Prospective longitudinal trajectory of cancer survivorship among patients with recurrent rectal cancer: impact of treatment modalities and resection status

IF 2.9 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease Pub Date : 2025-05-15 DOI:10.1111/codi.70110

Tarik Sammour, Oliver Peacock, Brian K. Bednarski, Arvind Dasari, Prajnan Das, Benny Johnson, Grace L. Smith, George J. Chang, John Skibber, Y. Nancy You

{"title":"Prospective longitudinal trajectory of cancer survivorship among patients with recurrent rectal cancer: impact of treatment modalities and resection status","authors":"Tarik Sammour, Oliver Peacock, Brian K. Bednarski, Arvind Dasari, Prajnan Das, Benny Johnson, Grace L. Smith, George J. Chang, John Skibber, Y. Nancy You","doi":"10.1111/codi.70110","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Aim</h3>\n \n <p>Recurrent rectal cancer (RRC) can be morbid and optimising cancer survivorship is a priority. The longitudinal trajectories of survivorship associated with RRC have not been prospectively depicted.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>We prospectively enrolled patients with RRC. Participants self-reported quality of life (QOL) using validated European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 and CR29, and pain using the Brief Pain Inventory, at baseline and then every 6 months for up to 5 years or until death. Baseline scores and the longitudinal trajectory of scores were examined using linear mixed-effects modelling.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Among 104 patients, 73 (70.2%) received multimodality salvage treatment with curative intent, while the remainder received best palliative treatments. Curative-intent salvage including surgery was associated with a 30-day operative morbidity rate of 49% and a 5-year overall survival of 51%. Patients undergoing curative-intent salvage versus palliative treatments did not differ in baseline QOL or pain, but the longitudinal trajectory after curative-intent salvage showed sustained improvement of QOL and symptoms over time. This contrasted with the initial transient improvement but persistent decline with palliative treatments. Baseline QOL was significantly impacted by the anatomical site of RRC, with posterior location associated with worst QOL (<i>P</i> = 0.012). Long-term QOL was impacted by anatomical site and status of residual tumour. Pain scores were worse among men.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Trajectories of cancer survivorship for patients with RRC diverge, mainly influenced by anatomical site of the RCC, residual tumour status, and ability to complete curative-intent salvage. These should inform treatment planning. Optimising selection and success of multimodality therapy remains the cornerstone for durable cancer survivorship.</p>\n </section>\n </div>","PeriodicalId":10512,"journal":{"name":"Colorectal Disease","volume":"27 5","pages":""},"PeriodicalIF":2.9000,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/codi.70110","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Colorectal Disease","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/codi.70110","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Aim

Recurrent rectal cancer (RRC) can be morbid and optimising cancer survivorship is a priority. The longitudinal trajectories of survivorship associated with RRC have not been prospectively depicted.

Methods

We prospectively enrolled patients with RRC. Participants self-reported quality of life (QOL) using validated European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 and CR29, and pain using the Brief Pain Inventory, at baseline and then every 6 months for up to 5 years or until death. Baseline scores and the longitudinal trajectory of scores were examined using linear mixed-effects modelling.

Results

Among 104 patients, 73 (70.2%) received multimodality salvage treatment with curative intent, while the remainder received best palliative treatments. Curative-intent salvage including surgery was associated with a 30-day operative morbidity rate of 49% and a 5-year overall survival of 51%. Patients undergoing curative-intent salvage versus palliative treatments did not differ in baseline QOL or pain, but the longitudinal trajectory after curative-intent salvage showed sustained improvement of QOL and symptoms over time. This contrasted with the initial transient improvement but persistent decline with palliative treatments. Baseline QOL was significantly impacted by the anatomical site of RRC, with posterior location associated with worst QOL (P = 0.012). Long-term QOL was impacted by anatomical site and status of residual tumour. Pain scores were worse among men.

Conclusion

Trajectories of cancer survivorship for patients with RRC diverge, mainly influenced by anatomical site of the RCC, residual tumour status, and ability to complete curative-intent salvage. These should inform treatment planning. Optimising selection and success of multimodality therapy remains the cornerstone for durable cancer survivorship.

查看原文本刊更多论文

复发性直肠癌患者癌症生存率的前瞻性纵向轨迹：治疗方式和切除状态的影响

目的复发性直肠癌（RRC）可能是病态的，优化癌症生存是当务之急。与RRC相关的生存率的纵向轨迹尚未被前瞻性描述。方法前瞻性纳入RRC患者。参与者使用经过验证的欧洲癌症研究和治疗组织生活质量问卷C30和CR29自我报告生活质量（QOL），使用简短疼痛量表（Brief pain Inventory）自我报告疼痛，然后每6个月报告一次，持续5年或直到死亡。基线得分和得分的纵向轨迹使用线性混合效应模型进行检查。结果104例患者中，73例（70.2%）接受了以治愈为目的的多模式抢救治疗，其余患者接受了最佳姑息治疗。包括手术在内的治疗目的挽救与30天手术发病率为49%和5年总生存率为51%相关。接受治愈性挽救与姑息性治疗的患者在基线生活质量或疼痛方面没有差异，但治疗性挽救后的纵向轨迹显示，随着时间的推移，生活质量和症状持续改善。这与姑息治疗的初始短暂改善但持续下降形成对比。RRC解剖位置对基线生活质量有显著影响，后侧位置与最差生活质量相关（P = 0.012）。远期生活质量受解剖部位和肿瘤残留状态的影响。男性的疼痛评分更差。结论RRC患者的生存轨迹存在差异，主要受RCC解剖部位、残留肿瘤状态和完成治疗目的挽救能力的影响。这些应该为治疗计划提供信息。优化选择和成功的多模式治疗仍然是持久的癌症生存的基石。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Colorectal Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

11.80%

发文量

406

审稿时长

1.5 months

期刊介绍： Diseases of the colon and rectum are common and offer a number of exciting challenges. Clinical, diagnostic and basic science research is expanding rapidly. There is increasing demand from purchasers of health care and patients for clinicians to keep abreast of the latest research and developments, and to translate these into routine practice. Technological advances in diagnosis, surgical technique, new pharmaceuticals, molecular genetics and other basic sciences have transformed many aspects of how these diseases are managed. Such progress will accelerate. Colorectal Disease offers a real benefit to subscribers and authors. It is first and foremost a vehicle for publishing original research relating to the demanding, rapidly expanding field of colorectal diseases. Essential for surgeons, pathologists, oncologists, gastroenterologists and health professionals caring for patients with a disease of the lower GI tract, Colorectal Disease furthers education and inter-professional development by including regular review articles and discussions of current controversies. Note that the journal does not usually accept paediatric surgical papers.