Clinical colorectal cancer最新文献_第3页

Escalated Segmental and Modified Radiation Lobectomy Dosing for Yttrium-90 Radioembolization of Liver-Dominant Metastatic Colorectal Cancer: 10-year Outcomes 肝主导型转移性结直肠癌的放射栓塞治疗中，渐进式节段放疗和改良放射肺叶切除术剂量：10年结果。

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical colorectal cancer

Pub Date : 2025-02-28 DOI: 10.1016/j.clcc.2025.02.005

Andrew C Gordon , Saad Abu Zahra , Muhamad Serhal , Sheetal M Kircher , Aparna Kalyan , Kent Sato , Ahsun Riaz , Elias Hohlastos , Riad Salem , Robert J Lewandowski

Purpose

This study evaluates the safety and efficacy of escalated-dosing Yttrium-90 transarterial radioembolization (TARE) for unresectable, unablatable metastatic colorectal cancer (mCRC) to the liver.

Materials and Methods

A retrospective review (September 2009 to March 2020) included 45 patients with liver-dominant mCRC treated with segmental Y90 or modified radiation lobectomy. Patient demographics, treatment details, adverse events, imaging response, and overall survival (OS) were analyzed. OS Prognosticators were examined using log-rank test and Cox proportional hazards regression.

Results

45 patients (median age 61.4 years; 60% male) were included, with 96% ECOG 0-1. Prior treatments included primary site resection (93%), liver resection (65%), chemotherapy (60%), and ablation (27%). Extrahepatic disease was present in 51%. 71% of patients had < 25% liver tumor burden (mean tumor size = 4.8 cm). Treatment was technically successful in all cases, with 4% 30-day mortality. Adverse events were mostly low-grade, including fatigue (58%) and abdominal pain (20%). Mean neutrophil-to-lymphocyte ratio (NLR) increase was 2.9, and 33% of patients showed 50% reduction in CEA. Imaging responses (RECIST) included SD (80%), PR (18%), PD (2%), and CR (0%), with PET/CT showing 39% objective response after 4.2 months. Median OS was 41.9 months (95% CI 15.4-NE). Extrahepatic disease significantly reduced OS (15.7 vs. 44.4 months, P = .0033). Both pre- and post-NLR (HR:1.42, P = .007; HR 1.12, P = .027) were associated with worse OS. In the multivariable analysis, Pre-NLR and extrahepatic disease remained adverse prognosticators.

Conclusion

Y90 TARE with escalated dosing demonstrated an acceptable safety profile in heavily pretreated mCRC patients. Extrahepatic disease and pre-NLR were significant adverse prognosticators. Future studies should explore Y90 TARE dosing in mCRC patients.

目的：本研究评估增大剂量钇-90经动脉放射栓塞（TARE）治疗不可切除、不可治愈的肝转移性结直肠癌（mCRC）的安全性和有效性。材料和方法：一项回顾性研究（2009年9月至2020年3月）包括45例肝为主的mCRC患者，他们接受了节段性Y90或改良的放射线肺叶切除术。分析患者人口统计学、治疗细节、不良事件、影像学反应和总生存期（OS）。采用log-rank检验和Cox比例风险回归对OS预后者进行检验。结果：45例患者(中位年龄61.4岁；60%为男性)，96%为ECOG 0-1。既往治疗包括原发部位切除（93%）、肝切除（65%）、化疗（60%）和消融（27%）。肝外疾病占51%。71%的患者肝脏肿瘤负荷< 25%（平均肿瘤大小= 4.8 cm）。所有病例的治疗在技术上都是成功的，30天死亡率为4%。不良事件大多为轻度，包括疲劳（58%）和腹痛（20%）。平均中性粒细胞与淋巴细胞比值（NLR）增加2.9,33%的患者CEA降低50%。影像学反应（RECIST）包括SD（80%）、PR（18%）、PD（2%）和CR(0%)， 4.2个月后PET/CT显示39%的客观反应。中位生存期为41.9个月（95% CI 15.4-NE）。肝外疾病显著降低OS（15.7个月vs. 44.4个月，P = 0.0033）。nlr前后(HR:1.42, P = .007；HR 1.12, P = 0.027)与较差的OS相关。在多变量分析中，前nlr和肝外疾病仍然是不良预后因素。结论：递增剂量的Y90 TARE在重度预处理的mCRC患者中显示出可接受的安全性。肝外疾病和nlr前是显著的不良预后因素。未来的研究应该探索Y90 TARE在mCRC患者中的剂量。

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引用次数: 0

Number of Lymph Nodes Examined as a Prognosis Factor in Patients With Stage II or III Colon Cancer 淋巴结数目与II期或III期结肠癌患者预后的关系

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical colorectal cancer

Pub Date : 2025-02-28 DOI: 10.1016/j.clcc.2025.02.004

Hyunwook Kim , Lingjie Shen , Jeongseok Jeon , Yoon Dae Han , Dai Hoon Han , Minsun Jung , Seo Jeong Shin , Seng Chan You , Nam Kyu Kim , Byung Soh Min , Hyuk Hur , Joong Bae Ahn , Sang Joon Shin , Anna Jacoba van Gestel , Felice N. van Erning , Gijs Geleijnse , Han Sang Kim

Background

Lymph node (LN) examination is important for staging colorectal cancer. Examining < 12 LN has been associated with a poor prognosis. However, surgical and pathological advances have led to increase examined LN, necessitating the reassessment of the best cutoff for prognosis.

Patients and Methods

We reviewed patients with stage II–III colon cancer from the Yonsei Cancer Center Registry (YCC) database and the Netherlands Cancer Registry (NCR). The optimal LN cutoff was determined by comparison with hazard ratio (HR) in 12 LN. We compared higher vs. lower LN cutoff effects on a 6-year overall survival (OS).

Results

From 2005 to 2015, the proportion with < 12 LN decreased significantly (P < .001). There was no significant association between 6-year OS and LN yield in all stages II–III patients (HR = 1.21, P = .116), stage II (HR = 1.39, P = .068), and stage III (HR = 1.18, P = .297) colon cancer based on the standard 12 LN examined, whereas the 20 LN cutoff examined was associated with a significant increase in 6-year OS in all patients (HR = 1.51, P < .001). Multivariate regression revealed a significant decrease in 6-year OS in stage II (HR = 1.39, P = .026) and stage III (HR = 1.47, P < .001) with < 20 LN yield. In the NCR, < 20 LN was associated with poorer 6-year OS in stage II–III patients (HR = 1.25, P < .001), stage II (HR = 1.43, P < .001), and stage III (HR = 1.13, P = .007).

Conclusion

Over the past decade, inadequate LN examinations have significantly decreased. Compared to < 12 LN, < 20 LN examined is more associated with a worse prognosis in patients who underwent surgery.

背景：淋巴结（LN）检查对结直肠癌的分期很重要。检查< 12 LN与预后不良有关。然而，手术和病理的进步导致检查的LN增加，需要重新评估预后的最佳界限。患者和方法：我们回顾了来自延世癌症中心登记处（YCC）数据库和荷兰癌症登记处（NCR）的II-III期结肠癌患者。通过与12例LN的风险比（HR）比较，确定最佳LN截止值。我们比较了较高和较低的LN截止效应对6年总生存期（OS）的影响。结果：2005 ~ 2015年，LN < 12的患者比例明显下降（P < 0.001）。在所有II-III期结肠癌患者（HR = 1.21, P = 0.116）、II期（HR = 1.39, P = 0.068）和III期（HR = 1.18, P = 0.297）中，基于标准12个LN检查的6年OS与所有患者的6年OS显著增加相关（HR = 1.51, P < .001）。多因素回归显示，6年OS在II期（HR = 1.39, P = 0.026）和III期（HR = 1.47, P < 0.001）显著降低，LN产率< 20。在NCR中，II-III期（HR = 1.25, P < .001）、II期（HR = 1.43, P < .001）和III期（HR = 1.13, P = .007）患者< 20 LN与较差的6年OS相关。结论：在过去的十年中，LN检查不充分的情况显著减少。与< 12 LN相比，接受手术的患者检查< 20 LN与较差的预后更相关。

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引用次数: 0

A Phase Two, Single-Arm, Open-Label Study With Dostarlimab Monotherapy in Participants With Untreated Stage II/III dMMR/MSI-H Locally Advanced Rectal Cancer (AZUR-1) 多斯塔利单抗单药治疗未治疗的II/III期dMMR/MSI-H局部晚期直肠癌（AZUR-1）的2期单臂开放标签研究

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical colorectal cancer

Pub Date : 2025-02-21 DOI: 10.1016/j.clcc.2025.02.003

Andrea Cercek , Jean-Baptiste Bachet , Jaume Capdevila , Naureen Starling , Eric Chen , Lisa Salvatore , Hideaki Bando , Sean O'Donnell , Lauren Harfst , Zsolt Szijgyarto , Volker Heinemann

Background

Colorectal cancer (CRC) had the second highest cancer mortality worldwide in 2020; nearly a third of CRCs were rectal cancers (RC). A recent study demonstrated that dostarlimab, an immune-checkpoint inhibitor, was highly effective in treating mismatch repair deficient (dMMR) locally advanced RC as all included patients had a clinical complete response (cCR) without radiation or chemotherapy. This study's objective is to evaluate the efficacy and safety of dostarlimab monotherapy in patients with previously untreated locally advanced dMMR RC.

Patients/Methods

AZUR-1 (NCT05723562) is a multicenter, open-label, nonrandomized, single-arm phase 2 study enrolling approximately 150 patients across 10 countries. Key eligibility criteria include dMMR status or microsatellite instability-high (MSI-H) phenotype. Dostarlimab 500 mg will be administered intravenously every 3 weeks for 9 cycles. The primary endpoint is cCR by independent central review (ICR) at 12 months. Key secondary endpoints include cCR by ICR at 24 and 36 months, and 3-year event-free survival by investigator assessment. Additional secondary endpoints include organ preservation rate at 3 years and disease-specific survival and overall survival at 5 years. Efficacy and safety will be assessed in all patients who receive ≥1 dose of dostarlimab. All patients will be followed for 5 years (unless consent is withdrawn).

Conclusions

AZUR-1 will evaluate the efficacy of dostarlimab immunotherapy in dMMR/MSI-H RC. Utilizing novel aspects including long follow-up of all patients and standardization of clinical response assessment, this study will provide international multicentric data to evaluate tumor response in an immunotherapy setting and new evidence on long-term outcomes.

背景：2020年，结直肠癌（CRC）是全球第二高的癌症死亡率；近三分之一的crc是直肠癌（RC）。最近的一项研究表明，dostarlimab是一种免疫检查点抑制剂，对于治疗局部晚期RC （dMMR）非常有效，因为所有纳入的患者在没有放疗或化疗的情况下都有临床完全缓解（cCR）。本研究的目的是评估多司达单抗单药治疗先前未治疗的局部晚期dMMR RC患者的疗效和安全性。患者/方法：AZUR-1 （NCT05723562）是一项多中心、开放标签、非随机、单臂2期研究，在10个国家招募了约150名患者。关键资格标准包括dMMR状态或微卫星不稳定性高（MSI-H）表型。Dostarlimab 500mg每3周静脉给药，共9个周期。主要终点是12个月时独立中心审查（ICR）的cCR。关键次要终点包括24个月和36个月ICR的cCR，以及研究者评估的3年无事件生存期。其他次要终点包括3年的器官保存率、5年的疾病特异性生存和总生存。将对所有接受≥1剂量dostarlimab的患者的疗效和安全性进行评估。所有患者将被随访5年（除非撤回同意）。结论：AZUR-1将评估多斯塔利单抗免疫治疗dMMR/MSI-H RC的疗效。利用新颖的方面，包括所有患者的长期随访和临床反应评估的标准化，本研究将提供国际多中心数据来评估免疫治疗环境下的肿瘤反应，并为长期结果提供新的证据。

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引用次数: 0

Association Between Colorectal Cancer Primary Features and Liver Metastases Histological Growth Patterns: Inflammation on the Primary Tumor is Associated with Desmoplastic Growth Pattern 结直肠癌原发特征与肝转移组织学生长模式的关系：原发肿瘤的炎症与结缔组织增生生长模式相关。

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical colorectal cancer

Pub Date : 2025-02-07 DOI: 10.1016/j.clcc.2025.01.004

Ana Margarida Abrantes , Rui Caetano-Oliveira , Bárbara Oliveiros , Maria Augusta Cipriano , José Guilherme Tralhão

Background

More than 50% of patients diagnosed with colorectal cancer (CRC) will develop liver metastases (CRCLM), which is the main cause of death for more than 60% of these patients. The aim of this study was to correlate the clinical and pathological characteristics of the primary CRC and CRCLM, with emphasis in predicting the histological growth pattern of the CRCLM.

Methods

Cohort of 73 patients with CRC. Analysis of clinical data and blinded pathological review was performed related with primary tumor and CRCLM features. The analysis was performed in SPSS (version 27) with a significance level of 5%.

Results

A statistically significant association was found between tumor size and metastasis growth pattern (P = .002), with larger tumors giving rise to metastases with a nondesmoplastic growth pattern. Lymphovascular invasion (LVI) was associated with metachronous CRCLM (P = .043). In the absence of LVI, the time required for CRCLM to appear was significantly longer (P = .011). The number of metastases was significantly higher (P = .049) in tumors without LVI when compared to tumors with LVI. There was a statistically significant association between CRC high-grade inflammation and the desmoplastic metastases growth pattern of the CRCLM (P = .017).

Conclusion

The possibility of predicting the CRCLM histological growth pattern resorting to primary CRC characteristics would be useful for proper patient selection for surgery and adapting biological therapies.

背景：超过50%的结直肠癌（CRC）患者会发展为肝转移（CRCLM），这是超过60%的结直肠癌患者死亡的主要原因。本研究的目的是将原发性结直肠癌和CRCLM的临床和病理特征联系起来，重点是预测CRCLM的组织学生长模式。方法：对73例结直肠癌患者进行队列研究。对原发肿瘤及CRCLM特征进行临床资料分析及病理盲法检查。采用SPSS （version 27）进行分析，显著性水平为5%。结果：在肿瘤大小和转移生长模式之间发现了统计学上显著的关联（P = 0.002），更大的肿瘤引起转移，而非结缔组织增生模式。淋巴血管侵袭（LVI）与异时性CRCLM相关（P = 0.043）。在没有LVI的情况下，CRCLM出现所需的时间明显更长（P = 0.011）。与有LVI的肿瘤相比，无LVI的肿瘤转移数量显著增加（P = 0.049）。CRC高级别炎症与CRCLM的结缔组织增生转移生长模式有统计学意义（P = 0.017）。结论：根据原发性结直肠癌的特征来预测CRCLM的组织学生长模式，将有助于正确选择患者的手术和适应生物治疗。

{"title":"Association Between Colorectal Cancer Primary Features and Liver Metastases Histological Growth Patterns: Inflammation on the Primary Tumor is Associated with Desmoplastic Growth Pattern","authors":"Ana Margarida Abrantes , Rui Caetano-Oliveira , Bárbara Oliveiros , Maria Augusta Cipriano , José Guilherme Tralhão","doi":"10.1016/j.clcc.2025.01.004","DOIUrl":"10.1016/j.clcc.2025.01.004","url":null,"abstract":"<div><h3>Background</h3><div>More than 50% of patients diagnosed with colorectal cancer (CRC) will develop liver metastases (CRCLM), which is the main cause of death for more than 60% of these patients. The aim of this study was to correlate the clinical and pathological characteristics of the primary CRC and CRCLM, with emphasis in predicting the histological growth pattern of the CRCLM.</div></div><div><h3>Methods</h3><div>Cohort of 73 patients with CRC. Analysis of clinical data and blinded pathological review was performed related with primary tumor and CRCLM features. The analysis was performed in SPSS (version 27) with a significance level of 5%.</div></div><div><h3>Results</h3><div>A statistically significant association was found between tumor size and metastasis growth pattern (<em>P</em> = .002), with larger tumors giving rise to metastases with a nondesmoplastic growth pattern. Lymphovascular invasion (LVI) was associated with metachronous CRCLM (<em>P</em> = .043). In the absence of LVI, the time required for CRCLM to appear was significantly longer (<em>P</em> = .011). The number of metastases was significantly higher (<em>P</em> = .049) in tumors without LVI when compared to tumors with LVI. There was a statistically significant association between CRC high-grade inflammation and the desmoplastic metastases growth pattern of the CRCLM (<em>P</em> = .017).</div></div><div><h3>Conclusion</h3><div>The possibility of predicting the CRCLM histological growth pattern resorting to primary CRC characteristics would be useful for proper patient selection for surgery and adapting biological therapies.</div></div>","PeriodicalId":10373,"journal":{"name":"Clinical colorectal cancer","volume":"24 2","pages":"Pages 239-247"},"PeriodicalIF":3.3,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143532242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Does Extramural Vascular Invasion Predict Response to Neoadjuvant Therapy in Locally Advanced Rectal Cancer? 外血管侵袭能预测局部晚期直肠癌新辅助治疗的疗效吗？

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical colorectal cancer

Pub Date : 2025-02-07 DOI: 10.1016/j.clcc.2025.02.002

Neal Bhutiani , Mahmoud MG Yousef , Abdelrahman MG Yousef , Emaan U. Haque , George J. Chang , Tsuyoshi Konishi , Brian K. Bednarski , Y. Nancy You , John Paul Shen , Abhineet Uppal

Introduction

Extramural vascular invasion (EMVI) is associated with distant recurrence after treatment of locogionally advanced rectal adenocarcinomas (LARCs), but its use as a marker for response to neoadjuvant therapy is less well understood. We examined the relationship between EMVI and tumor or nodal category downstaging after treatment of LARCs with neoadjuvant therapy.

Methods

Patients with EMVI categorized on initial staging pelvic MRI for LARC who underwent curative-intent surgery after neoadjuvant therapy at MD Anderson Cancer Center from 2016 to 2022 were identified. Patients received either preoperative chemoradiation or total neoadjuvant therapy (TNT). Associations between EMVI and demographic, radiologic, and clinicopathologic variables were analyzed.

Results

EMVI was associated with higher rates of lymphovascular invasion (LVI) (46.2% vs. 27.8%, P = .001) and perineural invasion (PNI) (51.9% vs. 28.4%, P < .001) on final pathology. Patients with EMVI were more likely to have cT4 tumors (31.7% vs. 16.3%, P = .004) and cN+ status (86.8% vs. 66.3%, P = .001) and more likely to be treated with TNT rather than chemoradiation alone (62.3% vs. 41.9%, P = .005). EMVI was associated with a lower rate of pathologic complete or near-complete response (20.1% vs. 34.2%, P = .018), downstaging to ypT0-2 from cT3/4 tumors (14.9% vs. 44.4%, P = .0001), and downstaging to ypN0 from cN+ status (47.9% vs. 66.4%, P = .015).

Conclusions

Rectal tumors with EMVI are more likely to have higher clinical stage, less likely to respond to neoadjuvant therapy despite increased use of TNT, and more likely to have high-risk features for recurrence. This suggests EMVI is a marker of disease with poorer response to neoadjuvant therapy. Disease biology should be strongly considered in treatment decision-making, and new treatment strategies are needed to improve disease response.

外膜血管侵犯（EMVI）与局部进展期直肠腺癌（LARCs）治疗后远处复发有关，但其作为新辅助治疗反应的标志尚不清楚。我们研究了EMVI与LARCs接受新辅助治疗后肿瘤或淋巴结分期降低的关系。方法：选取2016年至2022年在MD安德森癌症中心接受新辅助治疗后进行治愈意图手术的EMVI患者，这些患者在LARC的初始期骨盆MRI分类。患者接受术前放化疗或全新辅助治疗（TNT）。分析EMVI与人口统计学、放射学和临床病理变量之间的关系。结果：EMVI与淋巴血管侵袭（LVI）（46.2% vs. 27.8%, P = 0.001）和周围神经侵袭（PNI）（51.9% vs. 28.4%, P < 0.001）相关。EMVI患者更容易出现cT4肿瘤（31.7% vs. 16.3%, P = 0.004）和cN+状态（86.8% vs. 66.3%, P = 0.001），更容易接受TNT治疗而不是单独放化疗（62.3% vs. 41.9%, P = 0.005）。EMVI与较低的病理完全或接近完全缓解率（20.1%对34.2%,P = 0.018）、从cT3/4肿瘤降期为ypT0-2（14.9%对44.4%,P = 0.0001）和从cN+状态降期为ypN0（47.9%对66.4%,P = 0.015）相关。结论：直肠EMVI肿瘤临床分期较高，尽管增加了TNT的使用，但对新辅助治疗的反应较低，更有可能具有复发的高危特征。这表明EMVI是对新辅助治疗反应较差的疾病的标志。在治疗决策中应充分考虑疾病生物学，并需要新的治疗策略来提高疾病反应。

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引用次数: 0

Impact of Upfront DPYD Genotyping on Fluoropyrimidine Adjuvant Therapy in Colorectal Cancer: A Real-World Data 前期DPYD基因分型对结直肠癌氟嘧啶辅助治疗的影响：真实世界数据

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical colorectal cancer

Pub Date : 2025-02-04 DOI: 10.1016/j.clcc.2025.02.001

Jatta Saarenheimo , Hugo Willför , Nesna Wahid , Antti Jekunen , Heidi Andersén

Background

The application of fluoropyrimidine-based chemotherapy in colorectal cancer treatment is known to pose significant toxicity risks, which can be mitigated by tailoring treatment according to DPYD gene variants. This study evaluates the impact of DPYD genotype-guided dosing on treatment-related toxicities and patient outcomes.

Methods

A retrospective analysis was conducted on CRC patients treated with fluoropyrimidines in adjuvant setting at The Wellbeing Services County of Ostrobothnia. Patients were divided into two cohorts based on the implementation of routine DPYD genotyping: pregenotyping (2016-2018) (n = 80) and postgenotyping (2020-2022) (n = 69). The incidence of side effects, treatment discontinuation, hospitalization, and 90-day mortality were compared between groups.

Results

The study revealed a reduction in 90-day mortality rates among patients who underwent DPYD genotyping before treatment. Patients with pathogenic DPYD variants received ≥50% reduced doses initially, leading to no severe toxicities (grade ≥3). Class 3 variants showed similar side effect profiles and hospitalization rates as untested patients but had a lower rate of treatment discontinuation.

Conclusions

Upfront DPYD genotyping appears to improve patient safety in CRC patients treated with adjuvant fluoropyrimidines, leading to personalized dosing that reduces severe toxicities and early mortality. These findings underscore the importance of integrating pharmacogenetic testing in clinical oncology to optimize treatment regimens and enhance patient care.

背景：以氟嘧啶为基础的化疗在结直肠癌治疗中的应用具有明显的毒性风险，可以根据DPYD基因变异进行定制治疗来减轻毒性风险。本研究评估了DPYD基因型指导给药对治疗相关毒性和患者预后的影响。方法：回顾性分析在促进健康服务县接受氟嘧啶辅助治疗的结直肠癌患者。根据DPYD常规基因分型的实施，将患者分为两组：基因前分型（2016-2018）（n = 80）和基因后分型（2020-2022）（n = 69）。比较两组的副作用发生率、停药率、住院率和90天死亡率。结果：该研究显示，治疗前接受DPYD基因分型的患者90天死亡率降低。致病性DPYD变体患者最初接受≥50%的剂量减少，导致没有严重毒性（等级≥3）。3类变体显示出与未测试患者相似的副作用概况和住院率，但停药率较低。结论：前期DPYD基因分型似乎提高了接受辅助氟嘧啶治疗的结直肠癌患者的安全性，导致个性化给药，减少严重毒性和早期死亡率。这些发现强调了在临床肿瘤学中整合药物遗传学检测以优化治疗方案和加强患者护理的重要性。

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引用次数: 0

Prognostic Values of Pre- and Post-Therapeutic FDG-PET in Anal Canal Cancer: Analysis of a Prospective Study FDG-PET在肛管癌治疗前后的预后价值：一项前瞻性研究分析。

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical colorectal cancer

Pub Date : 2025-02-03 DOI: 10.1016/j.clcc.2025.01.006

C. Zwarthoed , C. Jaraudias , L. Evesque , D. Baron , E. François , D. Chardin , L. Marie , D. Mitrea , Y. Château , J. Gal , C. Bailleux

Background

The aim of this post hoc study was to assess the prognostic value of 18F-FDG PET/CT quantitative parameters recorded before and after treatment for anal canal neoplasm for the disease free survival.

Materials and Methods

Consecutive, previously untreated patients with histologically proved anal cancer, with 18F-FDG PET/CT pre- and 2 months post treatment were included. The following criteria were analyzed: baseline primary tumor lesion glycolysis (TLG), metabolic tumor volume (MTV), standardized tumor volume (SUV) max and mean, SUV normalized by lean body mass (SUL) max, mean and peak, variations between pre- and post-treatment examinations for SUVmax (Delta SUVmax), TLG (Delta TLG), MTV (Delta MTV), as well as post-treatment SULpeak and SUVmax for the primary tumor, and baseline sum of lesions TLG and MTV.

Results

About 78 consecutive patients were included in this study. Median follow-up was 49 months. Baseline TLG, SUVmax, SULpeak, SULmax, sum of lesions for TLG and MTV, Delta SUVmax, and post-therapeutic SULpeak and SUVmax for the primary tumor, were statistically significant for disease free survival.

Conclusion

Pretherapeutic 18F-FDG PET/CT has a statistically significant prognostic value. The wide variability of results published in literature compels us to specifically explore the interest of uptake variations between pre- and post-treatment examinations.

背景：本事后研究的目的是评估肛管肿瘤治疗前后记录的18F-FDG PET/CT定量参数对无病生存的预后价值。材料和方法：纳入连续未治疗的经组织学证实的肛门癌患者，治疗前和治疗后2个月进行18F-FDG PET/CT检查。分析以下标准：基线原发肿瘤病变糖酵解（TLG）、代谢肿瘤体积（MTV）、标准化肿瘤体积（SUV） max和平均值、SUV按瘦体重（SUL） max、平均值和峰值归一化、治疗前后SUVmax （Delta SUVmax）、TLG （Delta TLG）、MTV （Delta MTV）、原发肿瘤治疗后SULpeak和SUVmax检查的变化、TLG和MTV基线病变总和。结果：本研究共纳入78例患者。中位随访时间为49个月。基线TLG、SUVmax、SULpeak、SULmax、TLG和MTV的病变总和、Delta SUVmax以及原发肿瘤的治疗后SULpeak和SUVmax在无病生存方面具有统计学意义。结论：治疗前18F-FDG PET/CT具有统计学意义的预后价值。在文献中发表的结果的广泛变异性迫使我们特别探索治疗前和治疗后检查之间摄取变化的兴趣。

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引用次数: 0

Prognostic Value of External Iliac Lymph Node (N1b) Metastasis in Anal Carcinoma and Validation of a New Stage Grouping System 肛门癌髂外淋巴结（N1b）转移的预后价值及新的分期分类系统的验证。

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical colorectal cancer

Pub Date : 2025-02-01 DOI: 10.1016/j.clcc.2025.01.005

Hong'en Xu , Jie Zhuang , Chenyu Zhang , Weixuan Huang , Bingchen Chen , Bo'an Zheng , Tao Song

Objective

To assess the impact of external iliac lymph node (N1b) metastasis on anal carcinoma (AC) staging and refine the Tumor-Node-Metastasis (TNM) system without modifying existing criteria.

Methods

This retrospective study was performed utilizing the data of 3,815 patients with AC included in the Surveillance, Epidemiology, and End Results (SEER) registry from 2018 to 2021. We compared the TNM8th and 9th editions with our proposed system, focusing on overall survival (OS) and cancer-specific survival (CSS). The Kaplan–Meier survival analysis and time-dependent C-index measures were employed to evaluate the 3 staging systems.

Results

The SEER registry identified only 42 patients with solitary N1b metastasis, with lymph node (LN) metastasis rates rising with higher T stages. No significant survival differences were found among N1a to N1c subgroups, yet N1a showed better OS and CSS than N1b+c (hazard ratio [HR] = 1.306, 95% confidence interval (CI): 1.011–1.687, P = .041 for OS; HR = 1.432, 95% CI: 1.088–1.886, P = .011 for CSS). The proposed TNM system, reclassifying T 1N1M0 as stage I and defining T3-T4 with LN status as stages IIIA and IIIB, showed marginally improved predictive accuracy (C-index: 0.684 vs. 0.683 for OS; 0.635 vs. 0.634 for CSS).

Conclusions

N1b metastasis minimally affects AC staging. We introduce a simplified TNM system for clinical use:

M Staging: Distant metastasis presence as M1.

T Staging: T1 as stage I, T2 as stage II, T3-T4 as stage III.

N Staging: N status noncontributory for stage I; N negative as stage A (IIA or IIIA), N positive as stage B (IIB or IIIB).

目的评估髂外淋巴结（N1b）转移对肛门癌（AC）分期的影响，并在不修改现有标准的情况下完善肿瘤-结节-转移（TNM）系统：这项回顾性研究利用了2018年至2021年纳入监测、流行病学和最终结果（SEER）登记册的3815名肛门癌患者的数据。我们将 TNM 第 8 版和第 9 版与我们提出的系统进行了比较，重点关注总生存期（OS）和癌症特异性生存期（CSS）。我们采用卡普兰-梅耶生存分析和时间依赖性C指数来评估这3种分期系统：SEER登记系统仅发现42例N1b单发转移患者，淋巴结（LN）转移率随着T分期的升高而升高。从N1a到N1c亚组之间没有发现明显的生存差异，但N1a的OS和CSS均优于N1b+c（OS的危险比[HR] = 1.306，95%置信区间（CI）：1.011-1.687，P = .041；CSS的危险比[HR] = 1.432，95%置信区间（CI）：1.088-1.886，P = .011）。拟议的TNM系统将T 1N1M0重新分类为I期，将T3-T4的LN状态定义为IIIA和IIIB期，其预测准确性略有提高（C指数：OS为0.684 vs. 0.683；CSS为0.635 vs. 0.634）：结论：N1b 转移对 AC 分期的影响很小。结论：N1b 转移对 AC 分期的影响极小，我们将简化的 TNM 系统引入临床：M分期：远处转移灶作为 M1。T分期：T1 为 I 期，T2 为 II 期，T3-T4 为 III 期。N 分期：N 状态不影响 I 期；N 阴性为 A 期（IIA 或 IIIA），N 阳性为 B 期（IIB 或 IIIB）。

{"title":"Prognostic Value of External Iliac Lymph Node (N1b) Metastasis in Anal Carcinoma and Validation of a New Stage Grouping System","authors":"Hong'en Xu , Jie Zhuang , Chenyu Zhang , Weixuan Huang , Bingchen Chen , Bo'an Zheng , Tao Song","doi":"10.1016/j.clcc.2025.01.005","DOIUrl":"10.1016/j.clcc.2025.01.005","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the impact of external iliac lymph node (N1b) metastasis on anal carcinoma (AC) staging and refine the Tumor-Node-Metastasis (TNM) system without modifying existing criteria.</div></div><div><h3>Methods</h3><div>This retrospective study was performed utilizing the data of 3,815 patients with AC included in the Surveillance, Epidemiology, and End Results (SEER) registry from 2018 to 2021. We compared the TNM8th and 9th editions with our proposed system, focusing on overall survival (OS) and cancer-specific survival (CSS). The Kaplan–Meier survival analysis and time-dependent C-index measures were employed to evaluate the 3 staging systems.</div></div><div><h3>Results</h3><div>The SEER registry identified only 42 patients with solitary N1b metastasis, with lymph node (LN) metastasis rates rising with higher T stages. No significant survival differences were found among N1a to N1c subgroups, yet N1a showed better OS and CSS than N1b+<em>c</em> (hazard ratio [HR] = 1.306, 95% confidence interval (CI): 1.011–1.687, <em>P</em> = .041 for OS; HR = 1.432, 95% CI: 1.088–1.886, <em>P</em> = .011 for CSS). The proposed TNM system, reclassifying T 1N1M0 as stage I and defining T3-T4 with LN status as stages IIIA and IIIB, showed marginally improved predictive accuracy (C-index: 0.684 vs. 0.683 for OS; 0.635 vs. 0.634 for CSS).</div></div><div><h3>Conclusions</h3><div>N1b metastasis minimally affects AC staging. We introduce a simplified TNM system for clinical use:</div><div>M Staging: Distant metastasis presence as M1.</div><div>T Staging: T1 as stage I, T2 as stage II, T3-T4 as stage III.</div><div>N Staging: N status noncontributory for stage I; N negative as stage A (IIA or IIIA), N positive as stage B (IIB or IIIB).</div></div>","PeriodicalId":10373,"journal":{"name":"Clinical colorectal cancer","volume":"24 2","pages":"Pages 248-255.e2"},"PeriodicalIF":3.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

What the Clinician Needs to Know About Laboratory Analyses of Circulating Tumor DNA 关于循环肿瘤DNA的实验室分析，临床医生需要知道什么？

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical colorectal cancer

Pub Date : 2025-01-25 DOI: 10.1016/j.clcc.2025.01.003

Cecilie Mondrup Jacobsen , Luisa Matos do Canto , Søren Kahns , Torben Frøstrup Hansen , Rikke Fredslund Andersen

Liquid biopsies offer the possibility to evaluate cancer patients using noninvasive approaches. Circulating cell-free DNA (ccfDNA) is 1 of the most used and promising sources. Detecting tumor DNA among ccfDNA (ctDNA) can be used for early cancer detection, treatment response assessment, prognosis, and predictive evaluations. Providing analyses that can increase the quality of patient treatment is very much a joint effort between laboratory scientists and clinicians. With its use approaching clinical practice, it is important for clinicians to be familiar with the basic concepts and analyses behind ctDNA results in a similar way as laboratory scientists should have knowledge of the clinical needs to provide relevant analyses. In this Perspective, we describe the whole process of ctDNA analyses, from the preanalytical standards to reporting/analyzing results, and highlight some important factors that need to be addressed in the process of implementing them to clinical practice.

液体活检提供了使用无创方法评估癌症患者的可能性。循环无细胞DNA （ccfDNA）是最常用和最有前途的来源之一。ccfDNA （ctDNA）中肿瘤DNA的检测可用于早期癌症检测、治疗反应评估、预后和预测评估。提供能够提高患者治疗质量的分析在很大程度上是实验室科学家和临床医生的共同努力。随着ctDNA的应用越来越接近临床实践，临床医生熟悉ctDNA结果背后的基本概念和分析是很重要的，就像实验室科学家应该了解临床需求以提供相关分析一样。在这个视角中，我们描述了ctDNA分析的整个过程，从分析前标准到报告/分析结果，并强调了在将其实施到临床实践过程中需要解决的一些重要因素。

引用次数: 0

Significant Alterations of Colorectal Cancer Care in the COVID-19 Pandemic With High Adherence to Quality Criteria in German Cancer Centers (CC) ‒ Data From the AIO CancerCOVID Consortium (AIO-YMO/KRK 520/ass) 在德国癌症中心（CC）， COVID-19大流行期间结直肠癌护理的显著改变与高质量标准的遵守——来自AIO CancerCOVID联盟（AIO- ymo /KRK 520/ass）的数据。

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical colorectal cancer

Pub Date : 2025-01-21 DOI: 10.1016/j.clcc.2025.01.001

Céline Lugnier , Sarah Förster , Sabine Sommerlatte , Olaf Schoffer , Jens Christmann , Anna-Lena Kraeft , Tobias Terzer , Eleni Kourti , Oliver Overheu , Elena Schlageter , Ira Ekmekciu , Waldemar Uhl , Christoph Biermann , Lothar Müller , Marianne Sinn , Stefan Kasper-Virchow , Dominik Modest , Volker Heinemann , Jochen Schmitt , Jan Schildmann , Anke Reinacher-Schick

Background

Colorectal cancer (CRC) remains a leading cause of death despite notable advancements through guideline-based management. We present data on changes of CRC care during the COVID-19 pandemic in Germany.

Methods

Retrospective data from 22 AIO CCs and an academic Institute of Pathology compared the first (fw, 03-05.2020) and second wave (sw, 11-12.2020) of the pandemic with corresponding 2019 periods. Parameters were: number of cases diagnosed, age, sex, tumor stage, surgical procedures, quality criteria of CRC care (presentation in multidisciplinary tumor boards (MTB), psychological or social consultation), number of precancerous and malignant colorectal lesions (CRL). Data points were compared as mean values with confidence intervals estimated according to Clopper and Pearson (1934). Hypothesis tests were conducted using Poisson regression models that included interaction terms (year*sex or year*age over70). Statistical significance was considered at P < .05.

Results

A total of 4316 cases diagnosed (AIO CC) revealed a substantial reduction (fw -20.58%; sw -23.48%). Hypothesis test showed a significant decline in incidence due to the fw and sw of the pandemic. Quality criteria of cancer care remained stable except for trial participation. Analysis from 60,695 CRL detected a decrease in precancerous (fw: -16 %/sw: -4 %) and malignant (fw: -18 %) lesions while malignant CRL increased in the sw (+8 %). Hypothesis test revealed a significant decline only for the fw 2020 and detected age > 70 as independent risk factor in both waves.

Conclusion

We detected substantial alterations in cancer care during the pandemic, including detected precancerous CRL. CCs showed high resilience in quality criteria for CRC care.

背景：尽管基于指南的治疗取得了显著进展，但结直肠癌（CRC）仍然是导致死亡的主要原因。我们提供了德国COVID-19大流行期间CRC护理变化的数据。方法：来自22个AIO cc和病理学学术研究所的回顾性数据，将第一波（fw, 03-05.2020）和第二波（sw, 11-12.2020）与2019年相应时期进行比较。参数包括：确诊病例数、年龄、性别、肿瘤分期、手术方式、结直肠癌护理质量标准（在多学科肿瘤委员会（MTB）中的表现、心理或社会咨询）、癌前病变和恶性结直肠癌病变数量（CRL）。根据Clopper和Pearson（1934）估计的置信区间，将数据点作为平均值进行比较。使用泊松回归模型进行假设检验，其中包括相互作用项（年龄*性别或年龄* 70岁以上）。P < 0.05认为有统计学意义。结果：共有4316例诊断为AIO CC的患者显示出显著的降低(fw -20.58%；sw -23.48%)。假设检验表明，由于流感大流行的严重性，发病率显著下降。除试验参与外，癌症治疗的质量标准保持稳定。对60,695例CRL的分析发现癌前病变（fw: - 16% /sw: - 4%）和恶性病变（fw: - 18%）减少，而恶性CRL在sw中增加（+ 8%）。假设检验显示，只有在2020年之前，年龄才会显著下降，并发现年龄在70岁以下是两波的独立危险因素。结论：我们检测到大流行期间癌症护理的实质性变化，包括检测到的癌前CRL。CCs在CRC护理的质量标准中显示出高弹性。

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引用次数: 0