The survival benefit of adjuvant radiotherapy for pathological T4N2M0 colon cancer in the Modern Chemotherapy Era: evidence from the SEER database 2004–2015

Huang, Yong; Gu, Xiaoqing; Ge, Kuanxue; Fu, Guangshun; Chu, Junfeng; Wei, Wei

doi:10.1080/21691401.2020.1770270

Cited by 11 publications

(11 citation statements)

References 20 publications

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“…CEA is a routine index used for colon cancer diagnosis and surveillance 30 , 31 ; however, it remains controversial whether elevated CEA levels are an independent risk factor for poor prognosis 14 , 19 , 32 . In this study, serum CEA was an independent risk factor for OS.…”

Section: Discussionmentioning

confidence: 99%

“…The following data were also collected and categorized as follows: insurance (insured, uninsured, or unknown), age at diagnosis (< 50 years, 50–69 years, or ≥ 70 years), sex (male or female), race (white, black, others, or unknown), marital status (married, others, or unknown), differentiation status (well, moderate, poor, undifferentiated, or unknown), tumor size (< 3 cm, 3–4.9 cm, ≥ 5 cm, or unknown) 3 , 19 , serum carcinoembryonic antigen (CEA) level (elevated, normal, or unknown), perineural invasion (PNI) status (yes, no, or unknown), N classification (N0, N1, N2, or unknown), lymph node dissection (LND) number (< 12, ≥ 12, or unknown) 20 , adjuvant EBRT (yes or no), and survival (months). Data on adjuvant chemotherapy were not extracted in this study, mainly because it was hard to distinguish unknown chemotherapy from no chemotherapy in the SEER database 19 , 21 , although adjuvant chemotherapy is an important prognostic factor of colon cancer.…”

Section: Methodsmentioning

confidence: 99%

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Prognostic analysis and beneficiary identification of adjuvant external beam radiotherapy for stage pT4b sigmoid colon cancer

Lin

Wang

Shao

et al. 2021

Sci Rep

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The clinical efficacy of adjuvant radiotherapy in sigmoid colon cancer remains questioned. To evaluate the clinical efficacy of adjuvant external beam radiotherapy (EBRT) for patients with pathologic stage T4b sigmoid colon cancer. Patients with stage pT4b sigmoid colon cancer receiving adjuvant EBRT or not followed by surgery between 2004 and 2016 were extracted from the Surveillance, Epidemiology, and End Results database. Analysis of overall survival (OS) was performed using Kaplan–Meier curves and prognostic factors were identified using Cox proportional hazards regression models with 95% confidence intervals within the entire cohort. A risk-stratification system was then developed based on the β regression coefficient. Among 2073 patients, 284 (13.7%) underwent adjuvant EBRT. The median OS in the group receiving adjuvant EBRT was significantly longer than that in the non-radiotherapy group (p < 0.001). Age, serum carcinoembryonic antigen (CEA) level, perineural invasion, lymph node dissection (LND) number, and adjuvant EBRT were independent factors associated with OS. A risk‐stratification system was generated, which showed that low‐risk patients had a higher 5-year survival rate than high-risk patients (75.6% vs. 42.3%, p < 0.001). Adjuvant EBRT significantly prolonged the 5-year survival rate of high-risk patients (62.6% vs. 38.3%, p = 0.009) but showed no survival benefit among low‐risk patients (87.7% vs. 73.2%, p = 0.100). Our risk‐stratification model comprising age, serum CEA, perineural invasion, and LND number predicted the outcomes of patients with stage pT4b sigmoid colon cancer based on which subgroup of high-risk patients should receive adjuvant EBRT.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Prognostic analysis and beneficiary identification of adjuvant external beam radiotherapy for stage pT4b sigmoid colon cancer

Lin

Wang

Shao

et al. 2021

Sci Rep

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“…Serum CEA is a routinely-used marker for diagnosing and monitoring colorectal cancer [ 27 , 28 ]. However, different researchers hold different views on the role of serum CEA for prognosis [ 19 , 24 , 29 ]. In our current research, elevated serum CEA was found to be an independent predictor of locoregional recurrence ( p < 0.001), with a score of 5 in the risk stratification model.…”

Section: Discussionmentioning

confidence: 99%

“…All patients in the SEER database underwent surgery and divided into the surgery alone group (2,628 cases, 91.1%) and the surgery followed by adjuvant RT group (258 cases, 8.9%). Chemotherapy was not analyzed because the SEER database cannot distinguish which patients did not receive chemotherapy [ 19 , 20 ]. All patients were actively followed-up.…”

Section: Methodsmentioning

confidence: 99%

Postoperative locoregional recurrence pattern and treatment management of stage pT4 sigmoid colon cancer: a retrospective cohort study

Lin

Liu

et al. 2022

Radiat Oncol

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Background This study aimed to explore the pattern of locoregional recurrence after surgery in patients with non-metastatic stage pT4 sigmoid colon cancer and the role of adjuvant radiotherapy on survival. Methods We retrospectively analyzed data from 208 patients who underwent surgery in our hospital. The patients were randomly divided into training and validation groups at a 1:1 ratio. Patients at high risk for locoregional recurrence were screened using Cox regression analysis. Based on the data of 2,886 patients in the Surveillance, Epidemiology, and End Results (SEER) database, the effect of adjuvant radiotherapy on overall survival (OS) and cancer-specific survival (CSS) was evaluated by Kaplan–Meier curves. Results Of the 208 patients, 57 (27.4%) presented with locoregional recurrences (14 anastomotic and 43 abdominal or pelvic lymph node recurrences). Multivariate analysis showed that serum CEA, differentiation, lymph node dissection number, and N stage were independent predictors of locoregional recurrence-free survival (all p < 0.05). A risk-stratification model was constructed, and a total score of ≥ 6.5 points was considered the high-risk group for locoregional recurrence. Both the training and validation sets presented that the model had a good predictive ability (area under the curve = 0.828 and 0.724, respectively). Analysis of SEER data revealed that adjuvant radiotherapy significantly prolonged OS and CSS in the high-risk population (all p < 0.05, vs. no radiotherapy). Conclusions Patients with a total risk score of 6.5 or more had a high likelihood of locoregional recurrence, and perhaps adjuvant radiotherapy could improve their survival.

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“…Nonetheless, it should be pointed out that delivery of radiotherapy has considerably improved since these initial studies largely due to the advent of highly conformal radiotherapy techniques such as 3-dimensional conformal radiotherapy, imageguided radiotherapy (IGRT), intensity-modulated radiotherapy (IMRT), and volumetric modulated arc therapy (VMAT) that now allow extensive normal tissue sparing. Use of IMRT for preoperative rectal cancer, for example, is associated with lower toxicity [49] and a recent re-examination of the Surveillance, Epidemiology, and End Results (SEER) database suggest that sub-population of colon cancer patients (pT4N2M0) who received adjuvant radiation therapy could have significantly better overall survival and cancerspecific survival [50]. Even so, delivery of conventional radiation doses to most colon and disseminated GI cancers still remains a challenging problem mainly due to the proximity of healthy radiosensitive organs (kidneys, liver, small bowel, lungs, heart, and spinal cord) to the targeted tumors.…”

Section: Discussionmentioning

confidence: 99%

DUOX2, a New Biomarker for Disseminated Gastric Cancer’s Response to Low Dose Radiation in Mice

Parekh

Solano-González

Martins

et al. 2021

Cancers

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Treatment options are rather limited for gastrointestinal cancer patients whose disease has disseminated into the intra-abdominal cavity. Here, we designed pre-clinical studies to evaluate the potential application of chemopotentiation by Low Dose Fractionated Radiation Therapy (LDFRT) for disseminated gastric cancer and evaluate the role of a likely biomarker, Dual Oxidase 2 (DUOX2). Nude mice were injected orthotopically with human gastric cancer cells expressing endogenous or reduced levels of DUOX2 and randomly assigned to four treatment groups: 1; vehicle alone, 2; modified regimen of docetaxel, cisplatin and 5′-fluorouracil (mDCF) for three consecutive days, 3; Low Dose- Whole Abdomen Radiation Therapy (LD-WART) (5 fractions of 0.15 Gy in three days), 4; mDCF and LD-WART. The combined regimen increased the odds of preventing cancer dissemination (mDCF + LD-WART OR = 4.16; 80% CI = 1.0, 17.29) in the DUOX2 positive tumors, while tumors expressing lower DUOX2 levels were more responsive to mDCF alone with no added benefit from LD-WART. The molecular mechanisms underlying DUOX2 effects in response to the combined regimen include NF-κB upregulation. These data are particularly important since our study indicates that about 33% of human stomach adenocarcinoma do not express DUOX2. DUOX2 thus seems a likely biomarker for potential clinical application of chemopotentiation by LD-WART.

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The survival benefit of adjuvant radiotherapy for pathological T4N2M0 colon cancer in the Modern Chemotherapy Era: evidence from the SEER database 2004–2015

Cited by 11 publications

References 20 publications

Prognostic analysis and beneficiary identification of adjuvant external beam radiotherapy for stage pT4b sigmoid colon cancer

Prognostic analysis and beneficiary identification of adjuvant external beam radiotherapy for stage pT4b sigmoid colon cancer

Postoperative locoregional recurrence pattern and treatment management of stage pT4 sigmoid colon cancer: a retrospective cohort study

DUOX2, a New Biomarker for Disseminated Gastric Cancer’s Response to Low Dose Radiation in Mice

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