Challenges and solutions in patient treatment strategies for stage II colon cancer

Fotheringham, Susan; Mozolowski, Guy; Murray, Eleanor M A; Kerr, David

doi:10.1093/gastro/goz006

Cited by 48 publications

(39 citation statements)

References 73 publications

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“…One of these could be for example to examine the role of PIT values in CRC treatment decision: Current protocols recommend chemotherapy for stage III, IV and recurrent CRCs, but for stage II adjuvant chemotherapy still remains controversial [50][51][52]. Currently, there is no clear evidence if there is a benefit of adjuvant chemotherapy in stage II CRC [53]. Results from clinical trials [54,55] suggests that compared to surgery alone, adjuvant chemotherapy improved the cure and decreased the risk of death.…”

Section: Discussionmentioning

confidence: 99%

Personalized Indicator Thrombocytosis Shows Connection to Staging and Indicates Shorter Survival in Colorectal Cancer Patients with or without Type 2 Diabetes

Herold

Lohinszky

et al. 2020

Cancers

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Background: Pre- and postoperative thrombocytosis was reported to have significant effect on patient survival. However, the definition of thrombocytosis throughout the literature is not unified. Methods: A retrospective longitudinal observational study has been conducted with the inclusion of 150 colorectal cancer (CRC) patients and 100 control subjects. A new measure of platelet changes at an individual level, named personalized indicator thrombocytosis (PIT) was defined, including 4 anemia adjusted variants. Results: In concordance with the literature, PIT values of control subjects showed a slow decrease in platelet counts, while PIT values of CRC patients were significantly higher (p < 0.0001). More advanced staging (p < 0.0001) and both local (p ≤ 0.0094) and distant (p ≤ 0.0440) metastasis are associated with higher PIT values. Higher PIT values suggested shorter survival times (p < 0.0001). Compared to conventional, a PIT-based definition resulted in approximately 3-times more patients with thrombocytosis. 28% and 77% of the deceased patients had conventional- and PIT-based thrombocytosis, respectively. Conclusions: Compared to conventional thrombocytosis, as an individual metric, PIT values may indicate the condition of patients more precisely. Possible future applications of PIT may include its usage in therapy decision and early cancer detection; therefore, further investigations are recommended.

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Section: Discussionmentioning

confidence: 99%

Personalized Indicator Thrombocytosis Shows Connection to Staging and Indicates Shorter Survival in Colorectal Cancer Patients with or without Type 2 Diabetes

Herold

Lohinszky

et al. 2020

Cancers

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“…Deficient mismatch repair (dMMR) or microsatellite instability (MSI) is one of the well-established molecular biomarkers in colorectal cancer (CRC) and MSI testing has been recommended for all CRC patients according to the National Comprehensive Cancer Network (NCCN) guidelines 1 due to its aid in dictating management 2,3 . For instance, early-stage colorectal adenocarcinomas testing positive for MSI may carry a favorable prognosis and therefore do not require adjuvant chemotherapy [3][4][5] . Some studies suggest that these tumors are more prone to be sensitive to 5-FU chemo(radio)therapy, although this finding is controversial [6][7][8][9][10] .…”

Section: Introductionmentioning

confidence: 99%

Association of mismatch repair status with survival and response to neoadjuvant chemo(radio)therapy in rectal cancer

Cheng

Zhang

et al. 2020

npj Precis. Onc.

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Prior reports have indicated that defective mismatch repair (MMR) has a favorable impact on outcome in colorectal cancer patients treated with surgery, immunotherapy, or adjuvant chemotherapy. However, the impact of MMR status on response to neoadjuvant radiotherapy in rectal cancer is not well understood. Here we report that dMMR was associated with improved disease-free survival (DFS) (P = 0.034) in patients receiving neoadjuvant chemotherapy (NCT). Patients with dMMR tumors who received neoadjuvant chemoradiotherapy (NCRT) achieved significantly worse DFS (P = 0.026) than those treated with NCT. Conversely, NCRT improved DFS (P = 0.043) in patients with pMMR tumors, especially for stage III disease with improved DFS (P = 0.02). The presence of dMMR was associated with better prognosis in rectal cancer patients treated with NCT. NCT benefited patients with dMMR tumors; while NCRT benefited patients with stage III disease and pMMR tumors. Patients stratified by MMR status may provide a more tailored approach to rectal cancer neoadjuvant therapy.

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“…Patients diagnosed with colorectal cancer have many options for treatment including chemotherapy, surgery and radiation therapy depending on their cancer stage, medical history and preferences. For some clinical situations, such as stage II colon cancer, there is significant variability between options, including surgery alone versus surgery and chemotherapy, as well as the choice of chemotherapy 1 2. In addition, patients diagnosed with rectal cancer often have to decide between two equally efficacious, but lifestyle altering, surgical options: bowel reconnection with low anterior resection (LAR) versus permanent colostomy with abdominal perineal resection (APR).…”

Section: Introductionmentioning

confidence: 99%

The impact of decision aids in patients with colorectal cancer: a systematic review

et al. 2019

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ObjectivesOur aim was to conduct a systematic review of the literature to determine the impact of patient decision aids (PDA) on patients facing treatment decisions for colorectal cancer.DesignSystematic review.Data sourcesSources included Embase, Medline, Web of Science, CINAHL and the Cochrane Library from inception to June, 20, 2019.Eligibility criteriaWe included randomised controlled trials (RCTs), cohort studies, mixed methods and case series in which a PDA for colorectal cancer treatment was used. Qualitative studies were excluded from our review.Data extraction and synthesisFollowing execution of the search strategy by a medical librarian, two blinded independent reviewers identified articles for inclusion. Two blinded reviewers were also responsible for data extraction, risk of bias and study quality assessments. Any conflict in article inclusion or extraction was resolved by discussion.ResultsOut of 3773 articles identified, three met our inclusion criteria: one RCT, one before-and-after study and one mixed-method study. In these studies, the use of a PDA for colorectal cancer treatment was associated with increased patient knowledge, satisfaction and preparation for making a decision. On quality assessment, two of three studies were judged to be of low quality.ConclusionA paucity of evidence exists on the effect of PDA for colorectal cancer treatment with existing evidence being largely of low quality. Further investigation is required to determine the effect of decision aids for colorectal cancer treatment as well as reasons for the lack of PDA development and implementation in this area.Prospero registration numberCRD42018095153.

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Challenges and solutions in patient treatment strategies for stage II colon cancer

Cited by 48 publications

References 73 publications

Personalized Indicator Thrombocytosis Shows Connection to Staging and Indicates Shorter Survival in Colorectal Cancer Patients with or without Type 2 Diabetes

Personalized Indicator Thrombocytosis Shows Connection to Staging and Indicates Shorter Survival in Colorectal Cancer Patients with or without Type 2 Diabetes

Association of mismatch repair status with survival and response to neoadjuvant chemo(radio)therapy in rectal cancer

The impact of decision aids in patients with colorectal cancer: a systematic review

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