Surveillance, Epidemiology, and End Results-based analysis of the impact of preoperative or postoperative radiotherapy on survival outcomes for T3N0 rectal cancer

Peng, Luke; Milsom, Jeffrey W.; Garrett, Kelly A.; Nandakumar, Govind; Coplowitz, Shana; Parashar, Bhupesh; Nori, Dattatreyudu; Chao, K.; Wernicke, A. Gabriella

doi:10.1016/j.canep.2013.12.008

Cited by 26 publications

(22 citation statements)

References 16 publications

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“…According to the demographic data in our study, the median age at diagnosis of LARC patients was 60 years, which agrees with a previous study by Rolf Sauer, et al [15]. Meanwhile, we found that older age (> 60 years) significantly increased the risk of mortality, and in the cohort of surgery alone, the median age at diagnosis was 73 years, which agrees with a study by Peng et al [16]. In our study, approximately 60% of patients were male, which agrees with previous studies [11,17,18].…”

Section: Discussionsupporting

confidence: 92%

“…Our study indicated that high pathological grades of the tumour was associated with a worse OS. This finding is in line with the results of a former study [16]. Additionally, we found that tumour size > 5 cm was associated with a poor prognosis, which agrees with the results of a previous study by Kornprat et al, which demonstrated that a median tumour size of colorectal cancer exceeding 4.5 cm was significantly associated with survival [22].…”

Section: Black Ethnic Background Was Associated With Poor Ossupporting

confidence: 93%

“…In this study, white patients accounted for the largest proportion of patients (80.8%), which was consistent with the race distribution in the Western population [20]. Our study demonstrated that black race is a significant risk factor for OS, similar to a former study [16]. One possible reason for this finding is that black men are less likely to be treated with curative intent than are white men.…”

Section: Black Ethnic Background Was Associated With Poor Ossupporting

confidence: 90%

“…In this study, we showed that neoadjuvant RT contributed to prolonging the OS compared with adjuvant RT only in the group of stage T3/4N + M0 patients with a mean survival of 104.47 M versus 93.94 M. Interestingly, it was noted that in stage T1/2N + M0 patients, adjuvant RT showed a trend towards improving OS compared to that of neoadjuvant RT, with a mean survival of 124.25 M versus 121.5 M, with only marginal significance. Additionally, Peng et al reported that adjuvant RT had better 10-year CSS than neoadjuvant RT for T3N0M0 patients [16]. Therefore, the former randomized trials may not have shown significant OS benefits of neoadjuvant RT due to the lack of a subgroup analysis of patients with stage T3/4N0M0, T1/2N + M0, and T3/4N + M0, and the OS benefits for T3/4N + M0 patients might have been weakened by the other groups.…”

Section: Neoadjuvant Rt Improves Os For T3/4n + M0 Rectal Cancer Patimentioning

confidence: 99%

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Neoadjuvant radiotherapy improves overall survival for T3/4N+M0 rectal cancer patients: a population-based study of 20300 patients

Zhao

Wang

et al. 2020

Radiat Oncol

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Background: Neoadjuvant radiotherapy (RT) has been shown to improve local control; however, whether it can improve overall survival (OS) in locally advanced rectal cancer (LARC) patients remains controversial. We therefore aimed to examine the benefits of surgery alone, neoadjuvant radiotherapy (RT), adjuvant RT, and surgery plus chemotherapy in stage II (T3/4N0M0) and III (any T and N + M0) on the OS of rectal cancer patients. Methods: Date from the Surveillance, Epidemiology, and End Results (SEER) database diagnosed between 2004 and 2016 were used. Kaplan-Meier analyses were used to compare patient prognoses across different treatment modalities. Cox hazard regression analysis were used to identify independent predictors of OS. Results: For stage T3/4N0M0 patients, neoadjuvant RT, adjuvant RT, and surgery plus chemotherapy resulted in similar OS (all p > 0.05; mean survival, 115.89 months (M), 111.97 M, and 117.22 M, respectively), with better OS observed in these patients than in patients who underwent surgery alone (all p < 0.001, mean survival, 88.96 M). For stage T1/2N + M0 patients, neoadjuvant RT, adjuvant RT, and surgery plus chemotherapy resulted in similar OS (all p > 0.05; mean survival, 121.50 M, 124.25 M, and 121.20 M, respectively), with better OS observed in these patients than in patients who underwent surgery alone (all p < 0.001, mean survival 83.81 M). For stage T3/4N + M0 patients, neoadjuvant RT (HR = 0.436; 95% CI, 0.396~0.478; p < 0.001) resulted in significantly longer OS than adjuvant RT and surgery plus chemotherapy (mean survival, 104.47 M, 93.94 M, and 93.62 M, respectively), with better OS observed in these patients than in patients who underwent surgery alone (all p < 0.001, mean survival 54.87 M). Older age (> 60 years), black race, unmarried status, high tumour grade, and tumour size > 5 cm were all associated with a poor prognosis (all p < 0.05). Conclusions: Neoadjuvant RT, adjuvant RT, and surgery plus chemotherapy results in better OS than surgery alone in LARC patients. Neoadjuvant RT has the potential to be highly recommended over adjuvant RT and surgery plus chemotherapy for T3/4N + M0 patients; however, it showed no OS advantage over adjuvant RT or surgery plus chemotherapy for T3/4N0M0 and T1/2N + M0 patients.

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Section: Discussionsupporting

confidence: 92%

Section: Black Ethnic Background Was Associated With Poor Ossupporting

confidence: 93%

Section: Black Ethnic Background Was Associated With Poor Ossupporting

confidence: 90%

Section: Neoadjuvant Rt Improves Os For T3/4n + M0 Rectal Cancer Patimentioning

confidence: 99%

See 2 more Smart Citations

Neoadjuvant radiotherapy improves overall survival for T3/4N+M0 rectal cancer patients: a population-based study of 20300 patients

Zhao

Wang

et al. 2020

Radiat Oncol

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“…Postoperative CCRT can improve local control, recurrent-free survival, and overall survival (OS) for locally advanced rectal cancer [2,12]. Postoperative CCRT is the standard treatment in patients with locally advanced rectal cancers who do not receive CCRT before surgery (pre-S).…”

Section: Introductionmentioning

confidence: 99%

Severe lymphopenia as a prognostic factor in rectal cancer patients receiving adjuvant chemoradiotherapy: a retrospective study

Zhang

You²,

et al. 2019

Preprint

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Objectives The relationship between total lymphocyte counts (TLCs) and survival is not well documented in rectal cancer. This study aimed to investigate the association between TLCs and disease-free survival (DFS) and identify factors associated with lymphopenia in locally advanced rectal cancer patients receiving chemoradiotherapy. Methods Thirty-six patients with locally advanced rectal cancer were retrospectively analyzed. TLCs were evaluated before surgery (pre-S), before radiotherapy (pre-RT), and during concurrent chemoradiotherapy (CCRT). The relationship between TLCs and DFS was analyzed by univariate and multivariate analysis. Potential clinical factors associated with lymphopenia were also evaluated. Results Median TLC declined significantly during radiotherapy. Severe lymphopenia during CCRT was significantly associated with poorer DFS on Kaplan-Meier analysis (p=0.01), univariate regression analysis (p=0.036), and multivariate regression analysis (p=0.038). Pre-S TLCs (p=0.009) and pre-RT TLCs (p=0.042) were significantly associated with severe lymphopenia on univariate regression analysis; however, only pre-S TLCs (p=0.026) were significantly associated with severe lymphopenia on multivariate regression analysis. Conclusions Severe lymphopenia was a predictor of poorer DFS in patients with locally advanced rectal cancer receiving adjuvant chemoradiotherapy. Pre-S TLCs were predictors of severe lymphopenia. Further study is warranted to reduce the rate of severe lymphopenia.

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Lymph node identification following neoadjuvant therapy in rectal cancer: A stage‐stratified analysis using the surveillance, epidemiology, and end results (SEER)‐medicare database

Ecker

Paulson

Datta

et al. 2015

Journal of Surgical Oncology

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Surveillance, Epidemiology, and End Results-based analysis of the impact of preoperative or postoperative radiotherapy on survival outcomes for T3N0 rectal cancer

Cited by 26 publications

References 16 publications

Neoadjuvant radiotherapy improves overall survival for T3/4N+M0 rectal cancer patients: a population-based study of 20300 patients

Neoadjuvant radiotherapy improves overall survival for T3/4N+M0 rectal cancer patients: a population-based study of 20300 patients

Severe lymphopenia as a prognostic factor in rectal cancer patients receiving adjuvant chemoradiotherapy: a retrospective study

Lymph node identification following neoadjuvant therapy in rectal cancer: A stage‐stratified analysis using the surveillance, epidemiology, and end results (SEER)‐medicare database

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