Rectosigmoid Junction Cancer; The Role of Preoperative and Postoperative Radiation With Novel Nomogram in Predicting Survival in the United States

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical colorectal cancer Pub Date : 2024-11-22 DOI:10.1016/j.clcc.2024.11.002

Marjan Khan , Abdullah Chandasir , Abdul Qahar Khan Yasinzai , Jaylyn Robinson , Israr Khan , Zulfiqar Haider Jogezai , Agha Wali , Hritvik Jain , Asif Iqbal , Amir Humza Sohail , Asad Ullah

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引用次数: 0

Abstract

Background

There is controversy and limited data the management of rectosigmoid junction cancer (RSJC), especially the role of radiation. We aim to investigate the role of preoperative and postoperative radiation in RSJC and whether this cancer should be treated as a colon cancer or as a rectal cancer.

Methods

The data were extracted from the Surveillance, Epidemiology, and End Results (SEER) database and identified from 2000 to 2018.

Results

Of the 50,779 patients, 87% were ≥50 years old, 56.2% were male, 80.8% were White. Regarding tumor characteristics, 76% were Grade II, while 22.7% had distant-stage. 16.4% of patients were treated with multimodal therapy (surgery with chemoradiation), 47.9% surgery alone, 6.5% of patients received preoperative radiation, and 9.9% received postoperative radiation. Regarding prognostic significance of pre-operative and postoperative radiation factors, we evaluated factors, such as age, gender, race, tumor size, histologic variants of adenocarcinoma, and tumor grade. Patients with distant-staged tumors who received preoperative radiation had lower mortality compared to those who received postoperative radiation (95% CI, 0.73 – 0.97, (hazard ratio (HR) = 0.85, p = 0.04). There were no survival differences for localized or regional disease regarding pre and postoperative radiation, or when sub-stratifying for any other significant demographic or tumor characteristics.

Conclusion

Surgery with adjuvant chemoradiation had the best prognosis for all demographic and tumor characteristics. Preoperative radiation had a good prognosis only in distant disease. However, further randomized evidence is required to demonstrate the efficacy of pre-and post-operative radiation in rectosigmoid junction cancer.

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直肠乙状结肠结癌；在美国，术前和术后放疗与新型Nomogram预测生存率的作用。

背景：关于直肠乙状结肠结癌（RSJC）的治疗，特别是放射治疗的作用存在争议和有限的资料。我们的目的是探讨术前和术后放疗在RSJC中的作用，以及这种癌症是否应该作为结肠癌或直肠癌治疗。方法：数据从监测、流行病学和最终结果（SEER）数据库中提取，并从2000年至2018年进行识别。结果：50779例患者中，≥50岁的占87%，男性56.2%，白人80.8%。在肿瘤特征方面，76%为II级，22.7%为远处分期。16.4%的患者接受多模式治疗（手术加放化疗），47.9%的患者单独手术，6.5%的患者术前接受放疗，9.9%的患者术后接受放疗。关于术前和术后放疗因素的预后意义，我们评估了年龄、性别、种族、肿瘤大小、腺癌的组织学变异和肿瘤分级等因素。远处分期肿瘤患者术前接受放疗的死亡率低于术后接受放疗的患者（95% CI, 0.73 - 0.97，风险比(HR) = 0.85, p = 0.04）。对于局部或区域性疾病，在术前和术后放疗，或根据其他重要的人口统计学或肿瘤特征进行亚分层时，生存率没有差异。结论：手术配合放化疗在所有人口统计学和肿瘤特征方面预后最好。术前放疗仅对远处病变预后良好。然而，需要进一步的随机证据来证明术前和术后放射治疗直肠乙状结肠结癌的疗效。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical colorectal cancer 医学-肿瘤学

CiteScore

5.50

自引率

2.90%

发文量

审稿时长

27 days

期刊介绍： Clinical Colorectal Cancer is a peer-reviewed, quarterly journal that publishes original articles describing various aspects of clinical and translational research of gastrointestinal cancers. Clinical Colorectal Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of colorectal, pancreatic, liver, and other gastrointestinal cancers. The main emphasis is on recent scientific developments in all areas related to gastrointestinal cancers. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.