The significance of tumour deposits in rectal cancer after neoadjuvant therapy: a systematic review and meta-analysis

Lord, Amy; D’Souza, Nigel; Pucher, Philip H.; Brown, Gina; Nagtegaal, Irıs D.

doi:10.1016/j.ejca.2019.08.020

Cited by 32 publications

(31 citation statements)

References 16 publications

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“…Lord et al explored the significance of TDs in neoadjuvant therapy for rectal cancer. They found that, similar to untreated patients, the presence of TDS in rectal cancer patients after neoadjuvant therapy was related to disease progression and poor prognosis (23). Pricolo et al revealed the TDs and PIN were associated with worse survival in stage III colon cancer, and they recommended a combination of TDs and lymph node examination as "N2c" (24).…”

Section: Discussionmentioning

confidence: 99%

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A Nomogram for Predicting Multiple Metastases in Metastatic Colorectal Cancer Patients: A Large Population-Based Study

Xiang

Ren

et al. 2021

Front. Oncol.

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ObjectivesThe present study aims to discover the risk factors of multiple metastases and develop a functional nomogram to forecast multiple metastases in metastatic colorectal cancer (mCRC) patients.MethodsmCRC cases were retrospectively collected from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2016. Survival times between multiple metastases and single metastasis were compared using Kaplan–Meier analysis and log-rank tests. Risk factors for multiple metastases were determined by univariate and multivariate logistic regression analyses, and a nomogram was developed to forecast the probability of multiple metastases in mCRC patients. We assessed the nomogram performance in terms of discrimination and calibration, including concordance index (C-index), area under the curve (AUC), and decision curve analysis (DCA). Bootstrap resampling was used as an internal verification method, and at the same time we select external data from Renmin Hospital of Wuhan University as independent validation sets.ResultsA total of 5,302 cases were included in this study as training group, while 120 cases were as validation group. The patients with single metastasis and multiple metastases were 3,531 and 1,771, respectively. The median overall survival (OS) and cancer-specific survival (CSS) for patients with multiple metastases or single metastasis were 19 vs. 31 months, and 20 vs. 33 months, respectively. Based on the univariate and multivariate analyses, clinicopathological characteristics were associated with number of metastasis and were used to establish nomograms to predict the risk of multiple metastases. The C-indexes and AUC for the forecast of multiple metastases were 0.715 (95% confidence interval (CI), 0.707–0.723), which showed the nomogram had good discrimination and calibration curves of the nomogram showed no significant bias from the reference line, indicating a good degree of calibration. In the validation group, the AUC was 0.734 (95% CI, 0.653–0.834), and calibration curve also showed no significant bias, indicating the favorable effects of our nomogram.ConclusionsWe developed a new nomogram to predict the risk of multiple metastases. The nomogram shows the good prediction effect and can provide assistance for clinical diagnosis and treatment.

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Section: Discussionmentioning

confidence: 99%

“…explored the significance of TDs in neoadjuvant therapy for rectal cancer. They found that, similar to untreated patients, the presence of TDS in rectal cancer patients after neoadjuvant therapy was related to disease progression and poor prognosis ( 23 ). Pricolo et al.…”

Section: Discussionmentioning

confidence: 99%

A Nomogram for Predicting Multiple Metastases in Metastatic Colorectal Cancer Patients: A Large Population-Based Study

Xiang

Ren

et al. 2021

Front. Oncol.

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“…A recent meta-analysis focused on tumour deposits (TD) after neoadjuvant therapy [107]. The mean prevalence of TD (24.5% of patients) was only slightly increased compared to non-pretreated colorectal cancer patients (22.5%) [108], but compared to the cases with rectal carcinoma without neoadjuvant therapy (33.6%) [109][110][111] there is a decreased number.…”

Section: Tumour Deposits After Neoadjuvant Therapy Are Differentmentioning

confidence: 99%

How to measure tumour response in rectal cancer? An explanation of discrepancies and suggestions for improvement

Nagtegaal

Glynne‐Jones

2020

Cancer Treatment Reviews

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Various methods categorize tumour response after neoadjuvant therapy, including down-staging and tumour regression grading. Response categories allow comparison of different treatments within clinical trials and predict outcome. A reproducible response categorization could identify subgroups with high or low risk for the most appropriate subsequent treatments, like watch and wait. Lack of standardization and interpretation difficulties currently limit the usability of these approaches. In this review we describe these difficulties for the evaluation of chemoradiation in rectal cancer. An alternative approach of tumour response is based on patterns of residual disease, including fragmentation. We summarise the evidence behind this alternative method of response categorisation, which explains a number of very relevant clinical discrepancies. These issues include differences between downstaging and tumour regression, high local regrowth in advanced tumours during watchful waiting procedures, the importance of resection margins, the limited value of post-treatment biopsies and the relatively poor outcome of patients with a near complete pathological response. Recognition of these patterns of response can allow meaningful development of novel biomarkers in the future.

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“…Moreover, TDs identification after radiotherapy remains controversial. Although there are some arguments for lower survival due to TDs after neoadjuvant radiotherapy, 13 small number of studies have reported a poor prognosis in TD-positive tumors after neoadjuvant radiotherapy 7 while others showed no difference. 14 The aim of this study was to assess TD and N1c stage tumor prognosis in rectal cancer.…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of tumor deposits in rectal cancer: A monocentric series of 505 patients

Benoit

Svrcek

Creavin

et al. 2020

Journal of Surgical Oncology

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Background and Objectives: It has been suggested that tumor deposits (TDs) may have a worse prognosis in rectal cancer compared with colonic cancer. The aim of this study was to assess TDs prognosis in rectal cancer. Methods: Patients who underwent total mesorectum excision for rectal adenocarcinoma (2011-2016) were included. A case-matched analysis was performed to assess the accurate impact of TDs for each pN category after exclusion of synchronous metastasis. Results: A total of 505 patients were included. TDs were observed in 99 (19.6%) patients, (pN1c = 37 [7.3%]). TDs were associated with pT3-T4 stage (P = .037), synchronous metastasis (P = .003), lymph node (LN) invasion (P = .041), vascular invasion (P = .001), and perineural invasion (P < .001). TD was associated with a worse 3-year disease-free survival (DFS) among pN0 (51.2% vs 79.8%; P < .001); pN1 patients (35.2% vs 70.1%; P = .004) but not among pN2 patients (37.5% vs 44.7%; P = .499). After matching, pN1c patients had a worse 3-year DFS compared with pN0 patients (58.6% vs 82.4%; P = .035) and a tendency toward a worse DFS among N1 patients (40.1% vs 64.2%; P = .153). DFS was worse when one TD was compared with one invaded LN (40.8% vs 81.3%; P < .001). Conclusion: In rectal cancer, TDs have a metastatic risk comparable to a pN2 stage which may lead to changes in adjuvant treatment.

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The significance of tumour deposits in rectal cancer after neoadjuvant therapy: a systematic review and meta-analysis

Cited by 32 publications

References 16 publications

A Nomogram for Predicting Multiple Metastases in Metastatic Colorectal Cancer Patients: A Large Population-Based Study

A Nomogram for Predicting Multiple Metastases in Metastatic Colorectal Cancer Patients: A Large Population-Based Study

How to measure tumour response in rectal cancer? An explanation of discrepancies and suggestions for improvement

Prognostic value of tumor deposits in rectal cancer: A monocentric series of 505 patients

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