Survival In Rectal Cancer Patients Research Articles

Omission of Adjuvant Chemotherapy in Rectal Cancer Patients with Pathologic Complete Response: a National Analysis

BackgroundAn increasing number of patients achieve a pathologic complete response (pCR) after neoadjuvant chemoradiation for locally advanced rectal cancer. Consensus guidelines continue to recommend oncologic resection followed by adjuvant chemotherapy in these patients. We hypothesize that there is significant variability in compliance with this recommendation. MethodsThe National Cancer Database was queried from 2006 to 2015 for patients with locally advanced rectal cancer who underwent neoadjuvant chemoradiation followed by oncologic resection with a pCR (ypT0N0). Hierarchical logistic regression models were used to generate risk and reliability-adjusted rates of adjuvant chemotherapy utilization in patients with pCR at each hospital. ResultsIn total, 2421 pCR patients were identified. Five-year overall survival was improved in pCR patients who received adjuvant chemotherapy compared with those who did not (92 vs. 85%, p < 0.01). Multivariate analysis indicated that improvement in overall survival remained associated with adjuvant chemotherapy (HR 0.60, 95% CI 0.44–0.82, p < 0.01). The mean adjuvant chemotherapy utilization rate among hospitals was 32%. There was an upward trend in use over the past decade, but two-thirds still do not receive the recommended therapy. High chemotherapy utilizer hospitals were more likely to be academic centers (54.9 vs. 45.9%, p < 0.01) when compared with low chemotherapy utilizers. ConclusionAdjuvant chemotherapy is associated with improved survival in rectal cancer patients with pCR following neoadjuvant chemoradiation and oncologic resection. However, utilization among centers in the USA was only 32% with significant variability across centers. National efforts are needed to standardize treatment patterns according to national guidelines.

Total mesorectal excision with and without lateral lymph node dissection: a systematic review of the literature.

Treatment of lateral lymph node metastasis in rectal cancer is still under debate. While these nodes are routinely resected by Japanese teams, neoadjuvant radiochemotherapy alone is performed in Western countries. We aimed to systematically report the current literature assessing the overall and disease-free survivals of patients with rectal cancer treated with total mesorectal resection (TME) with or without lateral lymph node dissection (LLND). MEDLINE/Pubmed, Embase, Cochrane, and Web of Science were searched from database implementation until 19 January 2019. Studies reporting overall survival or recurrence-free survival in patients with LLND for rectal cancer were included. We excluded studies including patients with recurrent rectal cancer, multivisceral resection, and/or without control group (patients with rectal surgery without LLND). Eleven studies were included, accounting for a total of 4159 patients. Overall survival ranged between 55.6 and 92.6% for TME with LLND versus 49.2 and 90.2% for TME alone, with one study reporting statistically significant benefit of LLND. Recurrence-free survival ranged between 58.3 and 74.1% for TME with LLND versus 39.5 and 76.5% for TME alone. Two studies showed statistically significant differences between the two strategies, one randomized controlled trial showed improved recurrence-free survival in TME alone group (74.5% versus 74.1% with LLND at 5 years) and one observational retrospective study reported increased recurrence-free survival with more extensive resection (65.4% versus 39.5% without LLND, at 5 years). Benefits of LLND are not clear and further randomized controlled trials should be performed to determine which strategy would allow improving survival in rectal cancer patients. The study protocol was registered in PROSPERO prior to study screening (CRD42019123181) and published in September 2019.

Immunogenetic markers in IL17F predict the risk of metastases spread and overall survival in rectal cancer patients treated with neoadjuvant chemoradiotherapy

Background and purposeThe role of the immune system in tumor response to chemo-radiotherapy (CRT) is an emerging issue. This work aimed at identifying predictive and prognostic immunogenetic variants in LARC patients after preoperative (po)-CRT and surgery. Materials and methodsA set of 192 polymorphisms in 34 candidate genes involved in the regulation of the immune response signalling network, was selected and analyzed in 370 LARC patients treated with po-CRT and surgery, split into a Test Set (n = 233) and a Validation Set (n = 137). Immunogenetic markers were selected based on a concordant significant effect on 2-year relapse-free survival (2-yrRFS) (bootstrapped P < 0.05) in both patients Sets. The effect of the selected immunogenetic variants on 5-year metastases-free (5yrMFS), 5-year disease-free (5yrDFS), and 10-year overall (10yrOS) survival was tested in the entire Set of 370 patients. ResultsTwo immunogenetic IL17F (IL17F-rs641701 and IL17F-rs9463772) markers predictive of 2yrRFS, 5yrDFS, 5yrMFS, and 10yrOS were identified. The combination of tumor regression grade (TRG) and patients genotype for IL17F-rs641701 and IL17F-rs9463772 allowed the identification of subgroups of patients with differential prognosis in term of both 5yrDFS (HR 11.29, P-value <0.001, and HR 5.86, P-value = 0.001, respectively) and 10yrOS (HR 7.07, P-value = 0.005, and HR 6.05, P-value = 0.002, respectively). ConclusionIL17F-rs641701 and IL17F-rs9463772 were highlighted as promising immunogenetic markers significantly associated with the prognosis of LARC patients. After a prospective validation of the herein reported findings, the combination of TRG and patients genotype should be considered to provide additional stratification criteria for the selection of a personalized multimodality treatment.

Does anastomotic leakage after rectal cancer resection worsen long-term oncologic outcome?

The influence of anastomotic leakage on long-term survival in patients with rectal cancer is debatable. The aim of this study was to evaluate relationships between anastomotic leakage and long-term survival. In this multicenter retrospective cohort study, 395 consecutive stage I to III rectal cancer patients underwent anterior resection between 2007 and 2012. Five-year overall survival, 5-year disease-free survival, and 5-year local recurrence-free survival were compared between patients with leakage (Leakage (+)) and patients without leakage (Leakage (-)). Of 395 patients, 50 (12.7%) had anastomotic leakage. Of these 50, 34 (68.0%) required urgent surgery and 16 (32.0%) could be managed by watchful waiting or with percutaneous drainage. The median follow-up period was 62.6months. Five-year overall survival did not differ between the two groups (Leakage (+) 93.8% vs. Leakage (-) 89.0%, P = 0.121). Five-year disease-free survival also did not differ between the two groups (81.6% vs. 80.3%, P = 0.731), and neither did 5-year local recurrence-free survival (91.9% vs. 86.1%, P = 0.206). In a multivariable Cox regression model, BMI > 25, preoperative CA19-9 > 37, pathological T stage, pathological N stage, and circumferential resection margin (CRM) positive were independent predictors of disease-free survival. Moreover, pathological T stage, pathological N stage, and CRM positive were the only independent predictors of overall survival and local recurrence-free survival. Anastomotic leakage was not a risk factor for overall survival, disease-free survival, or local recurrence-free survival. Anastomotic leakage is not associated with a significant decrease in long-term survival in rectal cancer patients.

High neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio predict poor survival in rectal cancer patients receiving neoadjuvant concurrent chemoradiotherapy.

This study explored the prognostic value of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in rectal cancer patients receiving neoadjuvant concurrent chemoradiotherapy (CCRT).Between January 2006 and December 2016, 184 patients with newly-diagnosed rectal cancer receiving neoadjuvant CCRT were enrolled. Risk of overall survival (OS) and disease-free survival (DFS) were calculated using the Kaplan-Meier method and Cox proportional hazard models. Stratified survival analyses were also performed between post-neoadjuvant pathological (yp) stage.The mean follow-up time was 72.73 ± 36.82 months. High- and low-NLR patients differed significantly in both 5-year DFS (P = .026) and OS (P = .016). High- and low-PLR patients differed significantly in 5-year DFS (P = .011) but not OS (P = .185). Multivariate analyses revealed worse 5-year DFS (adjusted HR [aHR] = 2.8; 95% CI: 1.473-5.41; P = .002) and 5-year OS (aHR = 1.871; 95%CI: 1.029-3.4; P = .04) in the high-NLR group after adjusting for covariates. After adjustments, the high-PLR group had inferior 5-year DFS (aHR = 2.274; 95%CI: 1.473-5.419; P = .038) but not 5-year OS (aHR = 1.156; 95%CI: 0.650-2.056; P = .622). Further stratified analysis indicated that yp stage II and III patients with high NLR had worse 5-year DFS (aHR = 2.334; 95% CI: 1.158-4.725; P = .018) and OS (aHR = 2.226; 95% CI: 1.165-4.251; P = .015). Additionally, yp stage II and III patients with high PLR had inferior 5-year DFS (aHR = 2.012; 95% CI: 1.049-3.861; P = .036).Pre-CCRT NLR and PLR are independent prognostic factors for rectal cancer patients and could be used as a potential biomarker to identify high-risk patients for more intense treatment and care.

The Determination of Immunomodulation and Its Impact on Survival of Rectal Cancer Patients Depends on the Area Comprising a Tissue Microarray.

Background: T cell density in colorectal cancer (CRC) has proven to be of high prognostic importance. Here, we evaluated the influence of a hyperfractionated preoperative short-term radiation protocol (25 Gy) on immune cell density in tumor samples of rectal cancer (RC) patients and on patient survival. In addition, we assessed spatial tumor heterogeneity by comparison of analogue T cell quantification on full tissue sections with digital T cell quantification on a virtually established tissue microarray (TMA). Methods: A total of 75 RC patients (60 irradiated, 15 treatment-naïve) were defined for retrospective analysis. RC samples were processed for immunohistochemistry (CD3, CD8, PD-1, PD-L1). Analogue (score 0–3) as well as digital quantification (TMA: 2 cores vs. 6 cores, mean T cell count) of marker expression in 2 areas (central tumor, CT; invasive margin, IM) was performed. Survival was estimated on the basis of analogue as well as digital marker densities calculated from 2 cores (Immunoscore: CD3/CD8 ratio) and 6 cores per tumor area. Results: Irradiated RC samples showed a significant decrease in CD3 and CD8 positive T cells, independent of quantification mode. T cell densities of 6 virtual cores approximated to T cell densities of full tissue sections, independent of individual core density or location. Survival analysis based on full tissue section quantification demonstrated that CD3 and CD8 positive T cells as well as PD-1 positive tumor infiltrating leucocytes (TILs) in the CT and the IM had a significant impact on disease-free survival (DFS) as well as overall survival (OS). In addition, CD3 and CD8 positive T cells as well as PD-1 positive TILs in the IM proved as independent prognostic factors for DFS and OS; in the CT, PD-1 positive TILs predicted DFS and CD3 and CD8 positive T cells as well as PD-1 positive TILs predicted OS. Survival analysis based on virtual TMA showed no impact on DFS or OS. Conclusion: Spatial tumor heterogeneity might result in inadequate quantification of immune marker expression; however, if using a TMA, 6 cores per tumor area and patient sample represent comparable amounts of T cell densities to those quantified on full tissue sections. Consistently, the tissue area used for immune marker quantification represents a crucial factor for the evaluation of prognostic and predictive biomarker potential.

Relationship of lymphopenia to overall survival and progression-free survival in rectal cancer patients receiving neoadjuvant chemoradiation.

39 Background: Pelvic radiation and myelosuppressive chemotherapy can lead to lymphopenia during the course of preoperative chemoradiation when treating rectal cancer. Lymphopenia during chemoradiation has been associated with higher risks of recurrence in other cancers, possibly due to decreased immunosurveillance. The effect in rectal cancer is not well described. We hypothesize that high-grade lymphopenia is associated with worse progression-free survival (PFS) and overall survival (OS) in rectal cancer patients undergoing preoperative chemoradiation. Methods: All patients treated at our institution with neoadjuvant chemoradiation between 2013 and 2019 were reviewed (n = 99). The study was limited to patients with Stage II – IV (AJCC 8th edition) rectal adenocarcinoma. Patients were excluded if they had prior systemic therapy (n = 13) or if lymphocyte data was unavailable (n = 30). Lymphopenia which arose during or within 30 days of completion of chemoradiation was graded by the CTCAE v.4.0. Neoadjuvant Rectal (NAR) scores, indicators of pathologic response, were calculated for each surgical patient. Kaplan-Meier analysis was used to calculate PFS and OS. Two-tailed t-tests (a=0.05) were used to detect differences between subgroups. Results: Fifty-six patients met inclusion criteria. Grade 2 (G2) or higher lymphopenia occurred in 43 (76.8%) patients (G2 = 22, G3 = 20, G4 = 1). In patients with G2 vs G3-4 lymphopenia, there were no differences in baseline, treatment, or demographic characteristics. The median PFS for these patients was 20.0 months. Patients with G3-4 lymphopenia had significantly worse 2-year PFS compared to those with G2 lymphopenia (83.3% vs 59.3% p = 0.03). The two-year OS did not differ between groups (100% vs 60.3%, p = 0.10). Lymphocyte nadir did not correlate with pathologic response, as measured by the NAR score (r = -0.28, p = 0.07). Conclusions: In this study, G3-4 lymphopenia was associated with worse PFS in rectal cancer patients treated with neoadjuvant chemoradiation, despite a small sample size. The prognostic implications of lymphopenia in rectal cancer should be confirmed in larger cohorts and the underlying mechanisms explored.

Local versus Radical Excision of Early Distal Rectal Cancers: A National Cancer Database Analysis.

Local excision (LE) has been proposed as an alternative to radical resection for early distal rectal cancer, for which the optimal oncologic treatment remains unclear. The goal of this study was to compare the overall survival of rectal cancer patients with early distal tumors who underwent LE versus abdominoperineal resection (APR) using a large contemporary database. The National Cancer Database (2004-2013) was used to identify patients with early T-stage rectal adenocarcinoma who underwent LE or APR. Patients were split into groups based on T stage and type of surgery (LE vs. APR). The primary outcome measure was overall survival. An adjusted Cox proportional hazards model was used to evaluate the impact of treatment strategy on survival. Overall, there were 2084 patients with T1 tumors and 912 patients with T2 tumors. For patients with T1 disease, after adjusting for age, sex, income level, race, Charlson score, insurance payor, and tumor size, there was no significant difference in survival between the LE and APR groups (hazard ratio [HR] 0.89, 95% confidence interval [CI] 0.65-1.22; P = 0.49). For patients with T2 disease, after adjusting for age, Charlson score, and tumor size, there was no significant difference in survival between patients undergoing LE + chemoradiation therapy (CRT) and APR (HR 1.11, 95% CI 0.84-1.45; P = 0.47). Patients with early distal rectal adenocarcinoma who underwent LE had similar survival to patients who underwent APR. LE is an acceptable oncologic treatment strategy for patients with T1 rectal cancers, and LE with CRT is an acceptable oncologic treatment for patients with T2 distal rectal cancers.

An Overview of Five-Year Survival in Rectal Cancer in Relation to Lymph Node Status.

Introduction: Lymph node metastasis is regarded as an important prognostic factor for predicting disease recurrence and survival in patients with colorectal cancer. Several studies suggest that the lymph node ratio has a greater importance in survival than the number of metastatic lymph nodes. The scope of this study is to examine the 5-year survival of rectal cancer patients, examining several prognostic factors with emphasis on lymph node status. Material and Methods: A retrospective study was conducted at single surgical clinic from Romania, using data from patients who have been treated for rectal cancer between January 2009 and December 2014. Patient present status and regarding the multimodal treatment was assessed through telephonic method, data was extracted from the electronic database of the clinic and histopathological reports. Results: A total number of 144 patients affected by rectal cancer were assessed. Statistical analysis of the variables showed that age (p=0.001), T stage(p=0.049), N stage (p=0.005), LNR (p=0.006), type of surgery (p 0.001), presence of vascular invasion (p 0.001), metastases (p 0.001), to be significant prognostic factors for survival. Conclusions: The 5-year survival of the patients we included in the study was 63,9%. Nodal status, expressed by lymph node ratio proved to be a significant prognostic factor of patient survival.

Association of pre-surgery to pre-radiotherapy lymphocyte counts ratio with disease-free survival in rectal cancer patients receiving neoadjuvant concurrent chemoradiotherapy

BackgroundColorectal cancer is the fourth most common cancer globally and neoadjuvant concurrent chemoradiotherapy (nCRT) and surgery are the standard treatments for locally advanced colorectal carcinoma. This study investigated the association between dynamic changes in absolute lymphocyte counts (ALCs) and disease-free survival (DFS) in rectal cancer patients receiving nCRT and identified factors associated with these changes.MethodsWe retrospectively examined 34 patients with locally advanced rectal cancer who received nCRT followed by surgery and adjuvant chemotherapy. The association between ALCs and DFS and that between ALCs and downstaging were analyzed and potential clinical- and treatment-related factors related to dynamic changes in ALCs were subsequently evaluated. The patient eligibility criteria were as follows: pathologically confirmed rectal adenocarcinoma, clinical stages II–III, ≥ 18 years of age, and so on. Pre-RTL was defined as ALCs obtained before the initiation of nCRT and pre-SL was defined as ALCs obtained before surgery. We measured pre-SL to pre-RTL ratio (pre-SLR), DFS, and ALCs.ResultsThe median ALC declined significantly during nCRT. A lower pre-SLR was associated with poorer DFS with statistical significance in Kaplan–Meier (p = 0.007), univariate regression (hazard ratio [HR] = 6.287, 95% confidence interval [CI] 1.374–28.781, p = 0.018), and multivariable regression (HR = 7.347, 95% CI 1.595–33.850, p = 0.011) analyses. Neither patient characteristics nor treatment-related factors were related to downstaging. The pelvic bone marrow (PBM) volume receiving at least 30 Gy (V30) was significantly associated with pre-SLR in the univariate (HR = 5.760, 95% CI 1.317–25.187, p = 0.020) and multivariable (HR = 5.760, 95% CI 1.317–25.187, p = 0.020) regression analyses.LimitationsOur study had several limitations. The sample size was small and the study was performed in a selected population, which may limit the generalization of the findings.ConclusionsRadiotherapy had a profound impact on the change in ALCs. A lower pre-SLR was significantly associated with poorer DFS in rectal cancer patients receiving nCRT. The V30 of PBM was a predictor of pre-SLR.

Tumor budding outperforms ypT and ypN classification in predicting outcome of rectal cancer after neoadjuvant chemoradiotherapy

BackgroundBudding is a complementary prognostic factor for colorectal cancer. In this study, we aimed to clarify the role of tumor budding in rectal cancer patients after preoperative chemoradiotherapy.MethodsA total of 124 patients with rectal cancer treated with neoadjuvant chemoradiotherapy and consecutive surgery were included. Surgical specimens were evaluated for budding and routine clinicopathological features. Budding was evaluated on hematoxylin and eosin (H&E)-stained slides and by cytokeratin immunohistochemical (IHC) staining.ResultsA budding rate of 36.9% (n = 38) by H&E and 55.6% (n = 55) by IHC was observed. Budding was significantly associated with a high ypT and ypN status, poor differentiation, and low degrees of tumor regression. Moreover, budding was strongly predictive of a worse patient outcome, as measured by tumor recurrence or death. In multivariate analyses, budding remained the only significant parameter for overall survival and was even superior to the ypT and ypN status (budding in H&E: hazard ratio (HR) 2.72, 95% confidence interval (95% CI) 1.15–6.44, p = 0.023; budding in IHC: HR 5.19, 95% CI 1.62–16.61, p = 0.006).ConclusionBudding is a strong prognostic predictor of survival in rectal cancer patients after neoadjuvant therapy. A standardized evaluation of tumor budding after neoadjuvant therapy may thus aid in risk stratification and guide the clinical management of patients with rectal cancer. Immunostaining can help to enhance the diagnostic accuracy and prognostic significance.

Male sex and anterior wall tumor location as risk factors for urinary dysfunction after laparoscopic rectal surgery.

Total mesorectal excision (TME) has decreased the local recurrence rate and improved the overall survival of rectal cancer patients. However, urinary dysfunction remains a clinical problem after rectal cancer surgery. The aim was to assess the risk factors for postoperative urinary dysfunction. This study was a single-center, retrospective analysis of 104 patients who underwent laparoscopic rectal surgery between November 2016 and October 2017. Postoperative urinary dysfunction was defined as the need for urinary catheter re-insertion or the presence of residual urine (≥ 150mL) postoperatively. Postoperative urinary dysfunction was seen in 18 patients (17%). Multivariate analysis showed that male sex (odds ratio 3.89, p = 0.034) and anterior wall tumor location (odds ratio = 4.07, p = 0.037) were the predictors of postoperative urinary dysfunction. Compared with patients without risk factors, those with the two risk factors needed longer hospital stays (16days vs. 30days, p = 0.0022). Male sex and anterior wall tumor location were the risk factors for urinary dysfunction after laparoscopic rectal surgery.

Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio Predict Poor Survival in Rectal Cancer Patients Receiving Neoadjuvant Concurrent Chemoradiotherapy

Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio Predict Poor Survival in Rectal Cancer Patients Receiving Neoadjuvant Concurrent Chemoradiotherapy

A Population-Based Study of Secondary Prostate Cancer Risk after Radiotherapy in Male Patients with Rectal Cancer: A Retrospective Cohort Study.

Background and objective: Risk of secondary prostate cancer after radiation therapy among patients with rectal cancer remains undetermined. Given an increased incidence of rectal cancer in younger people and improved survival for rectal cancer patients who received radiation therapy, the potential risk of secondary prostate cancer needs to be further investigated. Materials and Methods: Male patients (n = 11,367) newly diagnosed rectal cancer and who underwent abdominoperineal resection (APR) or low anterior resection (LAR) from 1 January, 1998 to 31 December, 2010 were identified from Taiwan National Health Insurance Research Database. The incidence and relative risk of secondary prostate cancer in study patients with (n = 1586) and without (n = 9781) radiotherapy within one year after rectal cancer diagnosis were compared using a competing-risks analysis. Results: Rectal cancer patients with radiotherapy were at a significantly decreased risk of developing prostate cancer, with a hazard ratio (HR) of 0.41 (95% confidence interval = 0.20–0.83) after adjustment for age. Analysis of the risk estimated for various follow-up lengths suggested that a decreasing HR was seen through the period followed-up and that there was a trend of decreasing prostate cancer risk with time after radiotherapy. Conclusions: Radiotherapy was significantly associated with decreased risk of secondary prostate cancer among rectal cancer patients, by a magnitude of 59%.

Prognostic factors for survival in stage IV rectal cancer: A Swedish nationwide case–control study

PurposeThe aim was to identify patient-, tumor- and treatment-related prognostic factors for five-year survival in rectal cancer patients with synchronous stage IV disease. Material and methodsThis nationwide case-control study was based on the Swedish Colorectal Cancer Registry with supplementary information from medical records and the Swedish Inpatient Registry during the period 2000–2008. All resected rectal cancer patients with synchronous metastases that survived more than five years were included as cases. The control group consisted of corresponding patients who lived less than five years, matched in a 1:2 based on gender, age, resection of the rectal tumor, and the study period. ResultsA total of 405 patients were identified; 99 long-term survivors (LTS) and 182 short-term survivors (STS). Patient-related factors of symptoms and comorbidity did not differ between LTS and STS. Among the treatment-related factors, multiple site metastases (p = 0.007), bilobar liver metastasis (p = 0.002), and increasing number of liver metastasis (p < 0.001) were associated with STS. Prognostic treatment-related factors were preoperative radiotherapy (p = 0.001), metastasectomy (p < 0.001), and radical resection of the primary tumor (p = 0.014). In the multivariable analysis, the single most important factor for becoming a LTS was a metastasectomy (hazard ratio: 8.474, 95% confidence interval: 4.098–17.543). ConclusionsThe most important prognostic factor for long-term survival in patients with stage IV rectal cancer was metastasectomy, especially liver surgery. With thorough selection of patients for metastasectomy more patients with metastasized rectal cancer may survive beyond five years.

Anastomotic Leak Does Not Impact Oncologic Outcomes After Preoperative Chemoradiotherapy and Resection for Rectal Cancer.

The aim of this study was to evaluate the relationship of anastomotic leakage, local recurrence, and overall survival in rectal cancer patients treated with preoperative chemoradiotherapy (CRT) and curative resection. Little is known about the association between anastomotic leakage and oncologic outcomes after preoperative CRT. A total of 698 consecutive primary rectal cancer patients after preoperative CRT between April 19, 2000, and December 27, 2013, were retrospectively reviewed. Forty-seven patients who had anastomotic leakage were compared with 651 patients who had no anastomotic leakage. Of 698 patients, 47 (6.7%) patients had anastomotic leakage. Among these 47 patients, 39 (83.0%) had grade C leak that required urgent operation, while 8 (17.0%) had grade B leak that was managed expectantly or by percutaneous drainage. The median follow-up period was 47.6 months (range, 27.1 to 68.9 months). One hundred twenty (17.2%) recurrences were identified among all patients. The median overall disease-free survival was 43 months (range, 22.4 to 66.7 months). Five-year disease-free survival did not differ significantly between the 2 groups (80.5% vs 80.4%, P = 0.839). Five-year local recurrence-free survival did not differ significantly either between the 2 groups (93.7% vs 94.9%, P = 0.653). Five-year overall survival rates of patients with or without leakage were 90.9% and 86.3%, respectively (P = 0.242). Five-year cancer-specific survival rates of patients with or without leakage were 92.2% and 86.3%, respectively (P = 0.248). After preoperative CRT, an anastomotic leak is not associated with a significant increase in local recurrence or long-term survival in rectal cancer.

Preoperative neutrophil to lymphocyte ratio predicts disease-free survival in rectal cancer patients treated with preoperative chemoradiotherapy followed by curative surgery

Background: Neutrophil to lymphocyte ratio (NLR) is reported to be associated with prognosis of colorectal cancer. The aim of this study is to investigate the prognostic impact of NLR in rectal cancer treated with chemoradiotherapy followed by curative surgery.

Disqualification of Neoadjuvant Rectal Score Based on Data of 6596 Patients From the Netherlands Cancer Registry

BackgroundThe neoadjuvant rectal score (NAR) was developed as a surrogate endpoint for overall survival in patients with rectal cancer after neoadjuvant treatment. We aimed to validate the NAR score in patients from the Netherlands Cancer Registry database. Patients and MethodsWe studied patients with rectal cancer treated with long-course neoadjuvant therapy followed by surgery in the Netherlands between 2007 and 2014. The probability of concordance with overall survival and the goodness of fit of several models were evaluated using Harrell's concordance index (c index) and the Akaike information criterion (AIC), which is used to compare the quality of statistical models. ResultsThe NAR score resulted in a c index of 0.665. We found that single pathologic parameters (pT or pN) have similar concordance as the NAR formula (c index of 0.663 and 0.655, respectively). A combination of pT and pN resulted in better concordance with the true endpoint, overall survival (c index 0.684), and a simple Cox regression model with the 3 parameters included in the NAR formula (cT, pT, and pN) improved the concordance even more (c index 0.689). When the AIC index was compared for all models, the NAR score model showed the worst fit to the true endpoint. ConclusionWe found no additional value for using the NAR formula as a surrogate endpoint for overall survival in rectal cancer patients treated with neoadjuvant therapy.

Prognostic value of ABO blood group in a Chinese population in Northwest China region with curatively resected rectal cancer.

A positive association between the ABO blood types and survival has been suggested in several malignancies. However, little is known about the relationship between ABO blood group and survival in rectal cancer patients. The aim of this study was to assess the role of the ABO blood types in predicting the prognosis of a Chinese population in Northwest China region with curatively resected rectal cancer. We retrospectively analyzed 1613 consecutive patients who underwent curative surgery for rectal cancer between June, 2011 and December, 2016. The relationship between the ABO blood types and overall survival (OS) was analyzed. The median follow-up period of the 1613 rectal cancer patients was 69.6 months with 1427 alive. There was a significance difference of survival among ABO blood groups (P=0.007). The mean overall survival (OS) of the blood type B patients was 70.8 months, O was 64.3, whereas the mean OS of the AB and A blood type patients was significantly lower, 58.4 months and 59.7 months respectively (P=0.007, log-rank test). Compared with patients with A and AB blood types, patients with blood type B and O were more likely to have better survival(P=0.001). A blood groups were associated with significantly decreased overall survival in rectal cancer patients (hazard ratio = 1.263; 95% confidence interval = 0.776-2.054, P =0.010). In order to confirm our above results, we performed the same investigation in an independent cohort from another hospital of 505 Chinese patients and get the similar results. Our study showed that ABO blood group is associated with survival in Northwest Chinese patients with rectal cancer and the blood type B and O were favourable prognostic factors for patients with rectal cancer.

Comprehensive treatment of rectal cancer patients with synchronous distant metastases

Objective : to analyze short-term and long-term outcomes of surgical, combination, and comprehensive treatment in patients with metastatic rectal cancer. Materials and methods . We performed a retrospective analysis of prospectively collected data on the outcomes of rectal cancer patients receiving surgical, combination (surgery + chemotherapy), or comprehensive (chemoradiotherapy + surgery + chemotherapy) treatment in the Department of Proctology at the N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia, between 1999 and 2015. We assessed overall survival, frequency of postoperative complications, postoperative death rates and frequency of complications associated with chemoradiotherapy. Results . The study included 366patients that were divided into 3 groups according to the treatment strategy. The 2-year survival rate was 83 % in group 3 (comprehensive treatment) vs 40 % in groups 1 and 2. Median survival was 43 months in group 3 compared to 18 and 14 months in groups 2 and 1 respectively. The number of postoperative complications was 19 %, 13.4 %, and 15.1 % in groups 1, 2 and 3 respectively. There was one postoperative death (1.1 %) in group 3. Conclusion . Comprehensive treatment significantly improves overall survival of rectal cancer patients without increasing the risk of postoperative complications.