Impact of a history of metastases or synchronous metastases on survival in patients with locally recurrent rectal cancer

Voogt, E L K; Zoggel, D. M. G. I. van; Kusters, Miranda; Nieuwenhuijzen, Grard A. P.; Cnossen, Jeltsje S.; Creemers, Geert-Jan; Lijnschoten, Gesina van; Roef, Mark J.; Burger, J. W. A.; Rütten, Heidi

doi:10.1111/codi.15537

Cited by 5 publications

(3 citation statements)

References 21 publications

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“…Due to the poor therapeutic effect of LRRC with distant metastasis, it was considered an absolute contraindication for surgical treatment in the past, but the results varied by Cyr's research, there was a significant difference in median disease-specific survival (DSS) between M0 and M1 after surgical treatment (60 vs. 21 months, P=0.002) (7). However, in Voogt's study, although patients with synchronous metastasis tended to have worse OS than patients without synchronous metastasis (HR =1.43; 95% CI: 0.98-2.11), the history of metastasis did not affect OS (20). Both studies were based on large referral centers and excluded unresectable M1 patients, whereas patients were based on broader inclusion criteria.…”

Section: Discussionmentioning

confidence: 90%

Construction and validation of a prognostic nomogram for locally recurrent rectal cancer: a population-based study

Hu¹,

Zhou²,

Li³

et al. 2023

J Gastrointest Oncol

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Background: Postoperative recurrence was a life-threatening condition for patients with rectal cancer.Due to the heterogeneity of locally recurrent rectal cancer (LRRC) and controversy of the optimal treatment for patients, it was difficult to predict the prognosis of LRRC. This study aimed to develop and validate a nomogram that could accurately predict the survival probability of LRRC. Methods: Patients diagnosed with LRRC between 2004 and 2019 from the Surveillance, Epidemiology, and End Results (SEER) database were included in the analysis. Multiple imputations with chained equations were used for missing values. These patients were further randomized into training set and testing set. Cox regression was used for univariate and multivariate analysis. Potential predictors were screened by the least absolute shrinkage and selection operator (LASSO). The Cox hazards regression model was constructed and it was visualized by nomogram. C-index, calibration curve, and decision curve were used to evaluate the model's predictive ability. Then X-tile was used to calculate the optimal cut-off values for all patients and the cohort was divided into three groups. Results: A total of 744 LRRC patients were enrolled and allocated to the training set (n=503) and the testing set (n=241). Cox regression analysis of the training set yielded meaningfully clinicopathological variables. A survival nomogram was created based on the identification of ten clinicopathological features in the LASSO regression analyses of the training set. The C-index of 3-, 5-year survival probabilities were 0.756, 0.747 in training set, and 0.719, 0.726 in testing set, respectively. The calibration curve and decision curve both demonstrated the satisfactory performance of the nomogram for prognosis prediction. Moreover, the prognosis of LRRC could be well distinguished according to the grouping of risk scores (P<0.001 in three groups). Conclusions: This nomogram was the first prediction model to preliminarily evaluate the survival of LRRC patients, which could provide more accurate and efficient treatment in clinical practice.

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Section: Discussionmentioning

confidence: 90%

Construction and validation of a prognostic nomogram for locally recurrent rectal cancer: a population-based study

Hu¹,

Zhou²,

Li³

et al. 2023

J Gastrointest Oncol

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“…It seems unlikely that escalating surgical treatment would change that course. It should also be considered that patients with LRRC most often succumb to distant metastases, rather than to an overwhelming local re-recurrence 15,25,26 .…”

Section: Discussionmentioning

confidence: 99%

“…Tumour downstaging may result in less extensive surgical procedures in order to achieve an R0 resection. Surgical procedures could be postponed, allowing time for observation of the natural behaviour of the tumour, and thus avoiding upfront debilitating surgical procedures in patients who will present with metastases shortly after 23,26 . Although a pCR is still relatively rare in patients who have undergone radiotherapy for the primary tumour, pCR rates seem to have increased owing to intensification of neoadjuvant treatment, and may become a significant factor in treatment decisions in the future.…”

Section: Discussionmentioning

confidence: 99%

Locally recurrent rectal cancer: Oncological outcomes for patients with a pathological complete response after neoadjuvant therapy

Nordkamp

Piqeur

Berg

et al. 2023

British Journal of Surgery

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Background For patients with locally recurrent rectal cancer, it is an ongoing pursuit to establish factors predicting or improving oncological outcomes. In locally advanced rectal cancer, a pCR appears to be associated with improved outcomes. The aim of this retrospective cohort study was to compare the oncological outcomes of patients with locally recurrent rectal cancer with and without a pCR. Methods Patients who underwent neoadjuvant treatment and surgery for locally recurrent rectal cancer with curative intent between January 2004 and June 2020 at a tertiary referral hospital were analysed. Primary outcomes included overall survival, disease-free survival, metastasis-free survival, and local re-recurrence-free survival, stratified according to whether the patient had a pCR. Results Of a total of 345 patients, 51 (14.8 per cent) had a pCR. Median follow-up was 36 (i.q.r. 16–60) months. The 3-year overall survival rate was 77 per cent for patients with a pCR and 51.1 per cent for those without (P < 0.001). The 3-year disease-free survival rate was 56 per cent for patients with a pCR and 26.1 per cent for those without (P < 0.001). The 3-year local re-recurrence-free survival rate was 82 and 44 per cent respectively (P < 0.001). Surgical procedures (for example soft tissue, sacrum, and urogenital organ resections) and postoperative complications were comparable between patients with and without a pCR. Conclusion This study showed that patients with a pCR have superior oncological outcomes to those without a pCR. It may therefore be safe to consider a watch-and-wait approach in highly selected patients, potentially improving quality of life by omitting extensive surgical procedures without compromising oncological outcomes.

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Locally recurrent rectal cancer and distant metastases: is there still a chance ofcure?

Rees¹,

Nordkamp²,

Harmsen³

et al. 2023

European Journal of Surgical Oncology

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Impact of a history of metastases or synchronous metastases on survival in patients with locally recurrent rectal cancer

Cited by 5 publications

References 21 publications

Construction and validation of a prognostic nomogram for locally recurrent rectal cancer: a population-based study

Construction and validation of a prognostic nomogram for locally recurrent rectal cancer: a population-based study

Locally recurrent rectal cancer: Oncological outcomes for patients with a pathological complete response after neoadjuvant therapy

Locally recurrent rectal cancer and distant metastases: is there still a chance ofcure?

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