Pathologic Complete Response Despite Nodal Yield Has Best Survival in Locally Advanced Rectal Cancer

Narayanan, Sumana; Attwood, Kristopher; Gabriel, Emmanuel; Nurkin, Steven

doi:10.1016/j.jss.2020.01.019

Cited by 6 publications

(3 citation statements)

References 33 publications

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“…This study was designed to investigate that whether the middle-low rectal cancer patients who got a pathological complete response after neoadjuvant cheomradiotherapy followed by TME would have a better survival outcome. According to our study, there were totally two ndings, namely the PCR rate of the 246 patients was 20.3%(50/246), which is similar to someone else's previous studies [10][11][12][13] , as well as patients with pathological grade I-II, CRM not invaded, clinical T1-3, got PCR or downstage after preoperative chemoradiotherapy may have a better PFS and patients younger than 60 years, grade I-II, EMVI negative, CRM invasion negative, clinical T1-3, clinical N0, PCR or downstage after preoperative therapy seemed to have a better OS by single factor Kaplan-Meier survival analysis and log-rank test. After excluding the interaction effect of all the factors by cox-regression analysis, clinical T stage and PCR were the factors that related to PFS, clinical T stage, PCR and downstage after preoperative chemoradiotherapy were the factors that associated with OS, and clinical T1-3, got PCR or downstage after preoperative chemoradiotherapy may have a better survival.…”

Section: Discussionsupporting

confidence: 87%

Locally Advanced Rectal Cancer Patients Got PCR After Chemoradiotherapy May Have Better Survival Outcomes: A Retrospective Analysis of 246 Patients.

Wang

Chen

Peng

et al. 2021

Preprint

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Objective: To investigate whether the locally advanced rectal cancer patients who got a pathological complete response after neo-adjuvant chemoradiotherapy have a better survival. Methods: From January 1 2014 to January 1 2018, the clinical information of locally advanced rectal cancer patients who underwent neo-adjuvant chemoradiotherapy were collected for a retrospective analysis. Then a telephone follow-up visit was done to get the patients’ survival information of progression-free survival and overall survival. At last the information was analyzed by Kaplan-Meier analysis, log-rank test and cox-regression analysis. Results: The clinical information of 246 locally advanced rectal cancer patients were collected and analyzed, which shows that the PCR rate after chemoradiotherapy was 20.3% in these patients. There were correlations between pathological grade(grade III-IV Vs. I-II, P=0.001), CRM invasion(positive Vs. negative, P=0.001), clinical T stage(T4 Vs. T1-3, P=0.000), PCR status(PCR Vs. Non-PCR, P=0.027), downstage after preoperative therapy(yes Vs. not, P=0.009) and PFS. Similarly, age(≤60 Vs. >60, P=0.000), pathological grade(grade III-IV Vs. I-II, P=0.016), EMVI status(positive Vs. negative, P=0.005), CRM invasion(positive Vs. negative, P=0.000), clinical T stage(T4 Vs. T1-3, P=0.000), clinical N stage(N0-1 Vs. N2, P=0.013), PCR status(PCR Vs. Non-PCR, P=0.010), downstage after preoperative therapy(yes Vs. not, P=0.002) were associated with the OS. After the Cox-regression analyses, the responses after preoperative therapy or T4 tumors were identified as the prognostic factors that affected PFS and OS. Conclusions: The PCR rate after chemoradiotherapy was 20.3% in locally advanced rectal patients. Stage T1-3, better response after chemoradiotherapy tumors (PCR or downstage) might have a better survival outcome.

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Section: Discussionsupporting

confidence: 87%

Locally Advanced Rectal Cancer Patients Got PCR After Chemoradiotherapy May Have Better Survival Outcomes: A Retrospective Analysis of 246 Patients.

Wang

Chen

Peng

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…Several studies found that dissection of < 12 lymph nodes did not adversely affect survival (7,33,34). In contrast, Narayanan et al (35) extracted data from patients diagnosed with rectal cancer during 2004-2014 from the NCDB. They found that retrieving ≥ 12 lymph nodes in patients who did not reach ypCR after neoadjuvant therapy can improve OS but not in patients who achieved ypCR.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Lymph Node Harvest on Prognosis in Locally Advanced Middle-Low Rectal Cancer After Neoadjuvant Chemoradiotherapy

Lin

Song

et al. 2022

Front. Oncol.

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ObjectiveThe purpose of this study was to investigate the relationship between lymph node harvest and the prognosis in locally advanced rectal cancer (LARC) patients after neoadjuvant chemoradiotherapy (nCRT).MethodsPatients who were diagnosed with clinical LARC and treated with nCRT and radical surgery between June 2008 and July 2017 were included in this study. The relationship between lymph node retrieval and prognosis was analyzed. Other lymph node-related indicators were explored.ResultsA total of 837 patients with a median follow-up of 61 (7-139) months were included in the study. The five-year DFS and OS rates of all patients were 74.9% and 82.3%, respectively. Multivariate survival analysis suggested that dissection of ≥ 12 lymph nodes did not improve OS or DFS. 7 was selected as the best cutoff value for the total number of lymph nodes retrieved by Cox multivariate analysis (χ2 = 10.072, HR: 0.503, P=0.002). Dissection of ≥ 5 positive lymph nodes (PLNs) was an independent prognostic factor for poorer DFS (HR: 2.104, P=0.004) and OS (HR: 3.471, p<0.001). A positive lymph node ratio (LNR) of more than 0.29 was also an independent prognostic factor for poorer DFS (HR: 1.951, P=0.002) and OS (HR: 2.434, p<0.001).ConclusionThe recommends that at least 7 harvested lymph nodes may be more appropriate for LARC patients with nCRT. PLN and LNR may be prognostic factors for LARC patients with ypN+ after nCRT.

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“…The pCR rate of LARC after neoadjuvant CCRT was approximately 9%-30% [39,[41][42][43][44]. Compared with patients without pCR, patients with pCR have increased OS and DFS with a decreased incidence of LR [38][39][40]42,45,46]. Conversely, the role of pCR in LACC treatment remains inconclusive.…”

Section: Plos Onementioning

confidence: 99%

Critical reappraisal of neoadjuvant concurrent chemoradiotherapy for treatment of locally advanced colon cancer

Chen

Tsai

et al. 2021

PLoS ONE

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Background Locally advanced colon cancer (LACC) is associated with surgical challenges during R0 resection, increased postoperative complications, and unfavorable treatment outcomes. Neoadjuvant concurrent chemoradiotherapy followed by surgical resection is an effective treatment strategy that can increase the complete surgical resection rate and improve the patient survival rate. This study investigated the efficacy and toxicity of concurrent chemoradiotherapy in patients with LACC as well as the prognosis and long-term clinical outcomes of these patients. Materials From January 2012 to July 2020, we retrospectively reviewed the real-world data of 75 patients with LACC who received neoadjuvant concurrent chemoradiotherapy. The chemotherapy regimen consisted of folinic acid, 5-fluorouracil, and oxaliplatin (FOLFOX). The following data were obtained from medical records: patients’ characteristics, pathologic results, toxicity, and long-term oncologic outcome. Results Of the 75 patients, 13 (17.3%) had pathologic complete responses. Hematologic adverse effects were the most common (grade 1 anemia: 80.0% and leukopenia: 82.7%). Conversely, grade 2 or 3 adverse effects were relatively uncommon (<10%). Pathologic N downstaging, ypT0, and pathologic complete responses were significant prognostic factors for patient survival. Multivariate analysis revealed that pathologic N downstaging was an independent predictor of patients’ overall survival (P = 0.019). The estimated 5-year overall and disease-free survival rates were 68.6% and 50.6%, and the medians of overall and disease-free survival periods were 72.3 and 58.7 months, respectively. Moreover, patients with pathologic complete responses had improved overall survival (P = 0.039) and an improved local recurrence control rate (P = 0.042) but an unfavorable distant metastasis control rate (P = 0.666) in the long-term follow-up. Conclusion The long-term oncologic outcome of patients with LACC following concurrent chemoradiotherapy is acceptable, and the adverse effects seem to be tolerable. Pathologic N downstaging was an independent prognostic factor for patients’ overall survival. However, a large prospective, randomized control study is required to confirm the current results.

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Pathologic Complete Response Despite Nodal Yield Has Best Survival in Locally Advanced Rectal Cancer

Cited by 6 publications

References 33 publications

Locally Advanced Rectal Cancer Patients Got PCR After Chemoradiotherapy May Have Better Survival Outcomes: A Retrospective Analysis of 246 Patients.

Locally Advanced Rectal Cancer Patients Got PCR After Chemoradiotherapy May Have Better Survival Outcomes: A Retrospective Analysis of 246 Patients.

The Effect of Lymph Node Harvest on Prognosis in Locally Advanced Middle-Low Rectal Cancer After Neoadjuvant Chemoradiotherapy

Critical reappraisal of neoadjuvant concurrent chemoradiotherapy for treatment of locally advanced colon cancer

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