectum. In total, 68.54% of patients were operated on laparoscopically, and 31.46% received open surgery. Without taking wound infections into account, 97 (3.67%) patients had abdominal-pelvic septic complications. The aim was to evaluate the causes of the complications. The percentage of suppurations after surgery of the rectum treated by radiochemotherapy was considerably higher than after surgery of the non-radiated upper rectum. The fatality rate was 5.15%. The risk of fistulas was significantly associated with the preoperative treatment, tumour position and type of intervention. Sex, age, TNM stage or grade were not significant at 0.05 the threshold. The risk of fistulas is reduced with low anterior resection, but the gravity of these complications is higher in the lower rectum compared with the superior rectum. Preoperative radiochemotherapy is a contributing factor to septic complications.
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Affiliation(s)
- Călin Popa
- Surgery Clinic 3, Regional Institute of Gastroenterology and Hepatology "Prof. Dr. Octavian Fodor", "Iuliu Hațieganul" University of Medicine and Pharmacy, Croitorilor Street 19, 400394 Cluj-Napoca, Romania
| | - Virgiliu-Mihail Prunoiu
- Clinic I General and Oncological Surgery, "Prof. Dr. Alexandru Trestioreanu" Oncological Institute, "Carol Davila" University of Medicine and Pharmacy, Fundeni Street 252, 022328 Bucharest, Romania
| | - Paul Puia
- Surgery Clinic 3, Regional Institute of Gastroenterology and Hepatology "Prof. Dr. Octavian Fodor", "Iuliu Hațieganul" University of Medicine and Pharmacy, Croitorilor Street 19, 400394 Cluj-Napoca, Romania
| | - Diana Schlanger
- Surgery Clinic 3, Regional Institute of Gastroenterology and Hepatology "Prof. Dr. Octavian Fodor", "Iuliu Hațieganul" University of Medicine and Pharmacy, Croitorilor Street 19, 400394 Cluj-Napoca, Romania
| | - Mircea-Nicolae Brătucu
- General Surgery Clinic, Clinical Hospital "Dr. Carol Davila", "Carol Davila" University of Medicine and Pharmacy, Calea Griviței 4, 010731 Bucharest, Romania
| | - Victor Strâmbu
- General Surgery Clinic, Clinical Hospital "Dr. Carol Davila", "Carol Davila" University of Medicine and Pharmacy, Calea Griviței 4, 010731 Bucharest, Romania
| | - Eugen Brătucu
- Clinic I General and Oncological Surgery, "Prof. Dr. Alexandru Trestioreanu" Oncological Institute, "Carol Davila" University of Medicine and Pharmacy, Fundeni Street 252, 022328 Bucharest, Romania
| | - Hortensia-Alina Moisă
- Clinic I General and Oncological Surgery, "Prof. Dr. Alexandru Trestioreanu" Oncological Institute, "Carol Davila" University of Medicine and Pharmacy, Fundeni Street 252, 022328 Bucharest, Romania
| | - Eduard-Georgian Chiru
- Clinic I General and Oncological Surgery, "Prof. Dr. Alexandru Trestioreanu" Oncological Institute, "Carol Davila" University of Medicine and Pharmacy, Fundeni Street 252, 022328 Bucharest, Romania
| | - Bogdan Vasile Ileanu
- Center for Health Outcomes and Evaluation, Splaiul Unirii Street 45, 030126 Bucharest, Romania
| | - Petre Radu
- General Surgery Clinic, Clinical Hospital "Dr. Carol Davila", "Carol Davila" University of Medicine and Pharmacy, Calea Griviței 4, 010731 Bucharest, Romania
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Lutsyk M, Taha T, Billan S. Can lymphocytes serve as a predictor of response to preoperative chemoradiation therapy for locally advanced rectal cancer? Front Oncol 2023; 13:1138299. [PMID: 37077836 PMCID: PMC10109464 DOI: 10.3389/fonc.2023.1138299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/21/2023] [Indexed: 04/05/2023] Open
Abstract
IntroductionThe aim of this study is to identify factors that may predict the response of locally advanced rectal cancer tumors (LARC) to neoadjuvant chemoradiotherapy (CRT) and to evaluate the effect of circulating lymphocytes on pathological tumor response.MethodsThis retrospective study included neoadjuvant CRT-treated, LARC-diagnosed patients at the Rambam Health Care Campus in Haifa, Israel. CHAID analysis, t-test, χ2 test, and ROC curve analyses were performed to explore the association between pathological complete response (pCR) and several factors including patient demographics, tumor characteristics, type of treatment, and levels of circulating lymphocytes measured on a weekly basis.ResultsOut of 198 patients enrolled in the study, pCR was achieved in 50 patients (25%). ROC curve and CHAID analyses showed that absolute lymphopenia was significantly associated with lower pCR rates (p=0.046 and p=0.001, respectively). Other factors that were found to have a significant impact were radiation therapy type (p=0.033) and tumor distance from the anal verge (p= 0.041).ConclusionAn absolute decrease in the level of circulating lymphocytes during preoperative CRT to LARC is associated with poorer tumor response to treatment and thus may serve as a predictive biomarker for treatment resistance.
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Affiliation(s)
| | - Tarek Taha
- The Baruch Padeh Medical Center, Poriya, Poriah, Israel
- *Correspondence: Tarek Taha,
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Baiardi G, Clavarezza M, Stella M, Casazza S, De Censi A, Mattioli F. Precision fluoropyrimidines dosing in a compound heterozygous variant carrier of the DPYD gene: a case report. Cancer Chemother Pharmacol 2023; 91:435-439. [PMID: 36890284 DOI: 10.1007/s00280-023-04515-w] [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: 01/30/2023] [Accepted: 02/24/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND Fluoropyrimidines (FPs) form still nowadays the backbone of chemotherapic schemes in colorectal cancer (CRC). Inter-patient variability of the toxicity profile of FPs may be partially accounted for by variable expression of dihydropyrimidine dehydrogenase (DPD). DPD rate activity is genetically determined by its extremely polymorphic coding gene DPYD. In spite of pharmacogenetic guideline-directed-dosing of FPs based regimens treating carrier of multiple variants of DPYD gene remains still challenging. CASE PRESENTATION We present a case of a 48-year-old Caucasian man, compound heterozygous variant carrier of the DPYD gene (HapB3 and c.2194G>A) who had a diagnosis of adenocarcinoma of the left colon and was safely treated with a pharmacogenetic-guided 25% dose reduction of the standard CAP adjuvant treatment. Compound heterozygosis may have been responsible for an earlier over exposure to CAP resulting into low-grade toxicity with an anticipated median time to toxicity of the c.2194G>A variant to the 4th vs. 6th cycles. Some haplotypes of DPYD variants may have an advantage in terms of survival compared to wild-type patients. Our patient may also have benefitted from compound heterozygosis, as shown by no evidence of disease (NED) at 6-month follow-up. CONCLUSION Pharmacogenetic-guided dosing of DPYD intermediate metabolizer compound heterozygous HapB3 and c.2194G>A variant carries should be managed by a multidisciplinary team with a dose reduction ranging from 25 to 50% to maintain effectiveness and close clinical monitoring for early detection of ADRs.
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Affiliation(s)
- Giammarco Baiardi
- Clinical Pharmacology Unit, Ente Ospedaliero Ospedali Galliera, Mura Delle Cappuccine 14, 16128, Genoa, Italy. .,Pharmacology & Toxicology Unit, Department of Internal Medicine, University of Genoa, Viale Benedetto XV 2, 16132, Genoa, Italy.
| | - Matteo Clavarezza
- Medical Oncology Unit, Ente Ospedaliero Ospedali Galliera, Mura Delle Cappuccine 14, 16128, Genoa, Italy
| | - Manuela Stella
- Clinical Pharmacology Unit, Ente Ospedaliero Ospedali Galliera, Mura Delle Cappuccine 14, 16128, Genoa, Italy.,Pharmacology & Toxicology Unit, Department of Internal Medicine, University of Genoa, Viale Benedetto XV 2, 16132, Genoa, Italy
| | - Stefania Casazza
- Pathology Unit, Ente Ospedaliero Ospedali Galliera, Mura Delle Cappuccine 14, 16128, Genoa, Italy
| | - Andrea De Censi
- Medical Oncology Unit, Ente Ospedaliero Ospedali Galliera, Mura Delle Cappuccine 14, 16128, Genoa, Italy
| | - Francesca Mattioli
- Clinical Pharmacology Unit, Ente Ospedaliero Ospedali Galliera, Mura Delle Cappuccine 14, 16128, Genoa, Italy.,Pharmacology & Toxicology Unit, Department of Internal Medicine, University of Genoa, Viale Benedetto XV 2, 16132, Genoa, Italy
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Smith-Oskrochi L, Wustefeld-Janssens BG, Hollenbeck D, Stocks C, Deveau M. Safety and feasibility of short course pre-operative radiation therapy followed by surgical excision for canine solid tumours. Vet Comp Oncol 2023; 21:82-90. [PMID: 36271481 DOI: 10.1111/vco.12864] [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: 05/24/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 11/30/2022]
Abstract
Surgical resection of solid tumours, especially in early stages of disease, remains a cornerstone of cancer treatment in dogs and cats. There are numerous publications that show a strong association between local tumour control and outcome. To achieve local control in some cases radiation therapy and surgery are combined, with radiation therapy being delivered in the neoadjuvant or adjuvant setting. The objective of the study was to report acute toxicity and surgical site complication data in dogs that received a short-course pre-operative (SCPO) radiation therapy protocol, followed by surgical excision for various solid tumours. Medical records were reviewed, and data was analysed retrospectively. Dogs were included if a dermal or subcutaneous solid tumour was treated with SCPO radiation therapy and then was resected on the last day of radiation or 2-3 weeks later. A total of 34 dogs with 35 primary tumours were included. Acute radiation toxicity was diagnosed in 14 sites (40%). VRTOG scores were grade 1 in 50%, grade 2 in 43%, and grade 3 in 7%. Surgical site complications were identified in 17% of dogs with an overall surgical site infection rate of 11%. According to the Clavien-Dindo classification, two dogs required medical intervention (grade 2), 1 dog required surgical intervention under general anaesthesia (grade 3b), and 1 dog died as a result of complications (grade 5). Logistic regression analysis found that anatomic site was significantly associated with complications, where tumours located on the extremity was protective (P = .02; OR 0.06).
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Affiliation(s)
- Lauren Smith-Oskrochi
- College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Brandan G Wustefeld-Janssens
- College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA.,Flint Animal Cancer Center, Colorado State University, College of Veterinary Medicine and Biomedical Sciences, Fort Collins, Colorado, USA
| | - Danielle Hollenbeck
- College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Christian Stocks
- College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Michael Deveau
- College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
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Management of Low Anterior Resection Syndrome (LARS) Following Resection for Rectal Cancer. Cancers (Basel) 2023; 15:cancers15030778. [PMID: 36765736 PMCID: PMC9913853 DOI: 10.3390/cancers15030778] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/21/2023] [Accepted: 01/22/2023] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION A total of 60-80% of patients undergoing rectal resection (mostly as a treatment for rectal cancer) suffer from a variety of partly severe functional problems despite preservation of the anal sphincter. These patients are summarized under the term low anterior resection syndrome (LARS). Preoperative radiotherapy, vascular dissection and surgical excision of the low rectum and mesorectum lead, alone or all together, to a significant impairment of colonic and (neo-) rectal motility. This results in a variety of symptoms (multiple defecation episodes, recurrent episodes of urge, clustering, incontinence, etc.) which are associated with severe impairment of quality of life (QOL). METHODS This narrative review summarizes the present state of knowledge regarding the pathophysiology of LARS as well as the evidence for the available treatment options to control the symptoms resulting from this condition. RESULTS A review of the literature (Medline, Pubmed) reveals a variety of treatment options available to control symptoms of LARS. Medical therapy, with or without dietary modification, shows only a modest effect. Pelvic floor rehabilitation consisting of muscle exercise techniques as well as biofeedback training has been associated with improvement in LARS scores and incontinence, albeit with limited scientific evidence. Transanal irrigation (TAI) has gained interest as a treatment modality for patients with LARS due to an increasing number of promising data from recently published studies. Despite this promising observation, open questions about still-unclear issues of TAI remain under debate. Neuromodulation has been applied in LARS only in a few studies with small numbers of patients and partly conflicting results. CONCLUSION LARS is a frequent problem after sphincter-preserving rectal surgery and leads to a marked impairment of QOL. Due to the large number of patients suffering from this condition, mandatory identification, as well as treatment of affected patients, must be considered during surgical as well as oncological follow-up. The use of a standardized treatment algorithm will lead to sufficient control of symptoms and a high probability of a marked improvement in QOL.
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Dai D, Liu G, Liu H, Liu Y, Liu X, Li S, Lei Y, Gao Y, Wang Y, Zhang S, Zhang R. Clinical feasibility of the therapeutic strategies total neoadjuvant therapy and "watch and wait" in the treatment of rectal cancer patients with recurrence after clinical complete response. Front Surg 2023; 9:1006624. [PMID: 36726944 PMCID: PMC9885041 DOI: 10.3389/fsurg.2022.1006624] [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: 07/29/2022] [Accepted: 12/28/2022] [Indexed: 01/17/2023] Open
Abstract
Purpose In recent years, total neoadjuvant therapy (TNT) has emerged as a new therapeutic strategy against advanced rectal cancer (RC). After administration of TNT, some patients show complete clinical response (cCR) to treatment however, disputes about the effects of TNT and the alternative treatment plans in case of recurrence after cCR still exist. Methods A total of 100 patients were included in this paper. CR and non-CR was observed when these patients were administered with TNT at the First Affiliated Hospital of Dalian Medical University, China from May 2015 to June 2021. These patients received different chemotherapeutic regimens, with close monitoring and watch and wait (W&W) strategy being applied by a multidisciplinary team (MDT). According to treatment results, patients were divided into a cCR group and a non-cCR group; according to the recurrence during W&W, they were divided into a recurrence group and a no-local-recurrence group. This study analyzed the factors that may affect the prognosis, and summarized the surgery and treatment after recurrence. Results The TNT strategy was effective, and 85% of patients achieved local remission. However, W&W did not affect the survival time of CR patients, nor did it cause new distant metastasis due to local recurrence during the observation period (P > 0.05). However, for patients with positive CRM, we do not recommend W&W as the first choice of treatment (P < 0.05). Conclusion (1) Whole-course neoadjuvant therapy was an effective treatment scheme for advanced mid-term rectal cancer. The total local reduction rate of this group of cases was 85.00%, meaning that 25 patients achieved CR. (2) W&W was safe and reliable, and CR patients could receive it as the preferred treatment. (3) CRM was an independent risk factor for local recurrence in CR patients. We do not recommend W&W as the preferred treatment for CR patients with positive CRM.
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Affiliation(s)
- Dianyin Dai
- Department of Anorectal Surgery, Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Ge Liu
- Department of Anorectal Surgery, Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China,Correspondence: Ge Liu
| | - Huanran Liu
- Department of Anorectal Surgery, Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yanfeng Liu
- Department of Anorectal Surgery, Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xinlu Liu
- Department of Anorectal Surgery, Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Shuang Li
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yanan Lei
- Department of Anorectal Surgery, Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yun Gao
- Department of Anorectal Surgery, Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yuezhu Wang
- Department of Anorectal Surgery, Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Shoujia Zhang
- Department of Anorectal Surgery, Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Ran Zhang
- Department of Anorectal Surgery, Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China
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Astaras C, De Vito C, Chaskar P, Bornand A, Khanfir K, Sciarra A, Letovanec I, Corro C, Dietrich PY, Tsantoulis P, Koessler T. The first comprehensive genomic characterization of rectal squamous cell carcinoma. J Gastroenterol 2023; 58:125-134. [PMID: 36357817 PMCID: PMC9876866 DOI: 10.1007/s00535-022-01937-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/31/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Rectal cancers represent 35% of colorectal cancers; 90% are adenocarcinomas, while squamous cell carcinoma accounts for 0.3% of them. Given its rarity, little is known concerning its pathogenesis, molecular profile and therapeutic management. The current treatment trend is to treat rectal squamous cell carcinoma by analogy to anal squamous cell carcinoma with definitive chemo-radiotherapy, setting aside surgery in case of local recurrence. METHODS We performed an in-depth genomic analysis (next-generation sequencing, copy number variation, and human papilloma virus characterization) on 10 rectal squamous cell carcinoma samples and compared them in silico to those of anal squamous cell carcinoma and rectal adenocarcinoma. RESULTS Rectal squamous cell carcinoma shows 100% HPV positivity. It has a mutational (PIK3CA, PTEN, TP53, ATM, BCL6, SOX2) and copy number variation profile (3p, 10p, 10q, 16q deletion and 1q, 3q, 5p, 8q, 20p gain) similar to anal squamous cell carcinoma. PI3K/Akt/mTOR is the most commonly affected signaling pathway similarly to anal squamous cell carcinoma. Most commonly gained or lost genes seen in rectal adenocarcinoma (FLT3, CDX2, GNAS, BCL2, SMAD4, MALT1) are not found in rectal squamous cell carcinoma. CONCLUSION This study presents the first comprehensive genomic characterization of rectal squamous cell carcinoma. We confirm the existence of this rare histology and its molecular similarity with anal squamous cell carcinoma. This molecular proximity confirms the adequacy of therapeutic management based on histology and not localization, suggesting that rectal squamous cell carcinoma should be treated like anal squamous cell carcinoma and not as a rectal adenocarcinoma.
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Affiliation(s)
- Christoforos Astaras
- grid.150338.c0000 0001 0721 9812Medical Oncology Department, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1205 Geneva, Switzerland
| | - Claudio De Vito
- grid.150338.c0000 0001 0721 9812Pathology Department, Geneva University Hospitals, Geneva, Switzerland
| | - Prasad Chaskar
- grid.150338.c0000 0001 0721 9812Pathology Department, Geneva University Hospitals, Geneva, Switzerland
| | - Aurelie Bornand
- grid.150338.c0000 0001 0721 9812Pathology Department, Geneva University Hospitals, Geneva, Switzerland
| | - Kaouthar Khanfir
- grid.418149.10000 0000 8631 6364Radiation Oncology Department, Valais Hospital, Sion, Switzerland
| | - Amedeo Sciarra
- grid.418149.10000 0000 8631 6364Histopathology, Central Institute, Valais Hospital, Sion, Switzerland
| | - Igor Letovanec
- grid.418149.10000 0000 8631 6364Histopathology, Central Institute, Valais Hospital, Sion, Switzerland
| | - Claudia Corro
- grid.150338.c0000 0001 0721 9812Medical Oncology Department, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1205 Geneva, Switzerland ,grid.511014.0Swiss Cancer Center Léman, Lausanne, Geneva Switzerland ,grid.8591.50000 0001 2322 4988Translational Research Center in Onco-Hematology, Department of Medicine, Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland
| | - Pierre-Yves Dietrich
- grid.150338.c0000 0001 0721 9812Medical Oncology Department, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1205 Geneva, Switzerland ,grid.511014.0Swiss Cancer Center Léman, Lausanne, Geneva Switzerland ,grid.8591.50000 0001 2322 4988Translational Research Center in Onco-Hematology, Department of Medicine, Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland
| | - Petros Tsantoulis
- grid.150338.c0000 0001 0721 9812Medical Oncology Department, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1205 Geneva, Switzerland ,grid.8591.50000 0001 2322 4988Translational Research Center in Onco-Hematology, Department of Medicine, Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland
| | - Thibaud Koessler
- Medical Oncology Department, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1205, Geneva, Switzerland. .,Swiss Cancer Center Léman, Lausanne, Geneva, Switzerland.
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Sun M, Moquet J, Ellender M, Bouffler S, Badie C, Baldwin-Cleland R, Monahan K, Latchford A, Lloyd D, Clark S, Anyamene NA, Ainsbury E, Burling D. Potential risks associated with the use of ionizing radiation for imaging and treatment of colorectal cancer in Lynch syndrome patients. Fam Cancer 2023; 22:61-70. [PMID: 35718836 PMCID: PMC9829596 DOI: 10.1007/s10689-022-00299-9] [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: 02/08/2022] [Accepted: 05/29/2022] [Indexed: 01/13/2023]
Abstract
The aim of this review is to investigate the literature pertaining to the potential risks of low-dose ionizing radiation to Lynch syndrome patients by use of computed tomography (CT), either diagnostic CT colonography (CTC), standard staging CT or CT surveillance. Furthermore, this review explores the potential risks of using radiotherapy for treatment of rectal cancer in these patients. No data or longitudinal observational studies of the impact of radiation exposure on humans with Lynch syndrome were identified. Limited experimental studies utilizing cell lines and primary cells exposed to both low and high radiation doses have been carried out to help determine radio-sensitivity associated with DNA mismatch repair gene deficiency, the defining feature of Lynch syndrome. On balance, these studies suggest that mismatch repair deficient cells may be relatively radio-resistant (particularly for low dose rate exposures) with higher mutation rates, albeit no firm conclusions can be drawn. Mouse model studies, though, showed an increased risk of developing colorectal tumors in mismatch repair deficient mice exposed to radiation doses around 2 Gy. With appropriate ethical approval, further studies investigating radiation risks associated with CT imaging and radiotherapy relevant doses using cells/tissues derived from confirmed Lynch patients or genetically modified animal models are urgently required for future clinical guidance.
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Affiliation(s)
- Mingzhu Sun
- UK Health Security Agency, Department of Radiation Effects, RCEHD, Chilton, Didcot, OX11 0RQ, UK.
| | - Jayne Moquet
- UK Health Security Agency, Department of Radiation Effects, RCEHD, Chilton, Didcot, OX11 0RQ UK
| | - Michele Ellender
- UK Health Security Agency, Department of Radiation Effects, RCEHD, Chilton, Didcot, OX11 0RQ UK
| | - Simon Bouffler
- UK Health Security Agency, Department of Radiation Effects, RCEHD, Chilton, Didcot, OX11 0RQ UK
| | - Christophe Badie
- UK Health Security Agency, Department of Radiation Effects, RCEHD, Chilton, Didcot, OX11 0RQ UK ,Environmental Research Group Within the School of Public Health, Faculty of Medicine at Imperial College of Science, Technology and Medicine, London, W12 0BZ UK
| | - Rachel Baldwin-Cleland
- Intestinal Imaging Centre, St Mark’s Hospital, London North West University Healthcare NHS Trust, Watford Road, Harrow, HA1 3UJ UK
| | - Kevin Monahan
- Lynch Syndrome Clinic, Centre for Familial Intestinal Cancer, St Mark’s Hospital, London North West University Healthcare NHS Trust, Watford Road, Harrow, HA1 3UJ UK
| | - Andrew Latchford
- Lynch Syndrome Clinic, Centre for Familial Intestinal Cancer, St Mark’s Hospital, London North West University Healthcare NHS Trust, Watford Road, Harrow, HA1 3UJ UK
| | - David Lloyd
- UK Health Security Agency, Department of Radiation Effects, RCEHD, Chilton, Didcot, OX11 0RQ UK
| | - Susan Clark
- Lynch Syndrome Clinic, Centre for Familial Intestinal Cancer, St Mark’s Hospital, London North West University Healthcare NHS Trust, Watford Road, Harrow, HA1 3UJ UK
| | - Nicola A. Anyamene
- East and North Hertfordshire NHS Trust, Mount Vernon Cancer Centre, Rickmansworth Road, Northwood, HA6 2RN Middlesex UK
| | - Elizabeth Ainsbury
- UK Health Security Agency, Department of Radiation Effects, RCEHD, Chilton, Didcot, OX11 0RQ UK ,Environmental Research Group Within the School of Public Health, Faculty of Medicine at Imperial College of Science, Technology and Medicine, London, W12 0BZ UK
| | - David Burling
- Intestinal Imaging Centre, St Mark’s Hospital, London North West University Healthcare NHS Trust, Watford Road, Harrow, HA1 3UJ UK
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Kmeid M, Brar R, Sullivan L, Arslan ME, Shrestha N, Lee EC, Chen A, Jennings TA, Lee H. Diagnostic yield and repeat biopsies in rectal and nonrectal colorectal adenocarcinoma: Are we hedging on rectal biopsies? Acad Pathol 2023; 10:100063. [PMID: 36970329 PMCID: PMC10031322 DOI: 10.1016/j.acpath.2022.100063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/09/2022] [Accepted: 11/12/2022] [Indexed: 02/05/2023] Open
Abstract
Patients with rectal cancer undergo more repeat biopsies compared to those with nonrectal colon cancer prior to management. We investigated the factors driving the higher frequency of repeat biopsies in patients with rectal cancer. We compared clinicopathologic features of diagnostic and nondiagnostic (in regard to invasion) rectal (n = 64) and colonic (n = 57) biopsies from colorectal cancer patients and characterized corresponding resections. Despite similar diagnostic yield, repeat biopsy was more common in rectal carcinoma, especially in patients receiving neoadjuvant therapy (p < 0.05). The presence of desmoplasia (odds ratio 12.9, p < 0.05) was a strong predictor of making a diagnosis of invasion in both rectal and nonrectal colon cancer biopsies. Diagnostic biopsies had more desmoplasia, intramucosal carcinoma component and marked inflammation, and less low-grade dysplasia component (p < 0.05). Diagnostic yield of biopsy was higher for tumors with high-grade tumor budding, mucosal involvement by high-grade dysplasia/intramucosal carcinoma without low-grade dysplasia and diffuse surface desmoplasia irrespective of tumor location. Sample size, amount of benign tissue, appearance, and T stage did not affect diagnostic yield. Repeat biopsy of rectal cancer is primarily driven by management implications. Diagnostic yield in colorectal cancer biopsies is multifactorial and is not due to differing pathologists' diagnostic approach per tumor site. For rectal tumors, a multidisciplinary strategic approach is warranted to avoid repeat biopsy when unnecessary.
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Affiliation(s)
- Michel Kmeid
- Department of Pathology, Albany Medical Center, Albany, NY, USA
| | - Rupinder Brar
- Department of Pathology, Albany Medical Center, Albany, NY, USA
| | - Luz Sullivan
- Department of Pathology, Albany Medical Center, Albany, NY, USA
| | | | | | - Edward C. Lee
- Department of Surgery, Albany Medical Center, Albany, NY, USA
| | - Anne Chen
- Department of Pathology, Albany Medical Center, Albany, NY, USA
| | | | - Hwajeong Lee
- Department of Pathology, Albany Medical Center, Albany, NY, USA
- Corresponding author. Department of Pathology, Albany Medical Center, 47 New Scotland Ave., MC81, Albany, NY 12208, USA.
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Chang Y, Zhao X, Xiao Y, Yan S, Xu W, Wang Y, Zhang H, Ren S. Neoadjuvant radiohormonal therapy for oligo-metastatic prostate cancer: safety and efficacy outcomes from an open-label, dose-escalation, single-center, phase I/II clinical trial. Front Med 2022; 17:231-239. [PMID: 36580231 DOI: 10.1007/s11684-022-0939-9] [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: 02/21/2022] [Accepted: 05/12/2022] [Indexed: 12/30/2022]
Abstract
To evaluate the safety and efficacy of neoadjuvant radiohormonal therapy for oligometastatic prostate cancer (OMPC), we conducted a 3 + 3 dose escalation, prospective, phase I/II, single-arm clinical trial (CHiCTR1900025743), in which long-term neoadjuvant androgen deprivation was adopted 1 month before radiotherapy, comprising intensity modulated radiotherapy to the pelvis, and stereotactic body radiation therapy to all extra-pelvic bone metastases for 4-7 weeks, at 39.6, 45, 50.4, and 54 Gy. Robotic-assisted radical prostatectomy was performed after 5-14 weeks. The primary outcome was treatment-related toxicities and adverse events; secondary outcomes were radiological treatment response, positive surgical margin (pSM), postoperative prostate-specific antigen (PSA), pathological down-grading and tumor regression grade, and survival parameters. Twelve patients were recruited from March 2019 to February 2020, aging 66.2 years in average (range, 52-80). Median baseline PSA was 62.0 ng/mL. All underwent RARP successfully without open conversions. Ten patients recorded pathological tumor down-staging (83.3%), and 5 (41.7%) with cN1 recorded negative regional lymph nodes on final pathology. 66.7% (8/12) recorded tumor regression grading (TRG) -I and 25% (3/12) recorded TRG-II. Median follow-up was 16.5 months. Mean radiological progression-free survival (RPFS) was 21.3 months, with 2-year RPFS of 83.3%. In all, neoadjuvant radiohormonal therapy is well tolerated for oligometastatic prostate cancer.
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Affiliation(s)
- Yifan Chang
- Department of Urology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Xianzhi Zhao
- Department of Radiation Oncology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Yutian Xiao
- Department of Urology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Shi Yan
- Department of Urology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Weidong Xu
- Department of Urology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - Ye Wang
- Department of Urology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Huojun Zhang
- Department of Radiation Oncology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, 200433, China.
| | - Shancheng Ren
- Department of Urology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, 200003, China.
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Qu X, Zhou D, Lu J, Qin D, Zhou J, Liu HJ. Cancer nanomedicine in preoperative therapeutics: Nanotechnology-enabled neoadjuvant chemotherapy, radiotherapy, immunotherapy, and phototherapy. Bioact Mater 2022; 24:136-152. [PMID: 36606253 PMCID: PMC9792706 DOI: 10.1016/j.bioactmat.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 12/10/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Surgical resection remains a mainstay in the treatment of malignant solid tumors. However, the use of neoadjuvant treatments, including chemotherapy, radiotherapy, phototherapy, and immunotherapy, either alone or in combination, as a preoperative intervention regimen, have attracted increasing attention in the last decade. Early randomized, controlled trials in some tumor settings have not shown a significant difference between the survival rates in long-term neoadjuvant therapy and adjuvant therapy. However, this has not hampered the increasing use of neoadjuvant treatments in clinical practice, due to its evident downstaging of primary tumors to delineate the surgical margin, tailoring systemic therapy response as a clinical tool to optimize subsequent therapeutic regimens, and decreasing the need for surgery, with its potential for increased morbidity. The recent expansion of nanotechnology-based nanomedicine and related medical technologies provides a new approach to address the current challenges of neoadjuvant therapy for preoperative therapeutics. This review not only summarizes how nanomedicine plays an important role in a range of neoadjuvant therapeutic modalities, but also highlights the potential use of nanomedicine as neoadjuvant therapy in preclinical and clinic settings for tumor management.
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Affiliation(s)
- Xiaogang Qu
- Department of General Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Changshu, 215500, China
| | - Dong Zhou
- Department of General Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Changshu, 215500, China
| | - Jianpu Lu
- Department of General Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Changshu, 215500, China
| | - Duotian Qin
- Center for Nanomedicine and Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Jun Zhou
- Center for Nanomedicine and Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Corresponding author.
| | - Hai-Jun Liu
- Center for Nanomedicine and Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Corresponding author.
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Wang Z, Liang R, Yalikun D, Yang J, Li W, Kou Z. Laparoscopic extralevator abdominoperineal excision in distal rectal cancer patients: a retrospective comparative study. BMC Surg 2022; 22:418. [PMID: 36482294 PMCID: PMC9733400 DOI: 10.1186/s12893-022-01865-9] [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: 04/24/2022] [Accepted: 11/22/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND At present, abdominoperineal excision with neoadjuvant chemoradiotherapy (nCRT) is one of the treatment modalities of distal rectal cancer. Our study analyzed the effects of laparoscopic extralevator abdominoperineal resection (ELAPE) compared with laparoscopic conventional abdominoperineal resection(cAPR) in the treatment of distal rectal cancer. METHODS Retrospective analysis was conducted on the clinicopathological data of 177 distal rectal cancer patients treated with a laparoscopic abdominoperineal resection between 2011 and 2018. The patients were divided into four groups as follows: ELAPE without nCRT (group A), cAPR without nCRT (group B), ELAPE with long-course nCRT (group C) and cAPR with long-course nCRT (group D). RESULTS Positive circumferential resection margin (CRM), local recurrence rate, 3-year disease-free survival (DFS) and 3-year overall survival (OS) did not differ between group A and group B. The rate of positive CRM in group C was lower than group D (4.4% vs. 11.9%, respectively), although the difference was not significant (P = 0.377). The 3-year local recurrence rate in group C was lower compared with group D (6.6% vs. 16.7%, respectively), although the difference was not significant (P = 0.135). Three-year DFS and 3-year OS were not different between groups C and D. CONCLUSIONS This study showed that the effect of laparoscopic ELAPE in patients with low-risk rectal cancer is similar to laparoscopic cAPR, revealing that laparoscopic cAPR can be routinely selected for patients with low-risk rectal cancer. Furthermore, laparoscopic ELAPE has a tendency to reduce the rate of positive CRM and local recurrence in patients with high-risk rectal cancer. Laparoscopic ELAPE can be routinely considered for patients with high-risk rectal cancer.
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Affiliation(s)
- Zhiqiang Wang
- grid.412648.d0000 0004 1798 6160Department of Anorectal Surgery, The Second Hospital of Tianjin Medical University, Tianjin, 300211 China
| | - Rui Liang
- grid.412648.d0000 0004 1798 6160Department of Pathology, The Second Hospital of Tianjin Medical University, Tianjin, 300211 China
| | - Dilimulati Yalikun
- grid.412648.d0000 0004 1798 6160Department of Anorectal Surgery, The Second Hospital of Tianjin Medical University, Tianjin, 300211 China
| | - Jun Yang
- grid.414902.a0000 0004 1771 3912Department of Oncology, The First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Kunming, 650032 Yunnan China
| | - Wenliang Li
- grid.414902.a0000 0004 1771 3912Department of Oncology, The First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Kunming, 650032 Yunnan China
| | - Zhiyong Kou
- grid.414902.a0000 0004 1771 3912Department of Oncology, The First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Kunming, 650032 Yunnan China
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Paszt A, Ottlakan A, Abraham S, Simonka Z, Vas M, Maraz A, Szepes Z, Tiszlavicz L, Nyari T, Olah J, Lazar G. Clinical benefits of oral capecitabine over intravenous 5-fluorouracyl regimen in case of neoadjuvant chemoradiotherapy followed by surgery for locally advanced rectal cancer. Pathol Oncol Res 2022; 28:1610722. [PMID: 36567978 PMCID: PMC9773127 DOI: 10.3389/pore.2022.1610722] [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: 07/20/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022]
Abstract
Background: During the last decade, one of the most important treatment options for locally advanced, potencially resectable rectal tumours was neoadjuvant chemoradiotherapy (CRT) followed by surgery. Methods: Effects of the neoadjuvant treatment on surgical outcomes were retrospectively analysed in 185 patients with stage T2-T4 and N0-2, resectable rectal tumour among two patient groups defined by radiosensitizer agents. Group 1 (n = 94) involved radiotherapy (RT) with 50.4 Gy total dose (25 × 1.8 Gy + 3 × 1.8 Gy tumour bed boost), and intravenous 5-fluorouracil (5-FU) (350 mg/m2) with leucovorin (20 mg/m2) on the 1-5 and 21-25 days, while Group 2 (n = 91) RT and orally administrated capecitabine (daily 2 × 825 mg/m2) on RT days. Surgery was carried out after 8-10 weeks. Side effects, perioperative complications, type of surgery, number of removed regional lymph nodes, resection margins and tumour regression grade (TRG) were analysed. Results: More favourable side effects were observed in Group 2. Despite the same rate of diarrhoea (Group 1 vs. Group 2: 54.3% vs. 56.0%), Grade 2-3 diarrhoea ratio was lower (p = 0.0352) after capecitabine (Group 2). Weight loss occurred in 17.0% and 2.2% (p = 0.00067), while nausea and vomiting was described in 38.3% and 15.4% (p = 0.00045) with 5-FU treatment and capecitabine respectively. Anaemia was observed in 33.0% and 22.0% (p = 0.0941). Complete tumour regression occurred in 25.3% after oral- and 13.8% after intravenous treatment (p = 0.049). Ratio of sphincter preservation was higher with laparoscopy than open surgery (72.3% vs. 39.7%) (p = 0.00001). Conclusion: The study confirms advantages of neoadjuvant chemoradiotherapy with oral capecitabine for rectal tumours, such as more favourable side effect profile and overall clinical outcome, with increased rate of complete tumour regression.
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Affiliation(s)
- Attila Paszt
- Department of Surgery, University of Szeged, Szeged, Hungary,*Correspondence: Attila Paszt,
| | - Aurel Ottlakan
- Department of Surgery, University of Szeged, Szeged, Hungary
| | | | - Zsolt Simonka
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - Marton Vas
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - Aniko Maraz
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Zoltan Szepes
- 1st Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | | | - Tibor Nyari
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Judit Olah
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Gyorgy Lazar
- Department of Surgery, University of Szeged, Szeged, Hungary
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Yan M, Lin Z, Wu Z, Zheng H, Shi M. A predictive nomogram model for low anterior resection syndrome after rectal cancer resection. ANZ J Surg 2022; 92:3224-3231. [PMID: 36527689 DOI: 10.1111/ans.17966] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/17/2022] [Accepted: 07/25/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND The aim of this study was to identify risk factors associated with the low anterior resection syndrome (LARS) and to construct a nomogram capable of predicting the risk of LARS in patients who undergo rectal cancer resection. METHODS About 538 patients who had undergone anterior resection were recruited as a development set. In addition, 114 patients with rectal cancer were analysed as a validation set to test the new nomogram. Patients in the development set were grouped into two separate cohorts: those with major LARS and those with minor or no LARS. Multiple logistic regression was conducted to detect risk factors for major LARS. RESULTS The prevalence of major LARS was 40.7%, of minor LARS was 28.6% and the proportion with no LARS was 30.7% in the development set. In multivariate analysis, female gender, preoperative chemoradiation, low tumour height, diverting ileostomy, postoperative anastomotic leakage were shown to be independently associated with major LARS occurring in patients after rectal cancer resection. The area under the curve (AUC) values of the nomogram were 0.726 (95% CI: 0.682-0.769) and 0.750 (95% CI: 0.655-0.845) in the development and validation sets, respectively. The calibration curves and Hosmer-Lemeshow goodness of fit tests showed that the model was acceptably accurate. CONCLUSION A nomogram model based on risk factors could be valuable as a predictor of the probability of major LARS after rectal cancer surgery, and provides a guide that clinical staff can use to take preventive measures for high-risk patients.
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Affiliation(s)
- Mingfang Yan
- Department of Gastrointestinal Surgery, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, Fuzhou, China
| | - Zhenmeng Lin
- Department of Gastrointestinal Surgery, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, Fuzhou, China
| | - Zhiying Wu
- Department of Gastrointestinal Surgery, Zhongshan Hospital Affiliated to Xiamen University, Xiamen, China
| | - Huizhe Zheng
- Department of Anesthesiology Surgery, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, Fuzhou, China
| | - Meiqin Shi
- Department of Operating Theatre, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, Fuzhou, China
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Wang LW, Liu YS, Jiang JK. The effect of Mitomycin-C in neoadjuvant concurrent chemoradiotherapy for rectal cancer. J Chin Med Assoc 2022; 85:1120-1125. [PMID: 36194168 DOI: 10.1097/jcma.0000000000000819] [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: 12/14/2022] Open
Abstract
BACKGROUND Neoadjuvant concurrent chemoradiotherapy (nCCRT) followed by total mesorectal excision has become the standard of care for advanced rectal cancer, but the most effective regimen of chemotherapeutic agents has not yet been determined. The purpose of this study is to determine the effect of Mitomycin-C (MMC) in nCCRT for rectal cancer. METHODS From 2000 to 2017, patients with rectal adenocarcinoma who received nCCRT followed by radical surgery were enrolled in our study. The patients were retrospectively separated into two groups according to nCCRT regimens (with or without MMC). Other factors related to cancer down-staging after nCCRT, disease-free survival (DFS) and overall survival (OS) were analyzed. RESULTS One hundred ninety-five patients received radiotherapy (RT) + MMC + oral tegafur-uracil (UFUR), and 191 patients received RT + UFUR without MMC as neoadjuvant CCRT. Adding MMC might increase the down-staging rate (odds ratio [OR] = 1.520, p = 0.058), and down-staging had significant effect to improve OS (OR = 1.726, p = 0.002) and DFS (OR = 2.185, p < 0.001). The OS and DFS were improved in patients who received MMC, although this result did not reach a statistically significant difference. There was a higher incidence of low-grade toxicities in the MMC group, especially neutropenia, genitourinary side effects, and dermatological side effects ( p < 0.001). CONCLUSION Adding MMC to the regimen of nCCRT for rectal adenocarcinoma is shown to increase tumor down-staging rate and improve disease-free and OS, although these benefits come at the cost of increased low-grade toxicities. Prospective randomized studies are needed to explore the role of MMC in nCCRT for rectal cancer.
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Affiliation(s)
- Ling-Wei Wang
- Division of Radiation Oncology, Department of Oncology, Taipei Veteran General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yu-Shih Liu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veteran General Hospital, Taipei, Taiwan, ROC
- Division of Colon and Rectal Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan, ROC
- Department of Surgery, Erlin Christian Hospital, Changhua, Taiwan, ROC
| | - Jeng-Kai Jiang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veteran General Hospital, Taipei, Taiwan, ROC
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[LINC01285 promotes proliferation and metastasis of colorectal cancer cells by regulating epithelial-mesenchymal transition]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2022; 42:1697-1704. [PMID: 36504063 PMCID: PMC9742787 DOI: 10.12122/j.issn.1673-4254.2022.11.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To clarify the mechanism by which LINC01285 regulates proliferation and migration of colorectal cancer (CRC) cells and the clinical implications. METHODS We analyzed the expression of LINC01285 in CRC tissues and normal tissues using data from Starbase public database. We also examined the expression levels of LINC01285 in 70 pairs of CRC and adjacent tissue samples collected from our center and in different CRC cell lines using RT-qPCR, and analyzed the correlation of LINC01285 expression with the clinicopathological parameters and tumor-free survival time of the patients. In CRC cell lines (SW620 and HT-29), the changes in cell proliferation, apoptosis, metastasis and epithelial-mesenchymal transition (EMT) phenotype following LINC01285 knockdown were analyzed using CCK-8 assay, flow cytometry, Transwell assay and Western blotting. RESULTS The TCGA-COAD transcriptome sequencing data obtained from the Starbasev3.0 public database revealed a significantly higher expression level of LINC01285 in CRC tissues than in adjacent tissues (P=0.00016), which was verified by RT-qPCR results of the clinical samples (P=0.0002). In CRC patients, the expression level of LINC01285 was closely correlated with histological differentiation of the tumor (P=0.036), T classification (P=0.000), lymph node metastasis (P=0.001), TNM stage (P=0.000), Duke stage (P=0.009) and relapse-free survival (P=0.0102). In SW620 and HT-29 cells, which expressed significantly higher levels of LINC01285 than normal colorectal mucosal cells (P < 0.001), LINC01285 knockdown significantly inhibited cell proliferation (P < 0.001), increased early apoptosis, late apoptosis and total apoptosis rates (P < 0.05), suppressed cell migration and invasion (P < 0.001), upregulated the expression of E-cadherin (P < 0.001), and downregulated the expression of N-cadherin (P < 0.001). CONCLUSION The expression level of LINC01285, which modulates the EMT pathway to regulate the proliferation, apoptosis and metastasis of CRC cells, is closely correlated with the prognosis of CRC patients.
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Chen R, Zhan X, Jiang H, Liu Y, Jiang Z, Jiang M, Deng W, Liu X, Chen G, Fu B. Risk and prognosis of secondary malignant neoplasms after radiation therapy for bladder cancer: A large population-based cohort study. Front Oncol 2022; 12:953615. [DOI: 10.3389/fonc.2022.953615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 10/20/2022] [Indexed: 11/17/2022] Open
Abstract
ObjectiveTo investigate the association between radiotherapy and the risk of second malignant neoplasm (SMN) development among patients with bladder cancer (BC). Overall survival (OS) is compared among patients developing SMN and without.MethodWe identified patients diagnosed with BC from the Surveillance, Epidemiology, and End Results (SEER) database. The development of an SMN is defined as any SMN occurring more than 5 years after the diagnosis of BC. The Fine-Gray competing risk regression is used to estimate the probability of SMN. The radiotherapy-associated risk (RR) for SMNs is assessed by Poisson regression. The Kaplan–Meier method was used to evaluate the OS of patients with SMNs. Propensity score matching (PSM) is performed.ResultsA total of 76575 BC patients are enrolled in our study. The probability of SMNs in the radiotherapy cohort is statistically higher than in the non-radiotherapy cohort. In competing risk regression analysis, radiotherapy is proven to be associated with a higher risk of SMN (Hazard ratio: 1.23; 95% CI: 1.102–1.368). The radiotherapy-associated risks significantly increase in the radiotherapy cohort (RR: 1.28; 95% CI: 1.14–1.43). In site-specific analysis, statistically significant results are observed in lung and bronchus (LAB) cancer and hematological malignancies. The OS rate in patients developing SMN is significantly lower than that among matched patients with primary BC.ConclusionRadiotherapy for BC is associated with SMN. Radiotherapy increases the risk of secondary low-dose area cancer development, including LAB cancer or hematological malignancies. Notably, this effect is not observed in the high-dose area involving pelvic tumors. Patients developing SMN showed poorer OS.
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Cheng X, Zhang H, Hamad A, Huang H, Tsung A. Surgery-mediated tumor-promoting effects on the immune microenvironment. Semin Cancer Biol 2022; 86:408-419. [PMID: 35066156 DOI: 10.1016/j.semcancer.2022.01.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 02/07/2023]
Abstract
Surgical resection continues to be the mainstay treatment for solid cancers even though chemotherapy and immunotherapy have significantly improved patient overall survival and progression-free survival. Numerous studies have shown that surgery induces the dissemination of circulating tumor cells (CTCs) and that the resultant inflammatory response promotes occult tumor growth and the metastatic process by forming a supportive tumor microenvironment (TME). Surgery-induced platelet activation is one of the initial responses to a wound and the formation of fibrin clots can provide the scaffold for recruited inflammatory cells. Activated platelets can also shield CTCs to protect them from blood shear forces and promote CTCs evasion of immune destruction. Similarly, neutrophils are recruited to the fibrin clot and enhance cancer metastatic dissemination and progression by forming neutrophil extracellular traps (NETs). Activated macrophages are also recruited to surgical sites to facilitate the metastatic spread. More importantly, the body's response to surgical insult results in the recruitment and expansion of immunosuppressive cell populations (i.e. myeloid-derived suppressor cells and regulatory T cells) and in the suppression of natural killer (NK) cells that contribute to postoperative cancer recurrence and metastasis. In this review, we seek to provide an overview of the pro-tumorigenic mechanisms resulting from surgery's impact on these cells in the TME. Further understanding of these events will allow for the development of perioperative therapeutic strategies to prevent surgery-associated metastasis.
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Affiliation(s)
- Xiang Cheng
- Division of Surgical Oncology, Department of Surgery, The Ohio State University James Comprehensive Cancer Center, Columbus, OH, 43210, USA
| | - Hongji Zhang
- Division of Surgical Oncology, Department of Surgery, The Ohio State University James Comprehensive Cancer Center, Columbus, OH, 43210, USA
| | - Ahmad Hamad
- Division of Surgical Oncology, Department of Surgery, The Ohio State University James Comprehensive Cancer Center, Columbus, OH, 43210, USA
| | - Hai Huang
- Division of Surgical Oncology, Department of Surgery, The Ohio State University James Comprehensive Cancer Center, Columbus, OH, 43210, USA
| | - Allan Tsung
- Division of Surgical Oncology, Department of Surgery, The Ohio State University James Comprehensive Cancer Center, Columbus, OH, 43210, USA.
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