Adenocarcinomas of the upper third of the rectum and the rectosigmoid junction seem to have similar prognosis as colon cancers even without radiotherapy, SAKK 40/87

Käser, Samuel; Froelicher, J.; Li, Qiyu; Müller, Stefan; Metzger, U; Castiglione, M.; Laffer, U; Maurer, Christoph A.

doi:10.1007/s00423-014-1243-1

Cited by 25 publications

(12 citation statements)

References 25 publications

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“…Although management of low and mid LA rectal cancer is now well established and standardized, upper rectal cancer management remains debated. To date, very few studies have analyzed the impact of neoadjuvant treatment in patients with upper rectal cancer, and conflicting results have been reported (6)(7)(8)(9)(10)(11). The main reasons are: 1) most of the trials reporting the effectiveness of TME and neoadjuvant treatment have included upper rectal cancer along with mid and low rectal tumors.…”

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confidence: 99%

Neoadjuvant Treatment in Upper Rectal Cancer Does Not Improve Oncologic Outcomes But Increases Postoperative Morbidity

et al. 2020

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Background/Aim: Neoadjuvant chemoradiation/ radiation therapy in locally advanced (LA) upper rectal adenocarcinoma management remains unclear. The aim of this study was to compare outcomes between neoadjuvant chemoradiation therapy (CRT) and upfront surgery (US). Patients and Methods: A total of 127 patients were retrospectively included from 5 centers (79 treated with US and 48 with CRT). CRT and US groups were compared in terms of postoperative complications and long-term oncological and functional results. Results: Total mesorectal excision (TME) was more frequent in CRT (58% vs. 20% in US, p<0.001). CRT was associated with more overall and severe postoperative complications (60% vs. 30%, p<0.001 and 17% vs. 1%, p=0.002, respectively), and was the only risk 2), p=0.007]. Five-year overall survival and 5-year recurrence-free survival were similar between CRT and US (96% vs. 91% p=0.256 and 85.4% vs. 85%, p=0.495). The functional results were similar between the two groups. Conclusion: CRT did not improve long-term oncological outcomes in patients with LA upper rectal adenocarcinoma, but increased postoperative complications compared with US.Management of locally advanced (LA) rectal cancer is based on a multimodal approach including radiation therapy, chemotherapy followed by total (TME) or partial mesorectal excision (PME) (1-5). Although management of low and mid LA rectal cancer is now well established and standardized, upper rectal cancer management remains debated. To date, very few studies have analyzed the impact of neoadjuvant treatment in patients with upper rectal cancer, and conflicting results have been reported (6)(7)(8)(9)(10)(11). The main reasons are: 1) most of the trials reporting the effectiveness of TME and neoadjuvant treatment have included upper rectal cancer along with mid and low rectal tumors. Consequently, there is a lack of evidence regarding possible benefit of neoadjuvant treatment specifically in patients with LA upper rectal cancer (2, 12); 2) Most of the retrospective studies have compared long-term outcomes of sigmoid and/or upper rectal cancer to mid and/or low rectal cancer. This comparison could be considered irrelevant, because rectal cancer location is known to significantly affect oncological outcomes (13). Because of the great heterogeneity of the reported series, the ESMO Society for Medical Oncology states that upper rectal cancers do not benefit from preoperative neoadjuvant treatment and should be treated as colon cancer. However, many authors disagree and consider that patients with cT4 tumors of the upper rectum could 3579

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confidence: 99%

Neoadjuvant Treatment in Upper Rectal Cancer Does Not Improve Oncologic Outcomes But Increases Postoperative Morbidity

et al. 2020

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“…A nomogram risk prediction model for colorectal cancer patients has been developed, however lacking data on its pathological type and on the prognosis of lymph node positive patients [21][22][23]. Moreover, these reports have not distinguished RSJ from coloretal cancer [24,25]. A study by B.…”

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confidence: 99%

A Postsurgical Prognostic Nomogram for Patients with Lymph Node Positive Rectosigmoid Junction Adenocarcinoma

Yanlong

Wang

Yunxiao

2022

Preprint

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Objective: The definition of rectosigmoid junction (RSJ) is still in debate. The treatment and prognosis of patients with rectosigmoid junction cancer (RSJC) and positive lymph nodes (PLN-RSJCs) are mostly based on the American Joint Committee on Cancer (AJCC) staging system. Our study aims to assist clinicians in creating a more intuitive and accurate nomogram model for PLN-RSJCs for the prediction of patient overall survival (OS) after surgery. Methods: Based on the Surveillance, Epidemiology, and End Results (SEER) database, we extracted 3384 patients with PLN-RSJCs and randomly divided them into development (n=2344) and validation (n=1004) cohorts at a radio of 7:3. Using univariate and multivariate COX regression analysis, we identified independent risk factors associated with OS in PLN-RSJCs in the development cohort, which were further used to establish a nomogram model. To verify the accuracy of the model, the concordance index (C-index), receiver operating characteristic (ROC) curves, calibration curves, and an internal validation cohort have been employed. Decision curve analysis (DCA) was used to assess the clinical applicability and benefits of the generated model. Survival curves of the low- and high-risk groups were calculated using the Kaplan–Meier method together with the log-rank test. Results: Age, marital, chemotherapy, AJCC stage, T and N stage of TNM system, tumor size, and regional lymph nodes were selected as independent risk factors and included in the nomogram model. The C-index of this nomogram in the development (0.751;0.737-0.765) and validation cohorts (0.750;0.764-0.736) were more significant than that of the AJCC 7th staging system (0.681; 0.665-0.697). The ROC curve with the calculated area under the curve (AUC) in the development cohort was 0.845,0.808 and 0.800 for 1-year, 3-year and 5-year OS, AUC in the validation cohort was 0.815,0.833 and 0.814 for 1-year, 3-year and 5-year, respectively. The calibration plots of both cohorts for 1-year,3-year and 5-year OS all demonstrated good agreement between actual clinical observations and predicted outcomes. In the development cohort, the DCA showed that the nomogram prediction model is more advantageous for clinical application than the AJCC 7th staging system. Kaplan-Meier curves in the low and high groups showed significant differences in patient OS. Conclusions: We established an accurate nomogram model for PLN-RSJCs, intended to support clinicians in the treatment and follow-up of patients.

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“…In a multicenter randomized controlled trial from 1987 to 1993, Kaser and colleagues evaluated 725 R0-resected colorectal cancer patients without neoadjuvant or adjuvant RT or TME. The 5-year DFS and 5-year OS rates were 54% (95%CI, 0.47–0.60) and 64% (95%CI, 0.57–0.71) in their patients with cancers in the lower two-thirds of the rectum (11 cm or less from anal verge), whereas the 5-year DFS and 5-year OS rates were 68% (95%CI, 0.60–0.75) and 79% (95%CI, 0.71–0.85) in those with the upper-third of the rectum and recto–sigmoid junction (> 11–20 cm from anal verge), respectively [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of efficacy and safety of preoperative Chemoradiotherapy in locally advanced upper and middle/lower rectal cancer

et al. 2018

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BackgroundWe aimed to explore the efficacy and safety profile of preoperative neoadjuvant chemoradiation (NACRT) in locally advanced rectal cancer (LARC) in upper rectum versus middle/lower rectum.MethodsThe study included 173 patients with stage II or III (T2-4b, N0-2b) LARC who underwent NACRT followed by total mesorectal excision (TME) between January 2011 and October 2016. Cox regression, log-rank test, and Kaplan–Meier curves were calculated.ResultsAmong the 173 patients, 58 had lesions in the upper rectum and 115 patients had lesions in middle/lower rectum. In a median follow-up of 35 months (range, 6–73 months), the 5-year disease-free survival (DFS) and overall survival (OS) were 84% and 88% for the patients with upper rectal cancer and 77% and 68% for those with middle/lower rectal cancer (P = 0.251 and P = 0.058, respectively). The 5-year DFS (P = 0.012) and OS (P = 0.003) were better in the NACRT responders [tumor regression grade (TRG) 0 or 1] compared with nonresponders (TRG 2 or 3). The independent prognostic factor of favorable response to NACRT was the FOLFOX regimen (P = 0.004).ConclusionsPatients with LARC in the upper rectum who underwent NACRT followed by TME had similar DFS and a trend toward longer OS, compared with those who had middle/lower rectal lesions. Furthermore, FOLFOX may yield superior results than fluoropyrimidine based regimen during NACRT. NACRT might be an alternative option for patients with LARC in the upper rectum as it has a favorable pathological complete response rate and comparable clinical outcomes when compared with patients with LARC in middle/lower rectum.

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Adenocarcinomas of the upper third of the rectum and the rectosigmoid junction seem to have similar prognosis as colon cancers even without radiotherapy, SAKK 40/87

Abstract: Adenocarcinomas of the upper third of the rectum and the rectosigmoid-junction seem to have similar prognosis as colon cancers. Even for surgeons not familiar with the TME technique, preoperative radiotherapy may be avoided for most rectosigmoid cancers above 11 cm from anal-verge.

Cited by 25 publications

References 25 publications

Neoadjuvant Treatment in Upper Rectal Cancer Does Not Improve Oncologic Outcomes But Increases Postoperative Morbidity

Neoadjuvant Treatment in Upper Rectal Cancer Does Not Improve Oncologic Outcomes But Increases Postoperative Morbidity

A Postsurgical Prognostic Nomogram for Patients with Lymph Node Positive Rectosigmoid Junction Adenocarcinoma

Comparison of efficacy and safety of preoperative Chemoradiotherapy in locally advanced upper and middle/lower rectal cancer

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