Small Bowel Adenocarcinoma, Version 1.2020, NCCN Clinical Practice Guidelines in Oncology

Benson, Al B.; Venook, Alan P.; Al-Hawary, Mahmoud M.; Arain, Mustafa A.; Chen, Yi Jen; Ciombor, Kristen K.; Cohen, Stacey A.; Cooper, Harry S.; Deming, Dustin A.; Garrido‐Laguna, Ignacio; Grem, Jean L.; Hoffe, Sarah E.; Hubbard, Joleen M.; Hunt, Steven R.; Kamel, Ayman H.; Kirilcuk, Natalie; Krishnamurthi, Smitha; Messersmith, Wells A.; Meyerhardt, Jeffrey A.; Miller, Eric D.; Mulcahy, Mary F.; Nurkin, Ms Steven Nurkin; Overman, Michael J.; Parikh, Aparna; Patel, Hitendra; Pedersen, Katrina; Saltz, Leonard; Schneider, Charles J.; Shibata, David; Skibber, John M.; Sofocleous, Constantinos T.; Stoffel, Elena M.; Stotsky-Himelfarb, Eden; Willett, Christopher G.; Johnson-Chilla, Alyse; Gregory, Kristina M.; Gurski, Lisa A.

doi:10.6004/jnccn.2019.0043

Cited by 105 publications

(108 citation statements)

References 146 publications

(187 reference statements)

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“…[3][4][5][6] Given its clinical implications, MSI/MMR testing is nowadays recommended by the National Comprehensive Cancer Network (NCCN) guidelines for multiple cancer types. [7][8][9] At present, MSI/MMR status is most commonly determined using immunohistochemistry (IHC) or polymerase chain reaction (PCR). IHC involves staining for the MMR proteins (MLH1, MSH2, MSH6, and PMS2) while PCR analyzes five to seven highly conserved microsatellite markers.…”

Section: Introductionmentioning

confidence: 99%

Plasma-based microsatellite instability detection strategy to guide immune checkpoint blockade treatment

Wang

Zhao

Gao

et al. 2020

J Immunother Cancer

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BackgroundMicrosatellite instability (MSI) represents the first pan-cancer biomarker approved to guide immune checkpoint blockade (ICB) treatment. However its widespread testing, especially outside of gastrointestinal cancer, is hampered by tissue availability.MethodsAn algorithm for detecting MSI from peripheral blood was established and validated using clinical plasma samples. Its value for predicting ICB efficacy was evaluated among 60 patients with advanced gastrointestinal cancer. The landscape of MSI in blood was also explored among 5138 advanced solid tumors.ResultsThe algorithm included 100 microsatellite markers with high capture efficiency, sensitivity, and specificity. In comparison with orthogonal tissue PCR results, the method displayed a sensitivity of 82.5% (33/40) and a specificity of 96.2% (201/209), for an overall accuracy of 94.0% (234/249). When the clinical validation cohort was dichotomized by pretreatment blood MSI (bMSI), bMSI-high (bMSI-H) predicted both improved progression-free survival and overall survival than the blood microsatellite stable (bMSS) patients (HRs: 0.431 and 0.489, p=0.005 and 0.034, respectively). Four patients with bMSS were identified to have high blood tumor mutational burden (bTMB-H) and trended towards a better survival than the bMSS-bTMB-low (bTMB-L) subset (HR 0.026, 95% CI 0 to 2.635, p=0.011). These four patients with bMSS-bTMB-H plus the bMSI-H group collectively displayed significantly improved survival over the bMSS-bTMB-L patients (HR 0.317, 95% CI 0.157 to 0.640, p<0.001). Pan-cancer prevalence of bMSI-H was largely consistent with that shown for tissue except for much lower rates in endometrial and gastrointestinal cancers, and a remarkably higher prevalence in prostate cancer relative to other cancer types.ConclusionsWe have developed a reliable and robust next generation sequencing-based bMSI detection strategy which, in combination with a panel enabling concurrent profiling of bTMB from a single blood draw, may better inform ICB treatment.

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Section: Introductionmentioning

confidence: 99%

Plasma-based microsatellite instability detection strategy to guide immune checkpoint blockade treatment

Wang

Zhao

Gao

et al. 2020

J Immunother Cancer

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“…To make matters worse, few studies have been published to help guide the management of SIAC owing to the rarity of the tumors [6]. Although the National Comprehensive Cancer Network (NCCN) has recently published guidelines for the treatment of SIAC [7], management of SIAC has been historically extrapolated from colorectal cancer (CRC). Patient outcomes for SIAC are inferior to those for CRC at all stages of diagnosis [1,2].…”

Section: Introductionmentioning

confidence: 99%

Tumor Budding and Poorly Differentiated Clusters in Small Intestinal Adenocarcinoma

Jun

Chung

Yoon

et al. 2020

Cancers

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The clinicopathologic and prognostic significances of tumor budding (TB) and poorly-differentiated clusters (PDC) have not been investigated in small intestinal adenocarcinomas (SIACs). In 236 surgically-resected SIACs, we counted TB (single cells or clusters ≤4 tumor cells) and PDC (clusters ≥5 tumor cells) at the peritumoral-invasive front (p) and in the intratumoral area (i) independently to classify as grade-1 (≤4), grade-2 (5–9), or grade-3 (≥10). Consequently, grades-2 and -3 were considered high-grade. High-pTB, -iTB, -pPDC, and -iPDC were observed in 174 (73.7%), 129 (54.7%), 118 (50.0%), and 85 (36.0%) cases, respectively. High-TB/PDCs were more frequently observed in tumors with high-grade, higher T- and N-categories and stage grouping, and perineural or lymphovascular invasion. Patients with high-TB/PDC had a shorter survival than those with low-TB/PDC. In a multivariate analysis, high-pTB, nonintestinal type, high N-category, retroperitoneal seeding, and microsatellite-stable were worse independent-prognostic predictors. Subgroup analysis demonstrated that patients with high-pTB showed worse survival (median: 42.5 months) than those with low-pTB (133.7 months; p = 0.007) in the lower stage (stages I–II) group. High-TB/PDC, both in peritumoral and intratumoral localizations, were associated with aggressive behaviors in SIACs. High-pTB can be used as an adverse prognostic indicator in SIAC patients, especially when patients are in early disease stages.

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“…For patients with no mesenteric lymph node metastasis upon pathologic examination (regardless of the lateral lymph node status), the 2020 NCCN Guideline recommends the “watch and wait” approach. The results from the current study suggest that more attention should be given to lateral lymph node metastasis after neoadjuvant chemoradiation [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…The most recent Japanese Society for Cancer of the Colon and Rectum (JSCCR) Guidelines for the treatment of colorectal cancer classify metastasis to lateral lymph nodes as local metastasis and recommend lateral lymph node dissection (LLND) in both stage II and III low rectal cancers [ 2 ]. The NCCN Guidelines recommend chemoradiotherapy (CRT) plus total mesorectal excision (TME) treatment for lateral lymph node metastasis [ 3 ]. A recent study reported 19.5% 5-year local recurrence rate after CRT plus TME versus 5.5% 5-year local recurrence rate after CRT plus TME and LLND in patients with lateral lymph nodes at least 7 mm in diameter, supporting the notion that lateral lymph node involvement represents local metastasis [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Metastasis to lateral lymph nodes with no mesenteric lymph node involvement in low rectal cancer: a retrospective case series

et al. 2020

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Purpose The aim of this study is to examine the pattern of lymph node metastasis (lateral vs. mesenteric lymph nodes) in low rectal cancer. Methods This retrospective analysis included all patients undergoing laparoscopic total mesorectal excision plus lateral lymph node dissection for advanced low rectal cancer (up to 8 cm from the anal verge) during a period from July 1, 2017, to August 31, 2019, at the Department of Colorectal Surgery, Tianjin Union Medical Center. The decision to conduct lateral lymph node dissection was based on positive findings in preoperative imaging assessments. Results A total of 42 patients were included in data analysis. Surgery was successfully completed as planned, without conversion to open surgery in any case. A minimum of 10 mesenteric lymph nodes and 1 lateral lymph node on each side were dissected in all patients. Pathologic examination of resected specimens showed no metastasis to either mesenteric or lateral lymph nodes in 7 (16.7%) case, metastasis to both mesenteric and lateral lymph nodes in 26 (61.9%) cases, metastasis to mesenteric but not lateral lymph nodes in 4 (9.5%) cases, and metastasis to lateral but not mesenteric lymph nodes in 5 (11.9%) cases (n = 2 in the obturator region; n = 3 in the iliac artery region). Conclusion A clinically significant proportion of low rectal cancer patients have metastasis to lateral lymph nodes without involvement of mesenteric lymph nodes. More carefully planned prospective studies are needed to verify this preliminary finding.

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Small Bowel Adenocarcinoma, Version 1.2020, NCCN Clinical Practice Guidelines in Oncology

Cited by 105 publications

References 146 publications

Plasma-based microsatellite instability detection strategy to guide immune checkpoint blockade treatment

Plasma-based microsatellite instability detection strategy to guide immune checkpoint blockade treatment

Tumor Budding and Poorly Differentiated Clusters in Small Intestinal Adenocarcinoma

Metastasis to lateral lymph nodes with no mesenteric lymph node involvement in low rectal cancer: a retrospective case series

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