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Liao H, Li T, Liang Y, Liu Y, Yuan Y, Li M, Li A, Liu Y, Yao Y, Li T. Adjuvant chemotherapy improves long-term survival in pathologic stage III rectal mucinous adenocarcinoma after pre-operative chemoradiotherapy. Int J Colorectal Dis 2023; 38:207. [PMID: 37542591 DOI: 10.1007/s00384-023-04499-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2023] [Indexed: 08/07/2023]
Abstract
PURPOSE The benefits of adjuvant chemotherapy remain debated rectal mucinous adenocarcinoma (MC). Our study aims to delve into the efficacy of adjuvant chemotherapy in pathologic stage III rectal MC by a large population-based database. METHODS The Chi-square test was performed to examine the parameters between treatment groups. The overall survival (OS) and cancer-specific survival (CSS) of treatment groups were conducted by using the Kaplan-Meier method. The impact of factors on survival was assessed using Cox regression analyses. To balance the covariates and reduce the selection bias, we employed propensity score matching (PSM) to narrow the differences between treatment groups. RESULTS The median follow-up time for overall patients was 80 months. In the pre-operative chemoradiotherapy (pre-CRT) group, patients who received adjuvant chemotherapy had significantly better 5-year OS and CSS. Multivariate analyses found that adjuvant chemotherapy was associated with better OS (p < 0.001, HR (95% CI): 0.66 (0.51-0.86)) and CSS (p = 0.012, HR (95% CI): 0.71 (0.54-0.93)). However, adjuvant chemotherapy was not an independent prognosis factor in both OS (p = 0.149, HR (95% CI): 0.76 (0.53-1.1); Supplement Table 1) and CSS (p = 0.183, HR (95% CI): 0.74 (0.48-1.15)) in patients who did not receive pre-CRT. After PSM, similar results were found in the pre-CRT and the no pre-CRT groups. CONCLUSION In conclusion, our population-based retrospective cohort study indicates that the effects of adjuvant chemotherapy were associated with the pre-CRT status in patients with stage III rectal MC. In patients who underwent pre-CRT, the receipt of adjuvant chemotherapy was associated with better survival outcomes. Conversely, adjuvant chemotherapy does not seem to confer significant survival benefits to patients without pre-CRT.
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Affiliation(s)
- Hualin Liao
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
- Gastrointestinal Surgical Institute, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Tao Li
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
- Gastrointestinal Surgical Institute, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Yahang Liang
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
- Gastrointestinal Surgical Institute, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Yaxiong Liu
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
- Gastrointestinal Surgical Institute, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Yuli Yuan
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
- Gastrointestinal Surgical Institute, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Mingming Li
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
- Gastrointestinal Surgical Institute, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Aidi Li
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
- Gastrointestinal Surgical Institute, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Yang Liu
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
- Gastrointestinal Surgical Institute, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Yao Yao
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
- Gastrointestinal Surgical Institute, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Taiyuan Li
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China.
- Gastrointestinal Surgical Institute, Nanchang University, Nanchang, 330006, Jiangxi, China.
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Pham TD, Ravi V, Fan C, Luo B, Sun XF. Tensor Decomposition of Largest Convolutional Eigenvalues Reveals Pathologic Predictive Power of RhoB in Rectal Cancer Biopsy. THE AMERICAN JOURNAL OF PATHOLOGY 2023; 193:579-590. [PMID: 36740183 DOI: 10.1016/j.ajpath.2023.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/29/2022] [Accepted: 01/06/2023] [Indexed: 02/05/2023]
Abstract
RhoB protein belongs to the Rho GTPase family, which plays an important role in governing cell signaling and tissue morphology. RhoB expression is known to have implications in pathologic processes of diseases. Investigation in the regulation and communication of this protein, detected by immunohistochemical staining on the microscope, is worth exploring to gain insightful information that may lead to identifying optimal disease treatment options. In particular, the role of RhoB in rectal cancer is not well discovered. Here, we report that methods of deep learning-based image analysis and the decomposition of multiway arrays discover the predictive factor of RhoB in two cohorts of patients with rectal cancer having survival rates of <5 and >5 years. The analysis results show distinctions between the tensor decomposition factors of the two cohorts.
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Affiliation(s)
- Tuan D Pham
- Center for Artificial Intelligence, Prince Mohammad Bin Fahd University, Khobar, Saudi Arabia.
| | - Vinayakumar Ravi
- Center for Artificial Intelligence, Prince Mohammad Bin Fahd University, Khobar, Saudi Arabia
| | - Chuanwen Fan
- Department of Clinical and Experimental Medicine, Linkoping University, Linkoping, Sweden
| | - Bin Luo
- Department of Clinical and Experimental Medicine, Linkoping University, Linkoping, Sweden; Department of Gastrointestinal Surgery, Sichuan Provincial People's Hospital, Chengdu, China
| | - Xiao-Feng Sun
- Department of Clinical and Experimental Medicine, Linkoping University, Linkoping, Sweden
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Du J, Cheng Y, Hu D, Xing Y, Yue L, He R, Li H, Liu C, Liang X, Yang Y. A nomogram-based overall survival stratification to identify uterine sarcoma patients without distant metastases who may benefit from adjuvant radiotherapy. Gynecol Oncol 2023; 169:17-26. [PMID: 36469973 DOI: 10.1016/j.ygyno.2022.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/11/2022] [Accepted: 11/25/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE Adjuvant radiotherapy has been commonly performed in uterine sarcoma patients, but its role in overall survival (OS) remains controversial. Therefore, our study aimed to build a nomogram-based prognostic stratification to identify uterine sarcoma patients who might benefit from adjuvant radiotherapy. METHODS Uterine sarcoma patients without distant metastases between 2004 and 2015 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. The LASSO Cox regression was performed to identify essential prognostic predictors and a nomogram was built to predict the 1-, 3-, and 5-year OS. Receiver operating characteristic (ROC), calibration curves, and decision curve analysis (DCA) were used to validate the nomogram. Finally, prognostic stratification was performed by decision tree analysis based on the total points of the nomogram. RESULTS 2871 patients with uterine sarcoma were included. Preliminary analysis suggested that adjuvant radiotherapy failed to provide an OS benefit for the total population without our nomogram. The built nomogram showed good discrimination and calibration abilities to predict the OS in uterine sarcoma patients and the patients were stratified into three risk groups based on the nomogram. For patients in the high-risk group, adjuvant radiotherapy significantly improved the 5-year OS and median survival time by 26.4% and 17 months, respectively (P < 0.001); while radiotherapy failed to improve the survival outcomes of patients in the low- and intermediate-risk groups. CONCLUSIONS The nomogram-based prognostic stratification provides preliminary characterization of uterine sarcoma patients who may benefit from radiotherapy. The newly defined high-risk patients may gain significant OS benefit from adjuvant radiotherapy.
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Affiliation(s)
- Junhong Du
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Yuemei Cheng
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Dan Hu
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Yijuan Xing
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Ling Yue
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Ruifen He
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Hongli Li
- Department of Obstetrics and Gynecology, the First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Chang Liu
- Department of Obstetrics and Gynecology, the First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Xiaolei Liang
- Department of Obstetrics and Gynecology, the First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China.
| | - Yongxiu Yang
- Department of Obstetrics and Gynecology, the First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China.
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Zhao JY, Tang QQ, Luo YT, Wang SM, Zhu XR, Wang XY. Predictive value of a serum tumor biomarkers scoring system for clinical stage II/III rectal cancer with neoadjuvant chemoradiotherapy. World J Gastrointest Oncol 2022; 14:2014-2024. [PMID: 36310703 PMCID: PMC9611435 DOI: 10.4251/wjgo.v14.i10.2014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/06/2022] [Accepted: 08/22/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Multiple classes of molecular biomarkers have been studied as potential predictors for rectal cancer (RC) response. Carcinoembryonic antigen (CEA) is the most widely used blood-based marker of RC and has proven to be an effective predictive marker. Cancer antigen 19-9 (CA19-9) is another tumor biomarker used for RC diagnosis and postoperative monitoring, as well as monitoring of the therapeutic effect. Using a panel of tumor markers for RC outcome prediction is a practical approach.
AIM To assess the predictive effect of pre-neoadjuvant chemoradiotherapy (NCRT) CEA and CA19-9 levels on the prognosis of stage II/III RC patients.
METHODS CEA and CA19-9 levels were evaluated 1 wk before NCRT. According to the receiver operating characteristic curve analysis, the optimal cut-off point of CEA and CA19-9 levels for the prognosis were 3.55 and 19.01, respectively. The novel serum tumor biomarker (NSTB) scores were as follows: score 0: Pre-NCRT CEA < 3.55 and CA19-9 < 19.01; score 2: Pre-NCRT CEA > 3.55 and CA19-9 > 19.01; score 1: Other situations. Pathological information was recorded according to histopathological reports after the operation.
RESULTS In the univariate analysis, pre-NCRT CEA < 3.55 [P = 0.025 for overall survival (OS), P = 0.019 for disease-free survival (DFS)], pre-NCRT CA19-9 < 19.01 (P = 0.014 for OS, P = 0.009 for DFS), a lower NSTB score (0-1 vs 2, P = 0.009 for OS, P = 0.005 for DFS) could predict a better prognosis. However, in the multivariate analysis, only a lower NSTB score (0-1 vs 2; for OS, HR = 0.485, 95%CI: 0.251-0.940, P = 0.032; for DFS, HR = 0.453, 95%CI: 0.234-0.877, P = 0.019) and higher pathological grade, node and metastasis stage (0-I vs II-III; for OS, HR = 0.363, 95%CI: 0.158-0.837, P = 0.017; for DFS, HR = 0.342, 95%CI: 0.149-0.786, P = 0.012) were independent predictive factors.
CONCLUSION The combination of post-NCRT CEA and CA19-9 was a predictive factor for clinical stage II/III RC patients receiving NCRT, and the combined index had a stronger predictive effect.
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Affiliation(s)
- Jie-Yi Zhao
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Qing-Qing Tang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yu-Ting Luo
- West China Medical School, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Shu-Min Wang
- West China Medical School, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Xiao-Rui Zhu
- West China Medical School, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Xiao-Yu Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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Shi Y, Li X, Zhang X, Wang S, Pu J, Zhang L, Hu Z. Constructing and Validating a Prognosis Predictive Nomogram for Cancer-Specific Survival in Rectal Cancer Patients Receiving Preoperative Radiotherapy. J INVEST SURG 2022; 35:1526-1535. [PMID: 35618267 DOI: 10.1080/08941939.2022.2078021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background A predictive tool is required to identify the cancer-specific survival in rectal cancer (RC) patients who have opted to receive preoperative radiotherapy.Methods A database containing the data on RC patients' records of Surveillance, Epidemiology, and End Results (SEER) receiving surgery during 2000-2014 was selected. All patients received neoadjuvant radiotherapy (NR). The correlation of clinicopathological parameters was analyzed using the Chi-square test and the survival risk factors were analyzed using the Cox proportional hazards analysis (univariate and multivariate). Finally, the nomogram was developed and validated to visually represent an accurate prediction of the probability of 3- and 5-year cancer-specific survival (CSS) based on the screened variables of the cohort.Results 11,499 rectal cancer patients were included in our cohort. Patients' records were randomly allocated to either the development or validation cohorts based on an equal ratio (1:1). Performing the multivariate Cox regression analysis incorporating these variables in the development cohort determined 11 independent prognostic factors. Statistically significant differences were recorded among subgroups using log-rank tests, which confirmed the appropriateness and acceptability of factor stratifications. Then, the nomogram was constructed and its concordance index (C-index) values in the development cohort (0.720) and validation cohort (0.717) were evaluated to be higher (P<0.05) than those of the AJCC stage (0.631 and 0.633 respectively). Also, the 3-year AUC values of this nomogram were higher than those of the AJCC stage in both the development cohort (0.746 vs. 0.631) and the validation cohort (0.745 vs. 0.640). Using DCA curves, the predictive potential of the currently developed nomogram outperformed the conventional AJCC staging system.Conclusion The nomogram model might be a more reliable tool to predict prognosis accurately in rectal cancer patients receiving preoperative radiotherapy.
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Affiliation(s)
- Yunjie Shi
- Department of Anorectal Surgery, Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Xinxing Li
- Department of General Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xukun Zhang
- Academy for Engineering and Technology, Fudan University, Shanghai, China
| | - Shengyun Wang
- Department of Emergency and Critical Care Medicine, Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Jun Pu
- Department of Anesthesiology, Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Lihua Zhang
- Academy for Engineering and Technology, Fudan University, Shanghai, China
| | - Zhiqian Hu
- Department of Anorectal Surgery, Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai, China.,Department of General Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
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