Praachi Raje, Hiroko Kunitake, Christy E Cauley, Robert N Goldstone, Grace C Lee, Rocco Ricciardi
{"title":"一项国家癌症数据库分析：直肠癌新辅助短疗程放疗后延迟手术可改善病理结果而不影响生存。","authors":"Praachi Raje, Hiroko Kunitake, Christy E Cauley, Robert N Goldstone, Grace C Lee, Rocco Ricciardi","doi":"10.1007/s12029-024-01154-z","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Interval to surgery following short course radiotherapy (SCRT) for rectal cancer is not standardized. This study investigated pathologic outcomes and survival with varying intervals to surgery.</p><p><strong>Methods: </strong>Using the National Cancer Database, adults who received SCRT from 2005 to 2020 were grouped by additional neoadjuvant chemotherapy. Outcomes were analyzed for early (within 1 week) and delayed (over 4 weeks) intervals.</p><p><strong>Results: </strong>Of 1154 patients, 671 received neoadjuvant SCRT and chemotherapy (Group 1: median interval 29 days, 50% delayed) and 483 received SCRT only (Group 2: median interval 9 days, 27% delayed). In Group 1, delay was associated with tumor downstaging (OR 1.61; 95% CI, 1.03-2.51; p = 0.036), decreased lymphovascular invasion (OR 0.53; 95% CI, 0.33-0.85; p = 0.009), and complete pathologic response (OR 2.86; 95% CI, 1.06-7.76; p = 0.039). Delay was associated with decreased tumor deposits in Group 1 (OR 0.46; 95% CI, 0.30-0.71; p < 0.001) and Group 2 (OR 0.37; 95% CI 0.21-0.65; p = 0.001). Survival was not affected.</p><p><strong>Conclusion: </strong>Delaying surgery following neoadjuvant SCRT results in favorable pathologic outcomes without impacting overall survival, regardless of neoadjuvant chemotherapy.</p>","PeriodicalId":15895,"journal":{"name":"Journal of Gastrointestinal Cancer","volume":"56 1","pages":"30"},"PeriodicalIF":1.6000,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Delayed Surgery after Neoadjuvant Short-course Radiation for Rectal Cancer Improves Pathologic Outcomes without Impacting Survival: A National Cancer Database Analysis.\",\"authors\":\"Praachi Raje, Hiroko Kunitake, Christy E Cauley, Robert N Goldstone, Grace C Lee, Rocco Ricciardi\",\"doi\":\"10.1007/s12029-024-01154-z\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Interval to surgery following short course radiotherapy (SCRT) for rectal cancer is not standardized. This study investigated pathologic outcomes and survival with varying intervals to surgery.</p><p><strong>Methods: </strong>Using the National Cancer Database, adults who received SCRT from 2005 to 2020 were grouped by additional neoadjuvant chemotherapy. Outcomes were analyzed for early (within 1 week) and delayed (over 4 weeks) intervals.</p><p><strong>Results: </strong>Of 1154 patients, 671 received neoadjuvant SCRT and chemotherapy (Group 1: median interval 29 days, 50% delayed) and 483 received SCRT only (Group 2: median interval 9 days, 27% delayed). In Group 1, delay was associated with tumor downstaging (OR 1.61; 95% CI, 1.03-2.51; p = 0.036), decreased lymphovascular invasion (OR 0.53; 95% CI, 0.33-0.85; p = 0.009), and complete pathologic response (OR 2.86; 95% CI, 1.06-7.76; p = 0.039). Delay was associated with decreased tumor deposits in Group 1 (OR 0.46; 95% CI, 0.30-0.71; p < 0.001) and Group 2 (OR 0.37; 95% CI 0.21-0.65; p = 0.001). Survival was not affected.</p><p><strong>Conclusion: </strong>Delaying surgery following neoadjuvant SCRT results in favorable pathologic outcomes without impacting overall survival, regardless of neoadjuvant chemotherapy.</p>\",\"PeriodicalId\":15895,\"journal\":{\"name\":\"Journal of Gastrointestinal Cancer\",\"volume\":\"56 1\",\"pages\":\"30\"},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2024-12-09\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Gastrointestinal Cancer\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1007/s12029-024-01154-z\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Gastrointestinal Cancer","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1007/s12029-024-01154-z","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"ONCOLOGY","Score":null,"Total":0}
Delayed Surgery after Neoadjuvant Short-course Radiation for Rectal Cancer Improves Pathologic Outcomes without Impacting Survival: A National Cancer Database Analysis.
Purpose: Interval to surgery following short course radiotherapy (SCRT) for rectal cancer is not standardized. This study investigated pathologic outcomes and survival with varying intervals to surgery.
Methods: Using the National Cancer Database, adults who received SCRT from 2005 to 2020 were grouped by additional neoadjuvant chemotherapy. Outcomes were analyzed for early (within 1 week) and delayed (over 4 weeks) intervals.
Results: Of 1154 patients, 671 received neoadjuvant SCRT and chemotherapy (Group 1: median interval 29 days, 50% delayed) and 483 received SCRT only (Group 2: median interval 9 days, 27% delayed). In Group 1, delay was associated with tumor downstaging (OR 1.61; 95% CI, 1.03-2.51; p = 0.036), decreased lymphovascular invasion (OR 0.53; 95% CI, 0.33-0.85; p = 0.009), and complete pathologic response (OR 2.86; 95% CI, 1.06-7.76; p = 0.039). Delay was associated with decreased tumor deposits in Group 1 (OR 0.46; 95% CI, 0.30-0.71; p < 0.001) and Group 2 (OR 0.37; 95% CI 0.21-0.65; p = 0.001). Survival was not affected.
Conclusion: Delaying surgery following neoadjuvant SCRT results in favorable pathologic outcomes without impacting overall survival, regardless of neoadjuvant chemotherapy.
期刊介绍：
The Journal of Gastrointestinal Cancer is a multidisciplinary medium for the publication of novel research pertaining to cancers arising from the gastrointestinal tract.The journal is dedicated to the most rapid publication possible.The journal publishes papers in all relevant fields, emphasizing those studies that are helpful in understanding and treating cancers affecting the esophagus, stomach, liver, gallbladder and biliary tree, pancreas, small bowel, large bowel, rectum, and anus. In addition, the Journal of Gastrointestinal Cancer publishes basic and translational scientific information from studies providing insight into the etiology and progression of cancers affecting these organs. New insights are provided from diverse areas of research such as studies exploring pre-neoplastic states, risk factors, epidemiology, genetics, preclinical therapeutics, surgery, radiation therapy, novel medical therapeutics, clinical trials, and outcome studies.In addition to reports of original clinical and experimental studies, the journal also publishes: case reports, state-of-the-art reviews on topics of immediate interest or importance; invited articles analyzing particular areas of pancreatic research and knowledge; perspectives in which critical evaluation and conflicting opinions about current topics may be expressed; meeting highlights that summarize important points presented at recent meetings; abstracts of symposia and conferences; book reviews; hypotheses; Letters to the Editors; and other items of special interest, including:Complex Cases in GI Oncology: This is a new initiative to provide a forum to review and discuss the history and management of complex and involved gastrointestinal oncology cases. The format will be similar to a teaching case conference where a case vignette is presented and is followed by a series of questions and discussion points. A brief reference list supporting the points made in discussion would be expected.
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