Circulating tumor DNA and circumferential resection margin as key prognostic indicators for survival in rectal cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 3579-3579
Author(s):  
Mia Shepherdson ◽  
Erin L. Symonds ◽  
Susan Byrne ◽  
Kirsten Gormly ◽  
Christos Stelios Karapetis ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Circumferential Resection Margin ◽  
Resection Margin ◽  
Cox Regression ◽  
Prognostic Significance ◽  
Multivariable Analysis ◽  
Neoadjuvant Chemoradiotherapy ◽  
Venous Invasion ◽  
Circulating Tumor Dna ◽  
Prognostic Indicators

3579 Background: Recurrence of colorectal cancer has been linked to the presence of epigenetic circulating tumour DNA (ctDNA) in patient plasma after surgery. The prognostic significance of ctDNA prior to treatment remains unknown. This study investigated the correlation between pre-treatment ctDNA and current radiological (MRI) prognostic markers in patients with rectal cancer. Methods: Forty-two patients with rectal cancer were enrolled, with all having staging MRI prior to treatment. Plasma was taken for ctDNA at diagnosis. The presence of either methylated branched-chain amino acid transaminase 1 (BCAT1) or Ikaros family zinc finger (IKZF1) in cell-free DNA from plasma was deemed a positive ctDNA result. Correlation of MRI prognostic indicators and ctDNA results was assessed with chi-square tests. Univariable and multivariable cox regression analyses were performed to determine variables associated with overall survival (OS). Results: Mean age was 64.4 years (SD 12.5) and majority were male (30/42, 71.4%). 11, 13, 9 & 9 patients had stages I, II, III, IV respectively. Patients had a minimum follow-up of 36 months. Thirty-three (78.6%) patients received neoadjuvant chemoradiotherapy. 29 (69.0%) patients underwent surgical resection. 3-year survival rate was 64% in the overall group. 67% (n=28/42) of patients were positive for the methylated ctDNA at diagnosis. 11 out of 12 patients with a positive circumferential resection margin (CRM +) were ctDNA positive (p=0.03). Univariable analysis showed that prognostic indicators for OS were presence of extramural venous invasion (EMVI) (HR 3.0, 95% CI 1.1-8.4), CRM+ (HR 12.2, 95%CI 3.9-37.6), metastatic disease (HR 7.32, 95% CI 2.63-20.37) and ctDNA% methylation (HR 1.1, 95% CI 1.04-1.13) (Table 1). The presence of CRM+ and a positive ctDNA had a HR of 20.5 (95% CI 5.1-82.3). With multivariable analysis, including adjustment for age and EMVI, only CRM+/ctDNA+ variable was an independent predictor for poor survival (HR 20.2, 95% CI 4.5-90.9). Conclusions: In rectal cancer, almost all patients with CRM involvement have ctDNA, and these patients had the worst prognosis. Future studies with longitudinal ctDNA assessment pre and post treatment could potentially inform prognosis and help tailor patients’ treatment.[Table: see text]

The Effect of Formalin Fixation on Resection Margins in Colorectal Cancer

2019 ◽  
Vol 27 (7) ◽  
pp. 700-705
Author(s):  
David Lam ◽  
Yui Kaneko ◽  
Adam Scarlett ◽  
Basil D’Souza ◽  
Richard Norris ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Rectal Cancer ◽  
Circumferential Resection Margin ◽  
Resection Margin ◽  
Neoadjuvant Chemoradiotherapy ◽  
Recurrence Risk ◽  
Formalin Fixation ◽  
Resection Margins ◽  
Distal Resection Margin ◽  
Radial Margin

Resection margins in colorectal cancer carry clinical significance with regard to disease recurrence risk and selection for multimodal adjuvant therapy, especially with circumferential resection margins in rectal cancer. Colorectal cancer specimens are routinely fixed in formalin, which results in specimen and tumor-free margin shrinkage. However, the effects of shrinkage have not traditionally been taken into account when analyzing tumor-free margins. In this prospective study, 46 colorectal cancer specimens were measured in the fresh state and subsequently after formalin fixation for total specimen length, distal resection margin, and radial margin (circumferential resection margin for rectal cancer). The mean reduction after formalin fixation was 17.48 mm (14.7%) for distal resection margin and 1.20 mm (10.5%) for radial margin. For rectal cancer, circumferential resection margin reduction was 0.88 mm (11.8%); this was not affected by neoadjuvant chemoradiotherapy. Duration of formalin fixation did not significantly affect the extent of margin shrinkage. This is the first study to evaluate the effect of formalin fixation on radial resection margins, specifically as it relates to rectal cancer, and it demonstrates that shrinkage from formalin fixation should be a consideration in decision-making where the magnitude of tumor-free margins is small.

Prognostic Significance of the Circumferential Resection Margin in Invasive T3 Rectal Cancer

2008 ◽  
Vol 24 (4) ◽  
pp. 278 ◽  
Author(s):  
In Ho Joo ◽  
Sang Hwa Jin ◽  
Ki Beom Bae ◽  
Jin Yong Shin ◽  
Chang Soo Choi ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Circumferential Resection Margin ◽  
Resection Margin ◽  
Prognostic Significance ◽  
T3 Rectal Cancer

408 THE PRESENCE OF LYMPHATIC, VENOUS AND PERINEURAL INFILTRATION FOLLOWING ESOPHAGECTOMY WITHOUT NEOADJUVANT THERAPY TO IDENTIFY PATIENTS AT RISK OF RECURRENCE.

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
K Hardy ◽  
J Chmelo ◽  
R Khaw ◽  
M Navidi ◽  
A Phillips
Keyword(s):  
Neoadjuvant Treatment ◽  
Prognostic Significance ◽  
Multivariable Analysis ◽  
Disease Free Survival ◽  
Venous Invasion ◽  
Prognostic Indicators ◽  
Lymph Vessel ◽  
Carcinoma Of The Esophagus ◽  
Additional Information ◽  
Cancer Of The Esophagus

Abstract   Staging and prognostication in esophgaeal cancer patients is based on their TNM stage. Previous research has suggested venous invasion (VI), lymph vessel invasion (LI) and perineural invasion (PNI) as adverse prognostic indicators in patients with advanced disease receiving neoadjuvant treatment. The aim of this study was to assess the incidence and prognostic significance of these factors in patients with cancer of the esophagus or gastro-esophageal junction (GEJ) who were treated with unimodality surgery. Methods A contemporaneously maintained database was used to identify patients who underwent a primary 2-field transthoracic esophagectomy for adenocarcinoma or squamous cell carcinoma of the esophagus or gastro-esophageal junction. Between January 2000 and January 2018. Patients who died in hospital, underwent palliative resections or where the presence (or absence) of VI, LI or PNI was not reported were excluded. Patients were staged using UICC-TNM 7. Results 279 patients were included. VI was present in 99 (35%) patients, LI in 120 (43%), and PNI in 120 (43%). Median overall survival was 140 months (95% confidence interval (CI): 79.3–200.7) when PNI, LV and VI were absent, 55 months (95% CI: 42.2–67.8) when one factor was present, 18 months (95% CI: 5.4–30.6) with two factors and 31 months (95% CI: 17.6–44.4) with all three factors present. Univariable analysis revealed that LI, PNI and VI are significant prognostic indicators for length of disease-free survival (p < 0.001) with LI an independent prognostic factor on multivariable analysis (p = 0.05). Conclusion These findings suggest the importance of the presence of LI, VI and PNI in patients undergoing unimodality esophagectomy for cancer of the esophagus. It may provide additional information for identifying patients that are high risk who may be candidates for adjuvant therapy.

The Prognostic Value of Circumferential Resection Margin Involvement in Patients with Extraperitoneal Rectal Cancer

2016 ◽  
Vol 82 (4) ◽  
pp. 348-355 ◽  
Author(s):  
Dong Woo Shin ◽  
Jin Yong Shin ◽  
Sung Jin Oh ◽  
Jong Kwon Park ◽  
Hyeon Yu ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Circumferential Resection Margin ◽  
Resection Margin ◽  
Cox Model ◽  
Prognostic Significance ◽  
Multivariate Logistic Regression Analysis ◽  
T3 Rectal Cancer ◽  
Circumferential Resection Margin Involvement ◽  
Cox Analysis

The prognostic influence of circumferential resection margin (CRM) status in extraperitoneal rectal cancer probably differs from that of intraperitoneal rectal cancer because of its different anatomical and biological behaviors. However, previous reports have not provided the data focused on extraperitoneal rectal cancer. Therefore, the aim of this study was to examine the prognostic significance of the CRM status in patients with extraperitoneal rectal cancer. From January 2005 to December 2008, 248 patients were treated for extraperitoneal rectal cancer and enrolled in a pro-spectively collected database. Extraperitoneal rectal cancer was defined based on tumors located below the anterior peritoneal reflection, as determined intraoperatively by a surgeon. Cox model was used for multivariate analysis to examine risk factors of recurrence and mortality in the 248 patients, and multivariate logistic regression analysis was performed to identify predictors of recurrence and mortality in 135 patients with T3 rectal cancer. CRM involvement for extraperitoneal rectal cancer was present in 29 (11.7%) of the 248 patients, and was the identified predictor of local recurrence, overall recurrence, and death by multivariate Cox analysis. In the 135 patients with T3 cancer, CRM involvement was found to be associated with higher probability of local recurrence and mortality. In extraperitoneal rectal cancer, CRM involvement is an independent risk factor of recurrence and survival. Based on the results of the present study, it seems that CRM involvement in extraperitoneal rectal cancer is considered an indicator for (neo)adjuvant therapy rather than conventional TN status.

Prognostic Significance of Circumferential Resection Margin Following Total Mesorectal Excision and Adjuvant Chemoradiotherapy in Patients with Rectal Cancer

2006 ◽  
Vol 14 (2) ◽  
pp. 462-469 ◽  
Author(s):  
Seung Hyuk Baik ◽  
Nam Kyu Kim ◽  
Young Chan Lee ◽  
Hoguen Kim ◽  
Kang Young Lee ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Circumferential Resection Margin ◽  
Resection Margin ◽  
Prognostic Significance ◽  
Adjuvant Chemoradiotherapy ◽  
Mesorectal Excision

Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer

2002 ◽  
Vol 89 (3) ◽  
pp. 327-334 ◽  
Author(s):  
A. Wibe ◽  
P. R. Rendedal ◽  
E. Svensson ◽  
J. Norstein ◽  
T. J. Eide ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Circumferential Resection Margin ◽  
Resection Margin ◽  
Prognostic Significance ◽  
Mesorectal Excision
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