The Survival Effect of Radiotherapy on Stage II/III Rectal Cancer in Different Age Groups: Formulating Radiotherapy Decision-Making Based on Age

Li, Yuqiang; Liu, Heli; Zhou, Yuan; Zhou, Zhongyi; Liu, Wenxue; Zhao, Lilan; Güngör, Cenap; Wang, Dan; Pei, Qian; Pei, Haiping; Tan, Fengbo

doi:10.3389/fonc.2021.695640

Cited by 4 publications

(7 citation statements)

References 33 publications

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“…Previous studies found that EORC patients were generally present with aggressive characteristics, such as elevated CEA levels, larger tumor size, advanced stages, TD, and PNI [21,22]; while, others rejected that [11]. In this study of 7951 rectal cancer patients receiving surgery directly, EORC patients had a signi cantly higher probability of pT1-2N0 stage and lower probability of positive CEA compared with their old counterparts (both P < 0.05).…”

Section: Discussionmentioning

confidence: 53%

“…In a curious paradox, younger patients are generally present with more advanced disease and worse histopathological features than their old counterparts, yet have superior or at least noninferior survival pro les[6-8]. In addition, disparate response to treatment regardless of neoadjuvant and adjuvant is reported among different age groups, although it remains controversial [9][10][11].All of the above indicate that age should be taken into consideration in the management of CRC.…”

Section: Introductionmentioning

confidence: 99%

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Impact of age on the prognosis and decision-making of adjuvant treatment for resectable rectal cancer- a population based analysis

Wang

Lai

Zhong

et al. 2022

Preprint

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Background Different age groups exhibit disparate patterns of epidemiology, clinicopathology, treatment response, and prognosis in relation to rectal cancer (RC), but little is known about the interactions between age and adjuvant treatment (AT) for resectable RC. Methods The Surveillance, Epidemiology, and End Results database (SEER) was used to identify patients who had received surgery but not neoadjuvant treatment for rectal adenocarcinoma between 2010 and 2015. Restricted cubic spline (RCS) was used to identify the optimal cut-off value of age for overall survival (OS) and cancer-specific survival (CSS), and then further analysis was performed using Kaplan-Meier (KM) curves and propensity score matching (PSM) stratified by different age groups, pathological stage (pT1 − 2N0, pT3 − 4N0, pT1 − 4N+), and AT modalities including chemotherapy (CT), radiotherapy (RT), and CT + RT. Results 7951 patients were eligible for this study, and age was found to be an independent risk factor of OS and CSS after adjusted other risk factors (all P < 0.001). 50 years old was identified as the optimal cut-off value for OS and CSS using RCS, and patients aged < 50 years old (early-onset rectal cancer, EORC) have a significantly better prognosis than those aged ≥ 50 years old (late-onset rectal cancer, LORC) before and after PSM (both P < 0.001). Among the EORC patients, only subgroup of pT1 − 4N + was found to be benefited from AT before and after PSM (both P < 0.05), and further analysis showed that this population was only benefited from adjuvant CT in terms of OS (P < 0.05). Among LORC patients, subgroups of pT3 − 4N0 and pT1 − 4N + were both found to be benefited from AT (both P < 0.001). Further analysis showed that adjuvant CT and CT + RT could both significantly improve the OS of these two subgroups (all P < 0.05), but adjuvant RT alone was only found to benefit those staged at pT1 − 4N+ (P < 0.05). Conclusions The optimal age threshold for RC patients undergoing direct surgery was 50 years old. Patients with EORC staging at pT1-4N + should receive adjuvant CT + RT. Patients with LORC staging at pT3-4N0 and pT1-4N + should receive adjuvant CT + RT or CT. In addition, adjuvant RT alone could also be an option for selected LORC patients. However, this conclusion deserves further validation by prospective cohorts.

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Section: Discussionmentioning

confidence: 53%

Section: Introductionmentioning

confidence: 99%

Impact of age on the prognosis and decision-making of adjuvant treatment for resectable rectal cancer- a population based analysis

Wang

Lai

Zhong

et al. 2022

Preprint

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“…Another study found that chemotherapy didn’t seem to affect the prognosis of young patients with breast cancer, which is obviously inconsistent with most studies that are not grouped by age ( 20 ). In addition, a recent study focusing on stage II/III rectal cancer revealed that radiotherapy had different effects on the survival of patients at different ages ( 21 ). Moreover, treatment methods and postoperative recurrence methods are also diverse according to the different site of primary tumor of PDAC ( 16 ).…”

Section: Discussionmentioning

confidence: 99%

The Survival Effect of Radiotherapy on Stage IIB/III Pancreatic Cancer Undergone Surgery in Different Age and Tumor Site Groups: A Propensity Scores Matching Analysis Based on SEER Database

Wang

Tian

et al. 2022

Front. Oncol.

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BackgroundIt remains controversial whether radiotherapy (RT) improves survival in patients with stage IIB/III PDAC. A growing number of studies have found that patients’ age at diagnosis and tumor site not only affect prognosis, but also may lead to different treatment responses. Therefore, the purpose of this study was to verify whether the survival effect of radiotherapy in patients with stage IIB/III PDAC varies across age and tumor site groups.MethodsThe target population was selected from PDAC patients undergone surgery in the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2016. This study performed the Pearson’s chi-square test, Cox regression analysis, Kaplan-Meier (K-M) method, and focused on propensity frequency matching analysis.ResultsNeither neoadjuvant radiotherapy (nRT) nor adjuvant radiotherapy (aRT) patient group had probably improved survival among early-onset patients. For middle-aged patients, nRT seemed to fail to extend overall survival (OS), while aRT might improve the OS. Plus, both nRT and aRT were associated with improved survival in elderly patients. The aRT might be related with survival benefits in patients with pancreatic head cancer, while nRT was not. And RT in patients with PDAC at other sites did not appear to provide a survival benefit.ConclusionCarefully selected data from the SEER database suggested that age and tumor location may be the reference factors to guide the selection of RT for patients with stage IIB/III PDAC. These findings are likely to contribute to the development of personalized treatment for patients with stage IIB/III PDAC.

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Section: Colorectal Cancer Therapeutic Challengesmentioning

confidence: 99%

“…Regarding the use of neoadjuvant radiotherapy, it is an approach using high-energy rays (such as x-rays) or particles to destroy tumor cells and it is currently used to treat rectal cancer (RC), not colon cancer [ 7 ]. In fact, it has become the standard treatment for stage II/III rectal cancer patients to help reduce the size of a tumor or kill cancer cells that have spread [ 7 ]. This treatment can also be applied after the resection to destroy remaining cancer cells and used mainly in stage II/III RC patients who have not received preoperative radiotherapy [ 7 ].…”

Section: Colorectal Cancer Therapeutic Challengesmentioning

confidence: 99%

Modulation of the Tumor Microenvironment by Microbiota-Derived Short-Chain Fatty Acids: Impact in Colorectal Cancer Therapy

Gomes

Rodrigues

Pazienza

et al. 2023

IJMS

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Finding new therapeutic approaches towards colorectal cancer (CRC) is of increased relevance, as CRC is one of the most common cancers worldwide. CRC standard therapy includes surgery, chemotherapy, and radiotherapy, which may be used alone or in combination. The reported side effects and acquired resistance associated with these strategies lead to an increasing need to search for new therapies with better efficacy and less toxicity. Several studies have demonstrated the antitumorigenic properties of microbiota-derived short-chain fatty acids (SCFAs). The tumor microenvironment is composed by non-cellular components, microbiota, and a great diversity of cells, such as immune cells. The influence of SCFAs on the different constituents of the tumor microenvironment is an important issue that should be taken into consideration, and to the best of our knowledge there is a lack of reviews on this subject. The tumor microenvironment is not only closely related to the growth and development of CRC but also affects the treatment and prognosis of the patients. Immunotherapy has emerged as a new hope, but, in CRC, it was found that only a small percentage of patients benefit from this treatment being closely dependent on the genetic background of the tumors. The aim of this review was to perform an up-to-date critical literature review on current knowledge regarding the effects of microbiota-derived SCFAs in the tumor microenvironment, particularly in the context of CRC and its impact in CRC therapeutic strategies. SCFAs, namely acetate, butyrate, and propionate, have the ability to modulate the tumor microenvironment in distinct ways. SCFAs promote immune cell differentiation, downregulate the expression of pro-inflammatory mediators, and restrict the tumor-induced angiogenesis. SCFAs also sustain the integrity of basement membranes and modulate the intestinal pH. CRC patients have lower concentrations of SCFAs than healthy individuals. Increasing the production of SCFAs through the manipulation of the gut microbiota could constitute an important therapeutic strategy towards CRC due to their antitumorigenic effect and ability of modulating tumor microenvironment.

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The Survival Effect of Radiotherapy on Stage II/III Rectal Cancer in Different Age Groups: Formulating Radiotherapy Decision-Making Based on Age

Cited by 4 publications

References 33 publications

Impact of age on the prognosis and decision-making of adjuvant treatment for resectable rectal cancer- a population based analysis

Impact of age on the prognosis and decision-making of adjuvant treatment for resectable rectal cancer- a population based analysis

The Survival Effect of Radiotherapy on Stage IIB/III Pancreatic Cancer Undergone Surgery in Different Age and Tumor Site Groups: A Propensity Scores Matching Analysis Based on SEER Database

Modulation of the Tumor Microenvironment by Microbiota-Derived Short-Chain Fatty Acids: Impact in Colorectal Cancer Therapy

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