Tumor volume predicts local recurrence in early rectal cancer treated with radical resection: A retrospective observational study of 270 patients

Jiang, Yanjun; You, Kaiyun; Qiu, Xingsheng; Bi, Zhuofei; Mo, Huaqian; Li, Liting; Liu, Yimin

doi:10.1016/j.ijsu.2017.11.052

Cited by 22 publications

(25 citation statements)

References 41 publications

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“…Key factors previously shown to be associated with recurrence include poor tumour differentiation, growth type, positive nodal disease, number of retrieved lymph nodes, pathological response to neoadjuvant therapy, tumour volume, operative procedure, post‐operative complications, tumour location and increased pre‐operative carcinoembryonic antigen 13–16 . In our cohort, we found that increasing stage and grade were independently associated with recurrence.…”

Section: Discussionsupporting

confidence: 55%

Factors influencing recurrence of stage I–III rectal cancer in regional Australia

Haggstrom

Kang

Winn

et al. 2020

ANZ Journal of Surgery

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Background: As treatments for rectal cancer improve with developments in surgical techniques, radiotherapy and chemotherapy, the nature of recurrences are evolving. We used a comprehensive database of a large Australian population with stage I-III rectal adenocarcinoma to identify timing and prognostic significance of recurrences, and factors associated with risk of developing recurrent disease. Methods: All patients with locoregional rectal cancer treated with curative intent in our health district from 2006 to 2017 were included. Multivariate analysis using Cox regression models were used to identify factors associated with recurrence. Results: A total of 483 patients were included. Recurrence occurred in 117 (24.2%) of 483 patients, being locoregional in 15 (3.1%) patients, distant in 85 patients (17.6%) and both locoregional and distant in 17 (3.5%) patients. Compared to those with locoregional recurrence, those with both locoregional and distant recurrence had worse cancer-specific survival. On univariate analysis, factors associated with recurrence included stage, grade, radiotherapy, chemotherapy, surgery type and distal tumour location. Factors which remained significant on multivariate analysis included higher grade and stage. Conclusion: In the era of multimodality therapy for rectal cancer, recurrences are predominantly distant. Traditional predictors including higher stage, grade and distal tumour location remain independently associated with recurrence, despite current treatment paradigms.

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Section: Discussionsupporting

confidence: 55%

Factors influencing recurrence of stage I–III rectal cancer in regional Australia

Haggstrom

Kang

Winn

et al. 2020

ANZ Journal of Surgery

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“…Nevertheless, several recent studies address-either tumor size (1-dimension parameter) or tumor volume (3-dimension parameter) as a prognostic parameter that have a better outcome. 19,22,23 Gross tumor volume (GTV), a term commonly used in radiation oncology field, is an essential component of radiotherapy treatment planning. GTV is contoured, slice by slice by using a reconstructed CT simulation images and by fusion of MRI and/or fluorodeoxyglucose-positron emission tomography, the accuracy of the delineation is higher.…”

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confidence: 99%

Tumor Volume as Predictor of Pathologic Complete Response Following Neoadjuvant Chemoradiation in Locally Advanced Rectal Cancer

Lutsyk

Awawda

Gourevich

et al. 2021

American Journal of Clinical Oncology

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Purpose: Neoadjuvant chemoradiation followed by surgery is the current standard of care in the treatment of locally advanced rectal cancer. Those who achieved pathologic complete response, following this standard of care, complete pathologic response (pCR) had better outcome. Until now there are no reliable clinical parameters to predict this response. The purpose of the study was to evaluate whether tumor volume may serve as a predictive factor in patients treated with neoadjuvant chemoradiotherapy.Materials and Methods: Between September 2015 and September 2019, patients diagnosed with stage IIA to IIIC rectal adenocarcinoma, who were treated with neoadjuvant chemoradiation, were enrolled to this study. All patients underwent rectal ultrasound, pelvic magnetic resonance imaging, fluorodeoxyglucose-positron emission tomography-computed tomography and the diagnosis was confirmed by pathology report. Radiation therapy was consisted of 50 Gy delivered to the tumor site, 2 Gy a day, 5 times a week and to the pelvic lymph nodes for a total of 45 Gy in 1.8 Gy a day, 5 times a week. The gross tumor volume (GTV) was contoured by radiation oncology expert, reviewed by radiology and nuclear medicine expert and approved by radiation therapy tumor board. Chemotherapy was consisted of either capecitabine 875 mg/m 2 twice a day or continuous. IV infusion of 5 fluorouracil 375 mg/m 2 for 4 consecutive days in a 3 weeks apart. Operation, either low anterior or abdominoperineal resection was carried out 6 to 8 weeks following completion of treatment. Patients were assigned to either complete pathologic response (pCR) or non-pCR groups. GTV, among other clinical and treatment parameters, were evaluated for prediction of pCR. Statistical methods included independent t test, logistic regression, area under the curve-receiver operating characteristic, Bayesian independent statistics and multilayer perceptron model.Results: One hundred ninety-three patients were enrolled to this study, 6 were excluded due to metastatic disease detected at the time of operation. Seventy had stage II and 117 had stage III. Forty-four of 187 (23.5%) patients achieved pCR and 143 patients had either partial or no response/ progressive disease. Among the 44 pCR group, 21 had stage II and 23 had stage III disease. Treatment interruption, defined as either a delay of up to 1 week in radiation, and a dose reduction to 75%, was occurred in 42 patients. Sex, ethnicity, distance from anal verge to tumor, height, weight, age, delivered radiation dose, radiotherapy techniques, clinical T and N stage and GTV were evaluated for prediction of pCR. GTV at the volume of < 39.5 cm 3 was the only significant predictive factor to detect pCR by logistic regression model (P < 0.01) and by Bayesian independent test (P = 0.026). Area under the receiver operating characteristic curve of GTV < 39.5 cm 3 showed area under the curve of 0.715 (P = 0.009) for stage II and area under the curve of 0.62 (P > 0.05) for stage III. Conclusion:GTV may serve as a predictive factor for ach...

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“…For patients with rectal and endometrial cancers, tumor volume measurements can be used as a prognostic indicator of recurrence and survival (15,16). Deep myometrial invasion, lymph node metastasis, and high tumor grade have been widely used to stratify patients who require extensive surgical procedures with pelvic or para-aortic lymphadenectomy (17).…”

Section: Discussionmentioning

confidence: 99%

MR volumetry in predicting the aggressiveness of endometrioid adenocarcinoma: correlation with final pathological results

et al. 2019

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Background Magnetic resonance (MR) has been widely used in predicting the aggressiveness of endometrioid adenocarcinoma. However, the diagnostic value of the MR volume of the lesion has been controversial. Purpose To determine whether the whole-lesion MR volume measurement could be used as a better predictor for evaluating the aggressiveness of endometrioid adenocarcinoma. Material and Methods In this retrospective study, we include 357 patients with pathologically demonstrated endometrioid adenocarcinoma at our institution between 1 January 2013 and 31 December 2018. Whole-lesion MR volume was calculated on sagittal T2-weighted images with ITK-SNAP software on a personal computer. Results According to the receiver operating characteristics curve analysis, whole-lesion MR volume has the competitive advantage in evaluating deep myometrial invasion compared with the frozen results, generating area under the curve (AUC) values of 0.751 vs. 0.834 ( P = 0.0629, Z = 1.860). The AUC of tumor maximum diameter, simple tumor volume, and whole-lesion MR volume in predicting deep myometrial invasion was 63.8%, 67.6%, and 75.1%, respectively. Conclusion Whole-lesion MR volume is a good diagnostic tool for prediction of deep myometrial invasion, lymph node metastasis, and lymphovascular invasion. MR volumetry could reflect the aggressiveness of endometrioid adenocarcinoma more accurately than traditional lesion measurements.

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Tumor volume predicts local recurrence in early rectal cancer treated with radical resection: A retrospective observational study of 270 patients

Abstract: In conclusion, the tumor volume is significantly associated with DFS and LRFS of patients with stage T1/2 N0 rectal cancer who underwent radical resection alone. Tumor volume may be considered an important indicator for neoadjuvant or adjuvant therapeutic interventions.

Cited by 22 publications

References 41 publications

Factors influencing recurrence of stage I–III rectal cancer in regional Australia

Factors influencing recurrence of stage I–III rectal cancer in regional Australia

Tumor Volume as Predictor of Pathologic Complete Response Following Neoadjuvant Chemoradiation in Locally Advanced Rectal Cancer

MR volumetry in predicting the aggressiveness of endometrioid adenocarcinoma: correlation with final pathological results

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