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Long-term outcomes in patients with ypT0 rectal cancer after neoadjuvant chemoradiotherapy and curative resection

Chinese Journal of Cancer Research 2018年第2期30卷 272-281页

作者： Zhao Lu Pu Cheng Fu Yang Zhaoxu Zheng Xishan Wang Department of Colorectal Surgery National Cancer Center/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College

Objective： For patients with locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy（NCRT）, significant pathological response of the primary tumor has been proposed to identify candidates for organ preservation. However, this does not address metastatic lymph nodes in the mesorectum. The aim of this study was to assess the incidence of lymph node metastases in ypT0 patients treated with NCRT and curative resection and to explore risk factors associated with ***： This was a retrospective study of patients with ypT0 rectal cancer after NCRT and curative resection at a tertiary care center in China from 2005 to ***： A total of 60（18.6%） patients who underwent surgery after NCRT and achieved ypT0 were enrolled in this study; one patient was excluded owing to lack of follow-up. Of these 59 patients, lymph node metastases were found in the mesorectum（ypT0N＋） in eight（13.6%） patients. After a median follow-up of 52 months, 5-year recurrence-free survival（82.7% vs. 62.5%, P=0.014） and overall survival（OS）（90.9% vs. 70.0%, P=0.032） were much higher in ypN0 than yp N＋ patients. Multivariate analyses showed that ypN＋ status（P=0.009） and perioperative blood transfusion（BT）（P=0.001） were significantly independent risk factors associated with recurrence; however, no factor was correlated with 5-year ***： Patients with ypT0N0 rectal cancer can achieve excellent long-term outcomes; however, positive lymph nodes or tumor deposits can still be found in 13.6% of ypT0 patients. Nodal positivity in the mesorectum and perioperative BT are independent risk factors for recurrence.

关键词： Rectal cancer neoadjuvant chemoradiotherapy pathological response lymph node risk factor

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Radiation-induced injury on surgical margins:a clue to anastomotic leakage after rectal-cancer resection with neoadjuvant chemoradiotherapy?

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Gastroenterology Report 2019年第2期7卷 98-106,I0001页

作者： Qiyuan Qin Yaxi Zhu Peihuang Wu Xinjuan Fan Yan Huang Binjie Huang Jianping Wang Lei Wang Department of Colorectal Surgery The Sixth Affiliated HospitalSun Yat-sen UniversityGuangzhouGuangdong 510655P.R.China Department of Pathology The Sixth Affiliated HospitalSun Yat-sen UniversityGuangzhouGuangdong 510655P.R.China Guangdong Institute of Gastroenterology GuangzhouGuangdong 510655P.R.China Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases GuangzhouGuangdong 510655P.R.China

Background:Few studies on anastomotic condition after rectal-cancer resection and its effect on anastomotic leakage(AL)are available up to *** study aimed to investigate potential radiation-induced injury left on surgical margins of anterior resection after neoadjuvant chemoradiotherapy(nCRT)and its association with ***:We retrospectively identified 161 consecutive patients who underwent anterior resection with nCRT,neoadjuvant chemotherapy without radiation(nCT)or no neoadjuvant therapy between 2014 and *** samples of resection margins were assessed using a specific histopathological score and microvessel density in *** score matching was used to balance the baseline *** between AL and histopathological features was ***:AL occurred in 13 of 54 patients undergoing nCRT,5 of 48 patients undergoing nCT and 7 of 59 patients without neoadjuvant *** after matching showed median(range)histopathological scores as follows:3(0–8)vs 0(0–3)vs 0(0–2)for the proximal margin(P<0.001);4(2–9)vs 0(0–4)vs 0(0–3)for the distal margin(P<0.001).Correspondingly,mean(SD)microvessel densities were as follows:21.7(7.9)vs 27.2(8.6)vs 27.3(9.4)for the proximal margin(P=0.003);18.1(9.3)vs 25.2(12.9)vs 24.9(7.4)for the distal margin(P<0.001).Among patients undergoing nCRT,AL was associated with increased histopathological score(P=0.003)and decreased microvessel density(P=0.004)on the proximal ***:Surgical margins of rectal-cancer resection are exposed to certain radiation-induced injury after *** is associated with aggravated radiation damage on the proximal margin.

关键词： Anastomotic leakage rectal cancer anterior resection neoadjuvant chemoradiotherapy radiation injury histopathology

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Consolidation chemotherapy with capecitabine after neoadjuvant chemoradiotherapy in high-risk patients with locally advanced rectal cancer:Propensity score study

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World Journal of Gastrointestinal Oncology 2022年第9期14卷 1711-1726页

作者： Xue-Qing Sheng Hong-Zhi Wang Shuai Li Yang-Zi Zhang Jian-Hao Geng Xiang-Gao Zhu Ji-Zhong Quan Yong-Heng Li Yong Cai Wei-Hu Wang Department of Radiation Oncology Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing)Peking University Cancer Hospital and InstituteBeijing 100142China Department of Radiation Oncology Peking University People's HospitalBeijing 100044China Department of Radiation Oncology Jilin Guowen HospitalGongzhuling 136199Jilin ProvinceChina

BACKGROUND The effects of consolidation chemotherapy(CC) in neoadjuvant therapy in locally advanced rectal cancer(LARC) have been explored. However, the optimal neoadjuvant chemoradiotherapy(NCRT) and surgery interval, regimen, and cycles of chemotherapy remains *** To evaluate the effects of one to two cycles of CC with capecitabine on high-risk patients with LARC without extending NCRT and surgery *** We retrospectively evaluated high-risk patients with LARC, who were defined as having at least one of the following factors by magnetic resonance imaging: depth of invasion beyond the muscularis propria of more than 5 mm(c T3c-c T3d), T4, meso-rectal fascia or extramural vascular invasion positive, and treatment date between January 2015 and July 2019 in our center. Patients were divided into the CC and non-CC group according to whether they received CC(capecitabine 1000 mg/m^(2) twice daily from days 1 to 14 every 21 d) after NCRT. Propensity score matching(PSM) and inverse probability of treatment weight(IPTW) were used to balance the differences between the two groups. The main outcome was the complete response(CR) *** A total of 265 patients were enrolled: 136 patients in the CC group and 129 patients in the non-CC group. The median interval was 70 d(range, 37-168). The CR rate was 24.3% and 16.3%(P = 0.107) in the CC and non-CC groups’ original samples, respectively. After PSM and IPTW, the CR rate in the CC group was higher than that in non-CC group(27.6% vs 16.2%, P = 0.045;25.9% vs 16.3%, P = 0.045). The median follow-up was 39.8 mo(range, 2.9-74.8), and there were no differences in 3-year non-regrowth disease-free survival nor overall survival in the original samples(73.2% vs 71.9%, P = 0.913;92.3% vs 86.7%, P = 0.294), PSM(73.2% vs 73.5%, P = 0.865;92.5% vs 89.3%, P = 0.612), and IPTW(73.8% vs 72.1%, P = 0.913;92.4% vs 87.4%, P = 0.294). There was also no difference in grade 2 or higher acute toxicity during neoadjuvant therapy

关键词： High-risk locally advanced rectal cancer neoadjuvant chemoradiotherapy Capecitabine Consolidation chemotherapy Complete response

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Is adjuvant chemotherapy necessary for patients with ypT0–2N0 rectal cancer treated with neoadjuvant chemoradiotherapy and curative surgery?

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Gastroenterology Report 2018年第4期6卷 277-283,I0002页

作者： Zhao Lu Pu Cheng Ming-Guang Zhang Xi-Shan Wang Zhao-Xu Zheng Department of Colorectal Surgery National Cancer Center/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021P.R.China

Background and objective:The benefit from adjuvant chemotherapy for patients treated with neoadjuvant chemoradiotherapy(NCRT)and curative surgery remains controversial,particularly among those responding well to *** retrospective study aimed to clarify the benefits of adjuvant chemotherapy in terms of the oncological outcomes of patients with ypT0–2N0 rectal cancer after NCRT and curative ***:All patients with ypT0–2N0 rectal cancer after NCRT and curative resection between 2005 and 2014 were *** oncological outcomes between patients treated with adjuvant chemotherapy and those without any chemotherapy were ***:The clinicopathological characteristics of 110 patients were reviewed in this study;one patient was excluded due to lack of *** the 109 patients included,58(53.2%)underwent adjuvant chemotherapy(chemo group),whereas the remaining 51(46.8%)did not receive any chemotherapy(non-chemo group).After a median follow-up of 50 months,there were no significant differences in the 5-year overall survival(OS)or recurrence-free survival(RFS)rates between the groups(OS:92.1 vs 86.3%,P=0.375;RFS:80.9 vs 74.7%,P=0.534).Subgroup analysis also demonstrated no significant differences in 5-year OS and RFS rates between patients with ypT0N0 rectal cancer(P=0.712 and P=0.599,respectively)and those with ypT1–2N0 disease(P=0.255 and P=0.278,respectively).Conclusions:These results indicate that patients with ypT0–2N0 rectal cancer after NCRT followed by curative surgery may not derive significant benefit from adjuvant ***,further prospective randomized trials,with larger sample sizes,are warranted to confirm this conclusion.

关键词： Rectal cancer adjuvant chemotherapy neoadjuvant chemoradiotherapy survival

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Timing of surgery after neoadjuvant chemoradiotherapy affects oncologic outcomes in patients with esophageal cancer

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World Journal of Gastrointestinal Oncology 2020年第6期12卷 687-698页

作者： Qi-Xin Shang Yu-Shang Yang Yi-Min Gu Xiao-Xi Zeng Han-Lu Zhang Wei-Peng Hu Wen-Ping Wang Long-Qi Chen Yong Yuan Department of Thoracic Surgery West China Hospital of Sichuan UniversityChengdu 610041Sichuan ProvinceChina West China Biomedical Big Data Center West China Hospital of Sichuan UniversityChengdu 610041Sichuan ProvinceChina

BACKGROUND The optimal time interval between neoadjuvant chemoradiotherapy(nCRT)and esophagectomy in esophageal cancer has not been *** To evaluate whether a prolonged time interval between the end of nCRT and surgery has an effect on survival outcome in esophageal cancer *** We searched PubMed,Embase,Web of Science,the Cochrane Library,Wanfang and China National Knowledge Infrastructure databases for relevant articles published before November 16,2019,to identify potential studies that evaluated the prognostic role of different time intervals between nCRT and surgery in esophageal *** hazard ratios and 95%confidence intervals(95%CI)were merged to estimate the correlation between the time intervals and survival outcomes in esophageal cancer,esophageal squamous cell carcinoma and adenocarcinoma using fixed-and random-effect *** This meta-analysis included 12621 patients from 16 *** results demonstrated that esophageal cancer patients with a prolonged time interval between the end of nCRT and surgery had significantly worse overall survival(OS)[hazard ratio(HR):1.107,95%CI:1.014-1.208,P=0.023]than those with a shorter time *** analysis showed that poor OS with a prolonged interval was observed based on both the sample size and *** was also significant association between a prolonged time interval and decreased OS in Asian,but not Caucasian *** addition,a longer wait time indicated worse OS(HR:1.385,95%CI:1.186-1.616,P<0.001)in patients with *** A prolonged time interval from the completion of nCRT to surgery is associated with a significant decrease in ***,esophagectomy should be performed within 7-8 wk after nCRT.

关键词： Esophageal cancer neoadjuvant chemoradiotherapy Esophagectomy Time interval Survival outcome Meta-Analysis

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Compare clinical efficacy and safety of neoadjuvant therapy and neoadjuvant chemoradiotherapy for locally advanced rectal cancer: Meta-analysis

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World Journal of Gastrointestinal Surgery 2024年第6期16卷 1845-1856页

作者： Ying Wang Yan Yang Qi-Qi Liu Shao-Zhao Wang Department of Anus Intestinal Surgery Feicheng People’s HospitalFeicheng 271600Shandong ProvinceChina Department of Gastroenterology Qingdao Hospital of University of Health and Rehabilitation Sciences(Qingdao Municipal Hospital)Qingdao 266011Shandong ProvinceChina Department of Gastrointestinal Surgery Peking University Shenzhen HospitalShenzhen 518036Guangdong ProvinceChina Department of Anorectal Words Central Hospital Affiliated Shandong First Medical UniversityJinan 250013Shandong ProvinceChina

BACKGROUND To compare the efficacy and safety of total neoadjuvant therapy(TNT)and neoadjuvant chemoradiotherapy(nCRT)in the treatment of middle and low locally advanced rectal *** study will systematically collect and integrate studies to evaluate the ability of these two treatments to improve tumor shrinkage rates,surgical resection rates,tumor-free survival,and severe adverse *** To provide clinicians and patients with more reliable treatment options to optimize treatment outcomes and quality of life for patients with locally advanced rectal cancer by comparing the advantages and disadvantages of the two treatment *** A full search of all clinical studies on the effectiveness and safety of TNT and nCRT for treating locally advanced rectal cancer identified in Chinese(CNKI,Wanfang,China Biomedical Literature Database)and English(PubMed,Embase)databases was *** system assessors independently screened the studies according to the inclusion and exclusion *** evaluation and RESULTS Finally,14 studies were included,six of which were randomized controlled studies.A total of 3797 patients were included,including 1865 in the TNT group and 1932 in the nCRT *** two sets of baseline data were *** results of the meta-analysis showed that the pCR rate[odds ratio(OR)=1.57,95%confidence interval(CI):1.30-1.90,P<0.00001],T stage degradation rate(OR=2.16,95%CI:1.63-2.57,P<0.00001),and R0 resection rate(OR=1.42,95%CI:1.09-1.85,P=0.009)were significantly greater in the nCRT group than in the nCRT *** was no significant difference in the incidence of grade 3/4 acute toxicity or perioperative complications between the two *** 5-year OS[hazard ratio(HR)=0.84,95%CI:0.69-1.02,P=0.08]and DFS(HR=0.94,95%CI:0.03-1.39,P=0.74)of the TNT group were similar to those of the nCRT *** TNT has greater clinical efficacy and safety than nCRT in the treatment of locally advanced rectal cancer.

关键词： neoadjuvant therapy neoadjuvant chemoradiotherapy Advanced rectal cancer Clinical efficacy Meta-analysis

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CEA levels predict tumor response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer

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Oncology and Translational Medicine 2022年第4期8卷 180-185页

作者： Lili Shen Chao Li Jingwen Wang Jin Fan Ji Zhu Department of Oncology Nantong Haimen People’s HospitalHaimen Hospital of Nantong UniversityNantong 226100China Department of Radiotherapy Huashan HospitalFudan UniversityShanghai 200032China Department of Radiation Oncology Fudan University Shanghai Cancer CenterShanghai 200032China

Objective The aim of this study was to evaluate the impact of serum carcinoembryonic antigen(CEA)in the prediction of pathological complete response(pCR)in locally advanced rectal cancer(LARC)patients treated with neoadjuvant chemoradiotherapy(nCRT).Methods A total of 925 LARC patients who underwent nCRT followed by TME between March 2006 and February 2018 were enrolled at Fudan University Shanghai Cancer *** logistic regression models,we investigated the associations between serum CEA levels and pathological complete remission(pCR).Further stratified analyses were performed according to different CEA *** We found that pre-nCRT CEA and post-nCRT CEA were negatively correlated with pCR(P5 ng/mL achieved ***,when the CEA cutoff value was set to 10 ng/mL,only 6.8%of the patients with post-nCRT CEA levels>10 ng/mL achieved *** In summary,pre and post-nCRT CEA levels≤5 ng/mL were favorable predictors of pCR in LACR patients,and the“watch and wait”strategy is not recommended for patients with post-nCRT CEA levels>10 ng/mL.

关键词： locally advanced rectal cancer(LARC) carcinoembryonic antigen(CEA) neoadjuvant chemoradiotherapy pathological complete response(pCR)

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Effect of postoperative adjuvant chemotherapyon the prognosis of patients with ypT0-3N0 rectalcancer undergoing neoadjuvant chemoradiotherapy

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Oncology and Translational Medicine 2023年第1期9卷 43-48页

作者： Jueyi Huang Yongqian Cai Biao Wang Department of General Surgery Dazhou Central HospitalDazhou 635000China

Objective The aim of this study was to investigate the effect of adjuvant chemotherapy (AC) on theprognosis of patients with ypT0-3N0 rectal cancer undergoing neoadjuvant *** The study participants were 110 patients with locally advanced rectal cancer. Thirty-fourpatients did not receive postoperative AC treatment, and the other 76 patients received postoperative ACtreatment. The differences in the 5-year overall survival (OS) and disease-free survival (DFS) between thetwo groups were *** Age was an important determinant of the patients’ decision to undergo postoperative *** who did not receive AC treatment were significantly older than those who received AC treatment(P neoadjuvantchemoradiotherapy, especially those without adverse prognostic factors, do not need AC after surgery.

关键词： rectal cancer postoperative adjuvant chemotherapy neoadjuvant chemoradiotherapy total mesorectal excision

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Impact of neoadjuvant chemoradiotherapy on the local recurrence and distant metastasis pattern of locally advanced rectal cancer: a propensity score-matched analysis

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Chinese Medical Journal 2021年第18期134卷 2196-2204页

作者： Liang Yu Tian-Lei Xu Lin Zhang Shuo-Hao Shen Yue-Lu Zhu Hui Fang Hai-Zeng Zhang Department of Colorectal Surgery National Cancer Centre/National Clinical Research Centre for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021China State Key Lab of Molecular Oncology National Cancer Centre/National Clinical Research Centre for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021China Department of Pathology National Cancer Centre/National Clinical Research Centre for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021China Department of Radiation Oncology National Cancer Centre/National Clinical Research Centre for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021China

Background:Previous studies have demonstrated different predominant sites of distant metastasis between patients with and without neoadjuvant chemoradiotherapy(NCRT).This study aimed to explore whether NCRT could influence the metastasis pattern of rectal cancer through a propensity score-matched ***:In total,1296 patients with NCRT or post-operative chemoradiotherapy(PCRT)were enrolled in this study between January 2008 and December *** score matching was used to correct for differences in baseline characteristics between the two *** propensity score matching,the metastasis pattern,including metastasis sites and timing,was compared and ***:After propensity score matching,there were 408 patients in the PCRT group and 245 patients in the NCRT *** significantly reduced local recurrence(4.1%vs.10.3%,P=0.004),but not distant metastases(28.2%vs.27.9%,P=0.924)compared with *** both the NCRT and PCRT groups,the most common metastasis site was the lung,followed by the *** NCRT group developed local recurrence and distant metastases later than the PCRT group(median time:29.2[18.8,52.0]months vs.18.7[13.3,30.0]months,Z=–2.342,P=0.019;and 21.2[12.2,33.8]vs.16.4[9.3,27.9]months,Z=–1.765,P=0.035,respectively).The distant metastases occurred mainly in the 2nd year after surgery in both the PCRT group(39/114,34.2%)and NCRT group(21/69,30.4%).However,20.3%(14/69)of the distant metastases appeared in the 3rd year in the NCRT group,while this number was only 13.2%(15/114)in the PCRT ***:The predominant site of distant metastases was the lung,followed by the liver,for both the NCRT group and PCRT *** did not influence the predominant site of distant metastases,but the NCRT group developed local recurrence and distant metastases later than the PCRT *** follow-up strategy for patients with NCRT should be adjusted and a longer intensive follow-up is needed.

关键词： Locally advanced rectal cancer Metastases pattern neoadjuvant chemoradiotherapy Propensity score matching

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“Watch and wait”strategy after neoadjuvant chemoradiotherapy in rectal cancer:opportunities and challenges

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Holistic Integrative Oncology 2023年第1期2卷 47-54页

作者： Yong Yang An Huang Zhuang Sun Hao-peng Hong Nam KYu Kim Jin Gu Department of Gastrointestinal Surgery Peking University Shougang HospitalBeijingChina Department of Gastrointestinal SurgeryⅢ Peking University Cancer Hospital&InstituteBeijingChina Department of Surgery Colorectal Division Yongin Severance HospitalCollege of MedicineSeoulSouth Korea Center for Precision Diagnosis and Treatment of Colorectal Cancer and Inflammatory Diseases Peking University Health Science CenterBeijingChina

The"watch and wait"(W&W)strategy has been widely used in rectal cancer patients who have achieved clinical complete response(cCR)after neoadjuvant chemoradiotherapy(nCRT),which can save them from surgery and improve their quality of ***,this strategy also has many unsolved practical problems,including the improvement of cCR/pCR rate,the search for efficient predictors,the standard follow-up and the methods of rescue surgery,*** sample size and more standardized clinical trials are still needed to obtain credible ***,we must rationally view the cCR after nCRT for middle and low rectal cancer,understand the risk of W&W strategy,and make a reasonable *** is particularly important to emphasize that we should actively carry out prospective multi-center clinical trials to produce high-level evidence suitable for Chinese characteristics,so that more rectal cancer patients can benefit from nCRT.

关键词： Watch and wait Rectal cancer neoadjuvant chemoradiotherapy Clinical complete response

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