Early recurrence after neoadjuvant chemoradiation therapy for locally advanced rectal cancer: Characteristics and risk factors

Kim, Han Gil; Kim, Ho Seung; Yang, Seung Ryong; Han, Young Mi; Cho, Min Soo; Hur, Hyuk; Min, Byung Soh; Lee, Kang Young; Kim, Nam Kyu

doi:10.1016/j.asjsur.2020.07.014

Cited by 16 publications

(12 citation statements)

References 25 publications

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“…For cT1–2/N1, cT3N patients without CRM involvement nor lateral LN metastasis, upfront surgery without neoadjuvant therapy can be considered in early-stage patients with a good prognosis [ 80 ]. In our experience, oncologic outcomes of LAR and uLAR are significantly affected by positive ypN stage (hazard ratio [HR], 2.110; 95% confidence interval [CI], 1.144–3.892; P = 0.017) and tumor regression grade of 3 or more (HR, 2.962; 95% CI, 1.434–6.119; P = 0.003) with a recurrence rate of 20.0% in our locally advanced rectal cancer patients, coinciding with National Comprehensive Cancer Network guidelines where a recurrence rate of 20.8% is reported [ 81 ]. The high incidence of distant metastasis of rectal cancer, especially lung metastasis, can be explained as hematogenous metastasis by bypassing the liver via direct venous drainage into the vena cava [ 81 - 83 ].…”

Section: Surgical Managementsupporting

confidence: 83%

Surgical Treatment of Low-Lying Rectal Cancer: Updates

Varela

Kim

2021

Ann Coloproctol

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Despite innovative advancements, distally located rectal cancer remains a critical disease of challenging management. The crucial location of the tumor predisposes it to a circumferential resection margin (CRM) that tends to involve the anal sphincter complex and surrounding organs, with a high incidence of delayed anastomotic complications and the risk of the pelvic sidewall or rarely inguinal lymph node metastases. In this regard, colorectal surgeons should be aware of other issues beyond total mesorectal excision (TME) performance. For decades, the concept of extralevator abdominoperineal resection to avoid compromised CRM has been introduced. However, the complexity of deep pelvic dissection with poor visualization in low-lying rectal cancer has led to transanal TME. In contrast, neoadjuvant chemoradiotherapy (NCRT) has allowed for the execution of more sphincter-saving procedures without oncologic compromise. Significant tumor regression after NCRT and complete pathologic response also permit applying the watch-and-wait protocol in some cases, now with more solid evidence. This review article will introduce the current surgical treatment options, their indication and technical details, and recent oncologic and functional outcomes. Lastly, the novel characteristics of distal rectal cancer, such as pelvic sidewall and inguinal lymph node metastases, will be discussed along with its tailored and individualized treatment approach.

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Section: Surgical Managementsupporting

confidence: 83%

Surgical Treatment of Low-Lying Rectal Cancer: Updates

Varela

Kim

2021

Ann Coloproctol

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“…Late recurrence over three years in patients treated using PCRT was not significantly different from those without PCRT. Similarly, Kim et al [11] have also reported that the incidence of early recurrence of distant metastasis was higher in patients who received TME and neoadjuvant chemoradiation than in those without PCRT. Tumor regression grade and yp node positivity were regarded as predictive factors for early recurrence.…”

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confidence: 77%

Shifting Treatment Strategies to Prevent Early Relapse of Locally Advanced Rectal Cancer After Preoperative Chemoradiotherapy

Park

2020

Ann Coloproctol

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“…Colorectal cancer (CRC) ranks as the third most common cancers and the second most common cause of cancer-related deaths worldwide ( Siegel et al, 2019 ), and the overall 5-years relative survival rate for CRC patients is approximately 64% ( Miller et al, 2019 ). Though significant advances have been made in the treatment of CRC, the recurrence rate remains high in patients received standard chemotherapy and surgery ( Ahiko et al, 2021 ; Fang et al, 2021 ; Kim et al, 2021 ). Recently, immunotherapy has emerged as a novel treatment approach and achieved exciting results in some cancer types ( Doki et al, 2022 ; Makker et al, 2022 ; Schmid et al, 2022 ).…”

Section: Introductionmentioning

confidence: 99%

Predicting prognosis and immunotherapy response among colorectal cancer patients based on a tumor immune microenvironment-related lncRNA signature

Cai

Zhong

et al. 2022

Front. Genet.

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Long non-coding RNAs (lncRNAs) remodel the tumor immune microenvironment (TIME) by regulating the functions of tumor-infiltrating immune cells. It remains uncertain the way that TIME-related lncRNAs (TRLs) influence the prognosis and immunotherapy response of colorectal cancer (CRC). Aiming at providing survival and immunotherapy response predictions, a CRC TIME-related lncRNA signature (TRLs signature) was developed and the related potential regulatory mechanisms were explored with a comprehensive analysis on gene expression profiles from 97 immune cell lines, 61 CRC cell lines and 1807 CRC patients. Stratifying CRC patients with the TRLs signature, prolonged survival was observed in the low-risk group, while the patients in the high-risk group had significantly higher pro-tumor immune cells infiltration and higher immunotherapy response rate. Through the complex TRLs-mRNA regulation network, immunoregulation pathways and immunotherapy response pathways were found to be differently activated between the groups. In conclusion, the CRC TRLs signature is capable of making prognosis and immunotherapy response predictions, which may find application in stratifying patients for immunotherapy in the bedside.

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Early recurrence after neoadjuvant chemoradiation therapy for locally advanced rectal cancer: Characteristics and risk factors

Cited by 16 publications

References 25 publications

Surgical Treatment of Low-Lying Rectal Cancer: Updates

Surgical Treatment of Low-Lying Rectal Cancer: Updates

Shifting Treatment Strategies to Prevent Early Relapse of Locally Advanced Rectal Cancer After Preoperative Chemoradiotherapy

Predicting prognosis and immunotherapy response among colorectal cancer patients based on a tumor immune microenvironment-related lncRNA signature

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