Impact of total neoadjuvant therapy consisting of consolidation chemotherapy on locally advanced rectal cancer survival

Zhang, Haoyu; Li, Ganbin; Cao, Ke; Zhai, Zhiwei; Wei, Guanghui; Qu, Hao; Wang, Zhenjun; Han, Jiagang

doi:10.1007/s00384-022-04179-7

Cited by 7 publications

(3 citation statements)

References 28 publications

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“…These analyses revealed that the survival advantage of TNT persisted among patients with specific characteristics, including tumor distance from the anal verge ≥ 5 cm, clinical T3 stage, clinical N positive status, or positive mesorectal fascia involvement. Like our study, Zhang et al [ 22 ] also demonstrated that for patients with positive mesorectal fascia involvement or clinical N2, TNT decreased the 3-year distant metastasis rate. While no significant differences were observed between TNT and CRT in other subgroup analyses, it is essential to acknowledge the limitations imposed by small sample sizes.…”

Section: Discussionsupporting

confidence: 86%

Total neoadjuvant therapy for locally advanced rectal cancer: a three-group propensity score matched study

Zhou,

Huang,

Zhou

et al. 2024

Int J Colorectal Dis

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Purpose Total neoadjuvant therapy (TNT) has emerged as a therapeutic approach for locally advanced rectal cancer (LARC). However, the optimal chemotherapy cycles within TNT remain uncertain. This study aimed to evaluate and compare the prognostic efficacy of varying cycles of chemotherapy during TNT for LARC. Methods Patients diagnosed with LARC (T3-4N0M0/T1-4N1-2M0), who underwent TNT or chemoradiotherapy followed by total mesorectal excision (TME) between 2015 and 2020, were retrospective included. Patients were categorized into three groups based on their neoadjuvant strategy: CRT (long-course chemoradiotherapy), STNT (long-course CRT with one to three cycles of chemotherapy), and LTNT (long-course CRT with four or more cycles of chemotherapy). Propensity score matching (PSM) based on gender, age, body mass index, tumor distance from the anal verge, clinical T stage, clinical N stage, and mesorectal fascia status was employed to reduce confounding bias. Primary endpoints were disease-free survival (DFS) and metastasis-free survival (MFS). Results The study comprised 372 patients, with 73 patients in each group after PSM. Compared with CRT, both STNT and LTNT demonstrated improved DFS (5-year rate: 59.7% vs. 77.8% vs. 76.5%, p = 0.027) and MFS (5-year rate: 65.1% vs. 81.3% vs. 81.4%, p = 0.030). There was no difference in DFS or MFS between STNT and LTNT. These favorable outcomes were consistent among subgroups defined by tumor distance from the anal verge ≥ 5 cm, clinical T3 stage, clinical N positive status, or involved mesorectal fascia. Conclusion Compared to CRT, both STNT and LTNT demonstrated improved DFS and MFS outcomes. Notably, survival outcomes were similar between STNT and LTNT, suggesting that chemotherapy cycles in TNT may not significantly impact survival.

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Section: Discussionsupporting

confidence: 86%

Total neoadjuvant therapy for locally advanced rectal cancer: a three-group propensity score matched study

Zhou,

Huang,

Zhou

et al. 2024

Int J Colorectal Dis

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“…Locally advanced rectal cancer patients with T3‐4, negative/positive lymph nodes, and no distant metastases are recommended to undergo preoperative chemoradiotherapy followed by radical resection. This combination of treatments has been linked to established advantages, including tumor down‐staging and down‐sizing (Bosset et al, 2014; Boublikova et al, 2023; Dapra et al, 2023; Koukourakis et al, 2023; van Gijn et al, 2011; Xiong et al, 2023). Although multimodal therapy has significantly decreased the local recurrence rate, this has not significantly reduced the risk of distant metastatic recurrence, which is now the primary cause of death from rectal cancer (Gollins & Sebag‐Montefiore, 2016; Lord et al, 2020; Sebag‐Montefiore et al, 2009).…”

Section: Introductionmentioning

confidence: 99%

Prediction of liver metastasis and recommended optimal follow‐up nursing in rectal cancer

Yu,

Wu,

et al. 2024

Nursing & Health Sciences

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We aimed to analyze and investigate the clinical factors that influence the occurrence of liver metastasis in locally advanced rectal cancer patients, with an attempt to assist patients in devising the optimal imaging‐based follow‐up nursing. Between June 2011 and May 2021, patients with rectal cancer at our hospital were retrospectively analyzed. A random survival forest model was developed to predict the probability of liver metastasis and provide a practical risk‐based approach to surveillance. The results indicated that age, perineural invasion, and tumor deposit were significant factors associated with the liver metastasis and survival. The liver metastasis risk of the low‐risk group was higher at 6–21 months, with a peak occurrence time in the 15th month. The liver metastasis risk of the high‐risk group was higher at 0–24 months, with a peak occurrence time in the 8th month. In general, our clinical model could predict liver metastasis in rectal cancer patients. It provides a visualization tool that can aid physicians and nurses in making clinical decisions, by detecting the probability of liver metastasis.

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“…However, although tumor regression appeared in most patients following TNT, approximately 20% were resistant to TNT, which manifested as slight or no tumor regression ( 11 , 12 ). These patients seemed not to benefit from increased cycles of preoperative chemotherapy and a prolonged interval between radiation and surgery during TNT.…”

Section: Introductionmentioning

confidence: 99%

Active surveillance in long period of total neoadjuvant therapy in rectal cancer: Early prediction of poor regression response

Zhang

Cao

et al. 2022

Front. Oncol.

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AimTo analyze locally advanced rectal cancer (LARC) patients and tumor characteristics during the period of total neoadjuvant therapy (TNT) and explore the risk factors that may predict poor tumor regression in response to TNT.Materials and methodsThe data of 120 LARC patients who received TNT from December 2016 and September 2019 in our hospital were retrospectively analyzed. The clinicopathological characteristics of patients with different tumor regression responses were compared. Then we divided patients into two groups according to the carcinoembryonic antigen (CEA) clearance pattern after chemoradiation to explore risk factors that might predict the tumor regression response.ResultsOf 120 LARC patients, 34 (28.3%) exhibited poor regression. Stratified analysis by tumor response showed that patients with poor response to TNT were more likely to obtain elevated CEA during the course of TNT (all P < 0.05). For those with elevated pretreatment CEA, fewer patients with poor response obtained normal CEA after chemoradiation (13.6% vs. 72.7%, P < 0.001). Besides, less patients’ CEA levels in the poor response group decreased by greater than 50% after chemoradiation when compared with that in the good response group (18.2% vs. 60.6%, P = 0.002). Stratified analysis by CEA clearance pattern after chemoradiation showed patients who obtained an elevated pretreatment CEA and decreased by less than 50% after chemoradiation were more likely to have poor response to TNT compared to others (76.2% vs. 18.2%, P < 0.001). Logistic multivariate analysis revealed that cN2 (95% CI 1.553-16.448), larger tumors (95% CI 2.250-21.428) and CEA clearance pattern after chemoradiation (95% CI 1.062-66.992) were independent risk factors for poor tumor regression response.ConclusionApproximately one-fourth of LARC patients with TNT achieved a poor regression response. Here, cN2, larger tumor size before treatment and elevated CEA levels were considered predictive features of a poor response. Active surveillance of CEA levels during the TNT course are potentially important, and CEA levels after chemoradiation might have important implications for the tumor response to TNT.

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Impact of total neoadjuvant therapy consisting of consolidation chemotherapy on locally advanced rectal cancer survival

Cited by 7 publications

References 28 publications

Total neoadjuvant therapy for locally advanced rectal cancer: a three-group propensity score matched study

Total neoadjuvant therapy for locally advanced rectal cancer: a three-group propensity score matched study

Prediction of liver metastasis and recommended optimal follow‐up nursing in rectal cancer

Active surveillance in long period of total neoadjuvant therapy in rectal cancer: Early prediction of poor regression response

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