scholarly journals Monthly tegafur–uracil maintenance for increasing relapse-free survival in ypStage III rectal cancer patients after preoperative radiotherapy, radical resection, and 12 postoperative chemotherapy cycles: a retrospective study

BMC Cancer ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Yi-Hung Kuo ◽  
Chia-Hsuan Lai ◽  
Cheng-Yi Huang ◽  
Chih-Jung Chen ◽  
Yun-Ching Huang ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Retrospective Study ◽  
Cancer Patients ◽  
Preoperative Radiotherapy ◽  
Radical Resection ◽  
Postoperative Chemotherapy ◽  
Relapse Free Survival ◽  
Free Survival

scholarly journals Upregulated MUC2 Is an Unfavorable Prognostic Indicator for Rectal Cancer Patients Undergoing Preoperative CCRT

2021 ◽  
Vol 10 (14) ◽  
pp. 3030
Author(s):  
Chia-Lin Chou ◽  
Tzu-Ju Chen ◽  
Yu-Feng Tian ◽  
Ti-Chun Chan ◽  
Cheng-Fa Yeh ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Cancer Patients ◽  
Locally Advanced ◽  
Treatment Resistance ◽  
Radical Resection ◽  
Advanced Rectal Cancer ◽  
Prognostic Indicator ◽  
Locally Advanced Rectal Cancer ◽  
Free Survival ◽  
Muc2 Expression

For locally advanced rectal cancer patients, introducing neoadjuvant concurrent chemoradiotherapy (CCRT) before radical resection allows tumor downstaging and increases the rate of anus retention. Since accurate staging before surgery and sensitivity prediction to CCRT remain challenging, a more precise genetic biomarker is urgently needed to enhance the management of such situations. The epithelial mucous barrier can protect the gut lumen, but aberrant mucin synthesis may defend against drug penetration. In this study, we focused on genes related to maintenance of gastrointestinal epithelium (GO: 0030277) and identified mucin 2 (MUC2) as the most significantly upregulated gene correlated with CCRT resistance through a public rectal cancer transcriptome dataset (GSE35452). We retrieved 172 records of rectal cancer patients undergoing CCRT accompanied by radical resection from our biobank. We also assessed the expression level of MUC2 using immunohistochemistry. The results showed that upregulated MUC2 immunoexpression was considerably correlated with the pre-CCRT and post-CCRT positive nodal status (p = 0.001 and p < 0.001), advanced pre-CCRT and post-CCRT tumor status (p = 0.022 and p < 0.001), vascular invasion (p = 0.015), and no or little response to CCRT (p = 0.006). Upregulated MUC2 immunoexpression was adversely prognostic for all three endpoints, disease-specific survival (DSS), local recurrence-free survival (LRFS), and metastasis-free survival (MeFS) (all p < 0.0001), at the univariate level. Moreover, upregulated MUC2 immunoexpression was an independent prognostic factor for worse DSS (p < 0.001), LRFS (p = 0.008), and MeFS (p = 0.003) at the multivariate level. Collectively, these results imply that upregulated MUC2 expression is characterized by a more advanced clinical course and treatment resistance in rectal cancer patients undergoing CCRT, revealing the potential prognostic utility of MUC2 expression.

scholarly journals The watch-and-wait strategy versus surgical resection for rectal cancer patients with a clinical complete response after neoadjuvant chemoradiotherapy

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Qiao-xuan Wang ◽  
Rong Zhang ◽  
Wei-wei Xiao ◽  
Shu Zhang ◽  
Ming-biao Wei ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Cancer Patients ◽  
Surgical Resection ◽  
Neoadjuvant Chemoradiotherapy ◽  
Radical Resection ◽  
Complete Response ◽  
Sphincter Preservation ◽  
Watch And Wait ◽  
Free Survival ◽  
Clinical Complete Response

Abstract Background The watch-and-wait strategy offers a non-invasive therapeutic alternative for rectal cancer patients who have achieved a clinical complete response (cCR) after chemoradiotherapy. This study aimed to investigate the long-term clinical outcomes of this strategy in comparation to surgical resection. Methods Stage II/III rectal adenocarcinoma patients who received neoadjuvant chemoradiotherapy and achieved a cCR were selected from the databases of three centers. cCR was evaluated by findings from digital rectal examination, colonoscopy, and radiographic images. Patients in whom the watch-and-wait strategy was adopted were matched with patients who underwent radical resection through 1:1 propensity score matching analyses. Survival was calculated and compared in the two groups using the Kaplan–Meier method with the log rank test. Results A total of 117 patients in whom the watch-and-wait strategy was adopted were matched with 354 patients who underwent radical resection. After matching, there were 94 patients in each group, and no significant differences in term of age, sex, T stage, N stage or tumor location were observed between the two groups. The median follow-up time was 38.2 months. Patients in whom the watch-and-wait strategy was adopted exhibited a higher rate of local recurrences (14.9% vs. 1.1%), but most (85.7%) were salvageable. Three-year non-regrowth local recurrence-free survival was comparable between the two groups (98% vs. 98%, P = 0.506), but the watch-and-wait group presented an obvious advantage in terms of sphincter preservation, especially in patients with a tumor located within 3 cm of the anal verge (89.7% vs. 41.2%, P < 0.001). Three-year distant metastasis-free survival (88% in the watch-and-wait group vs. 89% in the surgical group, P = 0.874), 3-year disease-specific survival (99% vs. 96%, P = 0.643) and overall survival (99% vs. 96%, P = 0.905) were also comparable between the two groups, although a higher rate (35.7%) of distant metastases was observed in patients who exhibited local regrowth in the watch-and-wait group. Conclusion The watch-and-wait strategy was safe, with similar survival outcomes but a superior sphincter preservation rate as compared to surgery in rectal cancer patients achieving a cCR after neoadjuvant chemoradiotherapy, and could be offered as a promising conservative alternative to invasive radical surgery.

A simple scoring system for risk-stratifying rectal cancer patients prior to radical resection

2013 ◽  
Vol 18 (5) ◽  
pp. 459-465 ◽  
Author(s):  
P. J. Speicher ◽  
C. Ligh ◽  
J. E. Scarborough ◽  
J. K. Thacker ◽  
C. R. Mantyh ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Cancer Patients ◽  
Scoring System ◽  
Radical Resection

scholarly journals High SPINK4 Expression Predicts Poor Outcomes among Rectal Cancer Patients Receiving CCRT

2021 ◽  
Vol 28 (4) ◽  
pp. 2373-2384
Author(s):  
Tzu-Ju Chen ◽  
Yu-Feng Tian ◽  
Chia-Lin Chou ◽  
Ti-Chun Chan ◽  
Hong-Lin He ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Cancer Patients ◽  
Concurrent Chemoradiotherapy ◽  
Therapeutic Response ◽  
Tumor Regression ◽  
Free Survival ◽  
Cancer Transcriptome ◽  
Poor Outcomes ◽  
Univariate Analyses ◽  
Local Recurrence Free Survival

Background: Patients with rectal cancer can prospectively be favored for neoadjuvant concurrent chemoradiotherapy (CCRT) to downstage before a radical proctectomy, but the risk stratification and clinical outcomes remain disappointing. Methods: From a published rectal cancer transcriptome dataset (GSE35452), we highlighted extracellular matrix (ECM)-linked genes and identified the serine protease inhibitor Kazal-type 4 (SPINK4) gene as the most relevant among the top 10 differentially expressed genes associated with CCRT resistance. We accumulated the cases of 172 rectal cancer patients who received neoadjuvant CCRT followed by surgery and collected tumor specimens for the evaluation of the expression of SPINK4 using immunohistochemistry. Results: The results revealed that high SPINK4 immunoexpression was significantly related to advanced pre-CCRT and post-CCRT tumor status (both p < 0.001), post-CCRT lymph node metastasis (p = 0.001), more vascular and perineurial invasion (p = 0.015 and p = 0.023), and a lower degree of tumor regression (p = 0.001). In univariate analyses, high SPINK4 immunoexpression was remarkably correlated with worse disease-specific survival (DSS) (p < 0.0001), local recurrence-free survival (LRFS) (p = 0.0017), and metastasis-free survival (MeFS) (p < 0.0001). Furthermore, in multivariate analyses, high SPINK4 immunoexpression remained independently prognostic of inferior DSS and MeFS (p = 0.004 and p = 0.002). Conclusion: These results imply that high SPINK4 expression is associated with advanced clinicopathological features and a poor therapeutic response among rectal cancer patients undergoing CCRT, thus validating the prospective prognostic value of SPINK4 for those patients.

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