Stratified Prognostic Value of Pathological Response to Preoperative Treatment in yp II/III Rectal Cancer

AimAccumulated studies have verified that tumor regression is associated with the prognosis of rectal cancer. However, stratified analysis within a certain stage is still unknown. The purpose of our study was to assess the impact of pathologic response on the survival of stageII and III rectal cancer patients after neoadjuvant chemoradiotherapy (nCRT).MethodsClinicopathologic characteristics and tumor regression scores (TRS) were assessed in 236 rectal cancer patients who treated with nCRT followed by surgery. Survival analysis was performed using Cox proportional hazards models.ResultsAmong these patients, the stage of 88 patients was ypII, and 91 patients were with the stage of ypIII. The median follow-up time was 59.8 months. TRS was not an independent prognostic factor in ypII patients while it was significantly associated with the prognosis of ypIII patients (5-year survival rate 67.2% vs. 42.5%, P < 0.001). Furthermore, ypIII patients with the response to nCRT had similar survival to that of ypII patients (5-year survival rate 67.2% vs. 70.5%, P = 0.56). For ypIII patients, multivariable analysis showed that well differentiation, negative surgical margin, and the administration of adjuvant chemotherapy were associated with better survival. The surgical margin and differentiation were prognostic factors for ypII patients.ConclusionsypIII rectal cancer patients with poor response to preoperative treatment are at high risk of worse oncological outcomes.

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Importance of Tumor Regression Grade in ypStage III Rectal Cancer Patients Treated with Neoadjuvant Chemoradiotherapy

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2018.07.199 ◽

2018 ◽

Vol 102 (3) ◽

pp. e3

Author(s):

J.H. Chung ◽

C. Song ◽

S.B. Kang ◽

D.W. Kim ◽

J.H. Kim ◽

...

Keyword(s):

Rectal Cancer ◽

Cancer Patients ◽

Tumor Regression ◽

Neoadjuvant Chemoradiotherapy ◽

Tumor Regression Grade ◽

Regression Grade

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Clinical outcomes in elderly rectal cancer patients treated with neoadjuvant chemoradiotherapy: impact of tumor regression grade

Journal of Cancer Research and Clinical Oncology ◽

10.1007/s00432-020-03403-7 ◽

2020 ◽

Author(s):

Consuelo Rosa ◽

Monica Di Tommaso ◽

Luciana Caravatta ◽

Maria Taraborrelli ◽

Lucrezia Gasparini ◽

...

Keyword(s):

Rectal Cancer ◽

Cancer Patients ◽

Clinical Outcomes ◽

Tumor Regression ◽

Neoadjuvant Chemoradiotherapy ◽

Tumor Regression Grade ◽

Regression Grade

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Association of mismatch repair status with survival and response to neoadjuvant chemo(radio)therapy in rectal cancer

npj Precision Oncology ◽

10.1038/s41698-020-00132-5 ◽

2020 ◽

Vol 4 (1) ◽

Cited By ~ 1

Author(s):

Shu-Biao Ye ◽

Yi-Kan Cheng ◽

Lin Zhang ◽

Yi-Feng Zou ◽

Ping Chen ◽

...

Keyword(s):

Rectal Cancer ◽

Cancer Patients ◽

Mismatch Repair ◽

Neoadjuvant Chemoradiotherapy ◽

Disease Free Survival ◽

Stage Iii ◽

Neoadjuvant Radiotherapy ◽

Radio Therapy ◽

Colorectal Cancer Patients ◽

The Impact

Abstract Prior reports have indicated that defective mismatch repair (MMR) has a favorable impact on outcome in colorectal cancer patients treated with surgery, immunotherapy, or adjuvant chemotherapy. However, the impact of MMR status on response to neoadjuvant radiotherapy in rectal cancer is not well understood. Here we report that dMMR was associated with improved disease-free survival (DFS) (P = 0.034) in patients receiving neoadjuvant chemotherapy (NCT). Patients with dMMR tumors who received neoadjuvant chemoradiotherapy (NCRT) achieved significantly worse DFS (P = 0.026) than those treated with NCT. Conversely, NCRT improved DFS (P = 0.043) in patients with pMMR tumors, especially for stage III disease with improved DFS (P = 0.02). The presence of dMMR was associated with better prognosis in rectal cancer patients treated with NCT. NCT benefited patients with dMMR tumors; while NCRT benefited patients with stage III disease and pMMR tumors. Patients stratified by MMR status may provide a more tailored approach to rectal cancer neoadjuvant therapy.

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Local environment in biopsy better predict the pathological response to neoadjuvant chemoradiotherapy in rectal cancer

Bioscience Reports ◽

10.1042/bsr20190003 ◽

2019 ◽

Vol 39 (3) ◽

Cited By ~ 1

Author(s):

Yan Huang ◽

Xiao-ying Lou ◽

Ya-xi Zhu ◽

Yu-chen Wang ◽

Lei Zhang ◽

...

Keyword(s):

Rectal Cancer ◽

Tumor Response ◽

Tumor Regression ◽

Locally Advanced ◽

Neoadjuvant Chemoradiotherapy ◽

Pathological Response ◽

Local Tumor ◽

Independent Predictive Factor ◽

Tumor Environment ◽

The Impact

Abstract Neoadjuvant chemoradiotherapy (nCRT) followed by surgery is the standard treatment for locally advanced rectal cancer. Here, we analyzed the impact of local and systemic environments on the tumor response to preoperative chemoradiotherapy in rectal cancer. We recruited 141 patients with rectal cancer treated with nCRT. We evaluated the local tumor environment, including tumor-infiltrating lymphocytes (TILs), intratumor budding (ITB), and the systemic inflammatory environment, including the neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) level. Our finding revealed that tumor regression was significantly associated with the density of CD8+ TILs in the intraepithelial, the presence of ITB, the combination of NLR and CRP (NLR-CRP) value, and the combination of CD8+ intraepithelial TIL (iTIL) density and ITB presence. Moreover, multivariate analysis showed that only the combination of CD8+ iTILs and ITB was an independent predictive factor for the pathological response to nCRT in rectal cancer. Our finding demonstrate that the local tumor environment was a better predictor of the tumor response than the systemic environment and thus provided new insight into screening for patients who are more likely to benefit from cancer treatment.

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Oncologic results in rectal cancer patients with a subcentimeter distal margin after laparoscopic-assisted sphincter-preserving surgery: a propensity-score matched cohort analysis

10.21203/rs.3.rs-26917/v2 ◽

2020 ◽

Author(s):

Chenghai Zhang ◽

Hong Yang ◽

Ming Cui ◽

Jiadi Xing ◽

Zhendan Yao ◽

...

Keyword(s):

Rectal Cancer ◽

Propensity Score ◽

Propensity Score Matching ◽

Cancer Patients ◽

Cohort Analysis ◽

Neoadjuvant Chemoradiotherapy ◽

Distal Margin ◽

Rectal Cancers ◽

Laparoscopic Assisted ◽

The Impact

Abstract Background: Distal resection margin (DRM) is closely associated with sphincter-preserving surgery and oncologic safety for patients with mid-low rectal cancers. However, the optimal DRM has not been determined. The purpose of this study to assess the impact of a DRM of ≤ 1 cm on oncologic safetyMethods: Data of 378 rectal cancer patients who underwent laparoscopic-assisted sphincter-preserving surgery from 2009 to 2015 were retrospectively analyzed. Patients were divided into two groups based on DRM: ≤ 1 cm (n=74) and >1 cm (n=304). To minimize the differences between the two groups, propensity-score matching on baseline features was performed. Stratified analysis was performed according to neoadjuvant chemoradiotherapy.Results: Before propensity-score matching, no significant differences in 5-year disease-free survival (DFS) (92.8 vs. 81.3%; P=0.128) and 5-year overall survival (OS) (83.7 vs. 82.2%; p=0.892) were observed in patients with DRMs of ≤1(n=74) and >1cm (n=304), respectively. After propensity-score matching (1:1), there were also no significant differences in DFS (88.1 vs. 78.2%; P=0.162) and OS (84.5vs. 84.9%; P=0.420) between the DRM of ≤1 cm group (n=65) and >1 cm group (n=65), respectively. A total of 44 patients received preoperative chemoradiotherapy. In this cohort, the 5-year local recurrence (LR) rates ( p=0.118) and the 5-year DFS rates ( p=0.298) were not significantly different between two groups. A total of 334 patients received surgery without neoadjuvant chemoradiotherapy. There were also no significant differences in the 5-year LR rates ( p=0.150) and 5-year DFS rates ( p=0.172) between two groups.Conclusions: No matter whether patients with rectal cancers receiving neoadjuvant therapy or not, sphincter-preserving surgery with a DRM of ≤1 cm may be acceptable in mid-low rectal cancer without jeopardizing oncologic safety.

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Watch and wait approach following neoadjuvant chemoradiotherapy for rectal cancer patients: A single-centre experience.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.4_suppl.681 ◽

2019 ◽

Vol 37 (4_suppl) ◽

pp. 681-681

Author(s):

Ji Zhu ◽

Jingwen Wang

Keyword(s):

Rectal Cancer ◽

Cancer Patients ◽

Locally Advanced ◽

Neoadjuvant Chemoradiotherapy ◽

Disease Free Survival ◽

Complete Response ◽

Advanced Rectal Cancer ◽

Locally Advanced Rectal Cancer ◽

Preoperative Treatment ◽

Watch And Wait

681 Background: A watch-and-wait approach for patients with clinical complete response to neoadjuvant chemoradiation could avoid the morbidity of conventional surgery for rectal cancer. Here, we report the survival outcome of patients with this strategy in our center. Methods: We retrospectively analyzed the rectal cancer patients who received neoadjuvant chemoradiotherapy since 2015 in our center. Preoperative regimen included long-course radiotherapy (50 Gy / 25 Fx) combined fluoropyrimidin–based chemotherapy concurrently. MRI and endoscopic evaluation were performed after preoperative treatment. Patients with complete tumor response were referred to the “watch-and-wait” approach and omitted the surgery. Four to six cycles of consolidation chemotherapy were performed. Patients were followed up clinically, endoscopically, and radiologically to assess for local recurrence or disease progression. Results: From January 2015 to March 2018, a total of 47 patients with rectal cancer in our center received conservative treatment following neoadjuvant therapy. The median age of the patients is 58 (53-66). The proportions of stages I to IV are 4.3%, 12.8%, 70.2%, 8.5%, respectively. After a median follow-up of 20 month, tumor regrowth occurred in five out of 47 (10.6%) patients. All local regrowth was diagnosed in the first two years, and four out of five (80%) of local regrowth was located in the bowel wall. All patients underwent salvage surgery. Distant metastasis was diagnosed in four of 47 patients (8.5%). two-year overall survival was 89.9%, and two-year disease-free survival was 76.5%. Conclusions: Organ preservation for locally advanced rectal cancer is feasible for selected patients who achieve a complete response to individualized neoadjuvant CRT. The survival of patients is not impaired with “watch-and-wait” strategy.

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Elevated Platelet Count as Predictor of Recurrence in Rectal Cancer Patients Undergoing Preoperative Chemoradiotherapy Followed by Surgery

International Surgery ◽

10.9738/intsurg-d-13-00178.1 ◽

2015 ◽

Vol 100 (2) ◽

pp. 199-207 ◽

Cited By ~ 20

Author(s):

Yuji Toiyama ◽

Yasuhiro Inoue ◽

Mikio Kawamura ◽

Aya Kawamoto ◽

Yoshinaga Okugawa ◽

...

Keyword(s):

Rectal Cancer ◽

Cancer Patients ◽

Locally Advanced ◽

Neoadjuvant Chemoradiotherapy ◽

Disease Free Survival ◽

Advanced Rectal Cancer ◽

Poor Overall Survival ◽

Neutrophil Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

The Impact

The impact of systemic inflammatory response (SIR) on prognostic and predictive outcome in rectal cancer after neoadjuvant chemoradiotherapy (CRT) has not been fully investigated. This retrospective study enrolled 89 patients with locally advanced rectal cancer who underwent neoadjuvant CRT and for whom platelet (PLT) counts and SIR status [neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR)] were available. Both clinical values of PLT and SIR status in rectal cancer patients were investigated. Elevated PLT, NLR, PLR, and pathologic TNM stage III [ypN(+)] were associated with significantly poor overall survival (OS). Elevated PLT, NLR, and ypN(+) were shown to independently predict OS. Elevated PLT and ypN(+) significantly predicted poor disease-free survival (DFS). Elevated PLT was identified as the only independent predictor of DFS. PLT counts are a promising pre-CRT biomarker for predicting recurrence and poor prognosis in rectal cancer.

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Tumor budding outperforms ypT and ypN classification in predicting outcome of rectal cancer after neoadjuvant chemoradiotherapy

BMC Cancer ◽

10.1186/s12885-019-6261-5 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Iryna Trotsyuk ◽

Halina Sparschuh ◽

Alice Josephine Müller ◽

Konrad Neumann ◽

Martin Kruschewski ◽

...

Keyword(s):

Rectal Cancer ◽

Neoadjuvant Therapy ◽

Cancer Patients ◽

Tumor Regression ◽

Prognostic Significance ◽

Neoadjuvant Chemoradiotherapy ◽

Preoperative Chemoradiotherapy ◽

Tumor Budding ◽

Poor Differentiation ◽

Low Degrees

Abstract Background Budding is a complementary prognostic factor for colorectal cancer. In this study, we aimed to clarify the role of tumor budding in rectal cancer patients after preoperative chemoradiotherapy. Methods A total of 124 patients with rectal cancer treated with neoadjuvant chemoradiotherapy and consecutive surgery were included. Surgical specimens were evaluated for budding and routine clinicopathological features. Budding was evaluated on hematoxylin and eosin (H&E)-stained slides and by cytokeratin immunohistochemical (IHC) staining. Results A budding rate of 36.9% (n = 38) by H&E and 55.6% (n = 55) by IHC was observed. Budding was significantly associated with a high ypT and ypN status, poor differentiation, and low degrees of tumor regression. Moreover, budding was strongly predictive of a worse patient outcome, as measured by tumor recurrence or death. In multivariate analyses, budding remained the only significant parameter for overall survival and was even superior to the ypT and ypN status (budding in H&E: hazard ratio (HR) 2.72, 95% confidence interval (95% CI) 1.15–6.44, p = 0.023; budding in IHC: HR 5.19, 95% CI 1.62–16.61, p = 0.006). Conclusion Budding is a strong prognostic predictor of survival in rectal cancer patients after neoadjuvant therapy. A standardized evaluation of tumor budding after neoadjuvant therapy may thus aid in risk stratification and guide the clinical management of patients with rectal cancer. Immunostaining can help to enhance the diagnostic accuracy and prognostic significance.

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