Neoadjuvant Therapy in Rectal Cancer Patients With Clinical Stage II to III Across European Countries: Variations and Outcomes

被引：20

作者：

Babaei, Masoud ^{[1
]}

Jansen, Lina ^{[1
]}

Balavarca, Yesilda ^{[2
,3
]}

Sjovall, Annika ^{[4
]}

Bos, Amanda ^{[5
,6
]}

van de Velde, Tony ^{[7
]}

Moreau, Michel ^{[8
]}

Liberale, Gabriel ^{[8
]}

Goncalves, Ana Filipa ^{[9
]}

Bento, Maria Jose ^{[9
]}

Ulrich, Cornelia M. ^{[2
,3
,10
]}

Schrotz-King, Petra ^{[2
,3
]}

Lemmens, Valery ^{[5
,6
]}

Glimelius, Bengt ^{[11
]}

Brenner, Hermann ^{[1
,2
,3
,10
]}

机构：

[1] German Canc Res Ctr, Div Clin Epidemiol & Aging Res, INF 581, Heidelberg, Germany

[2] German Canc Res Ctr, Div Prevent Oncol, Heidelberg, Germany

[3] Natl Ctr Tumor Dis, Heidelberg, Germany

[4] Karolinska Inst, Ctr Digest Dis, Stockholm, Sweden

[5] Comprehens Canc Org Netherlands, Utrecht, Netherlands

[6] Erasmus MC Univ Med Ctr, Dept Publ Hlth, Rotterdam, Netherlands

[7] Netherlands Canc Inst, Biometr Dept, Amsterdam, Netherlands

[8] Inst Jules Bordet, Datactr, Brussels, Belgium

[9] Portuguese Oncol Inst Porto, Porto, Portugal

[10] German Canc Res Ctr, German Canc Consortium, Heidelberg, Germany

[11] Uppsala Univ, Sect Expt & Clin Oncol, Dept Immunol Genet & Pathol, Uppsala, Sweden

来源：

CLINICAL COLORECTAL CANCER | 2018年 / 17卷 / 01期

关键词：

Long-term outcomes; Neoadjuvant therapy; Rectal cancer; Survival; Variations; ADJUVANT CHEMOTHERAPY; RADIOTHERAPY; METAANALYSIS; GUIDELINES; SURGERY; DIAGNOSIS;

D O I：

10.1016/j.clcc.2017.09.002

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

This study is the largest observational study on neoadjuvant therapy in patients with stage II & III rectal cancer by including high-quality data from large population-based and clinical cancer registries. We observed large variations in administration of neoadjuvant chemo(radio) therapy across European countries. Our results support major survival advantages of patients treated with neoadjuvant radiotherapy. Background: Neoadjuvant therapy improves survival of patients with clinical stage II and III rectal cancer in clinical trials. In this study, we investigated the administration of neoadjuvant radiotherapy (neo-RT) and neoadjuvant chemoradiotherapy (neo-CRT) and its association with survival in resected patients in 2 European countries (The Netherlands and Sweden) and at 3 specialist centers. Materials and Methods: Administration of neoadjuvant treatment (all registries) and overall survival after surgery in The Netherlands and Sweden were assessed. Hazard ratios (HRs) were obtained using Cox regression adjusted for potential confounders. Results: A total of 16,095 rectal cancer patients with clinical stage II and III were eligible for analyses. Large variations in administration of neo-RT and neo-CRT were observed. Elderly patients less often received neo-RT and neo-CRT. Patients with stage III disease received neo-CRT more frequently than neo-RT. Administration of neo-RT versus surgery without neoadjuvant treatment was significantly associated with improved survival in The Netherlands (HR, 0.62; 95% confidence interval [CI], 0.53-0.73) as well as in Sweden (HR, 0.79; 95% CI, 0.69-0.90). Administration of neo-CRT was associated with enhanced survival in The Netherlands (HR, 0.62; 95% CI, 0.50-0.78) but not in Sweden (HR, 0.97; 95% CI, 0.80-1.18). The mortality of patients treated with neo-CRT compared with neo-RT showed inconsistent results in population-based centers. Conclusions: Our results support an association of neo-RT with enhanced survival among stage II and III rectal cancer patients. Comparing neo-CRT with neo-RT, larger variations and inconsistent results with respect to survival were observed across centers.

引用

页码：E129 / E142

页数：14

共 27 条

[1] Half of elderly patients routinely treated for colorectal cancer receive a sub-standard treatment [J].

Aparicio, Thomas ;

Navazesh, Atika ;

Boutron, Isabelle ;

Bouarioua, Nadia ;

Chosidow, Denis ;

Mion, Mathieu ;

Choudat, Laurence ;

Sobhani, Iradj ;

Mentre, France ;

Soule, Jean Claude .

CRITICAL REVIEWS IN ONCOLOGY HEMATOLOGY, 2009, 71 (03) :249-257

[2] Rectal Cancer Clinical Practice Guidelines in Oncology [J].

Benson, Al B., III ;

Bekaii-Saab, Tanios ;

Chan, Emily ;

Chen, Yi-Jen ;

Choti, Michael A. ;

Cooper, Harry S. ;

Engstrom, Paul F. ;

Enzinger, Peter C. ;

Fakih, Marwan G. ;

Fuchs, Charles S. ;

Grem, Jean L. ;

Hunt, Steven ;

Leong, Lucille A. ;

Lin, Edward ;

Martin, Michael G. ;

Salerno, Kilian ;

Mulcahy, Mary F. ;

Murphy, Kate ;

Rohren, Eric ;

Ryan, David P. ;

Saltz, Leonard ;

Sharma, Sunil ;

Shibata, David ;

Skibber, John M. ;

Small, William, Jr. ;

Sofocleous, Constantinos T. ;

Venook, Alan P. ;

Willett, Christopher G. ;

Freedman-Cass, Deborah A. ;

Gregory, Kristina M. .

JOURNAL OF THE NATIONAL COMPREHENSIVE CANCER NETWORK, 2012, 10 (12) :1528-1564

[3] Rectal Cancer, Version 2.2015 Featured Updates to the NCCN Guidelines [J].

Benson, Al B., III ;

Venook, Alan P. ;

Bekaii-Saab, Tanios ;

Chan, Emily ;

Chen, Yi-Jen ;

Cooper, Harry S. ;

Engstrom, Paul F. ;

Enzinger, Peter C. ;

Fenton, Moon J. ;

Fuchs, Charles S. ;

Grem, Jean L. ;

Grothey, Axel ;

Hochster, Howard S. ;

Hunt, Steven ;

Kamel, Ahmed ;

Kirilcuk, Natalie ;

Leong, Lucille A. ;

Lin, Edward ;

Messersmith, Wells A. ;

Mulcahy, Mary F. ;

Murphy, James D. ;

Nurkin, Steven ;

Rohren, Eric ;

Ryan, David P. ;

Saltz, Leonard ;

Sharma, Sunil ;

Shibata, David ;

Skibber, John M. ;

Sofocleous, Constantinos T. ;

Stoffel, Elena M. ;

Stotsky-Himelfarb, Eden ;

Willett, Christopher G. ;

Gregory, Kristina M. ;

Freedman-Cass, Deborah .

JOURNAL OF THE NATIONAL COMPREHENSIVE CANCER NETWORK, 2015, 13 (06) :719-728

[4] Is Chemotherapy or Radiation Therapy in Addition to Surgery Beneficial for Locally Advanced Rectal Cancer in the Elderly? A National Cancer Data Base (NCDB) Study [J].

Bergquist, J. R. ;

Thiels, C. A. ;

Shubert, C. R. ;

Habermann, E. B. ;

Hayman, A. V. ;

Zielinski, M. D. ;

Mathis, K. L. .

WORLD JOURNAL OF SURGERY, 2016, 40 (02) :447-455

[5] Randomized phase III study comparing preoperative radiotherapy with chemoradiotherapy in nonresectable rectal cancer [J].

Braendengen, Morten ;

Tveit, Kjell M. ;

Berglund, Ake ;

Birkemeyer, Elke ;

Frykholm, Gunilla ;

Pahlman, Lars ;

Wiig, Johan N. ;

Bystrom, Per ;

Bujko, Krzysztof ;

Glimelius, Bengt .

JOURNAL OF CLINICAL ONCOLOGY, 2008, 26 (22) :3687-3694

[6] Adjuvant chemotherapy after preoperative (chemo) radiotherapy and surgery for patients with rectal cancer: a systematic review and meta-analysis of individual patient data [J].

Breugom, Anne J. ;

Swets, Marloes ;

Bosset, Jean-Francois ;

Collette, Laurence ;

Sainato, Aldo ;

Cionini, Luca ;

Glynne-Jones, Rob ;

Counsell, Nicholas ;

Bastiaannet, Esther ;

van den Broek, Colette B. M. ;

Liefers, Gerrit-Jan ;

Putter, Hein ;

van de Velde, Cornelis J. H. .

LANCET ONCOLOGY, 2015, 16 (02) :200-207

[7] Postoperative chemotherapy in patients with rectal cancer receiving preoperative radio(chemo)therapy: A meta-analysis of randomized trials comparing surgery ± a fluoropyrimidine and surgery plus a fluoropyrimidine ± oxaliplatin [J].

Bujko, K. ;

Glimelius, B. ;

Valentini, V. ;

Michalski, W. ;

Spalek, M. .

EJSO, 2015, 41 (06) :713-723

[8] Preoperative chemoradiation versus radiation alone for stage II and III resectable rectal cancer [J].

De Caluwe, Laura ;

Van Nieuwenhove, Yves ;

Ceelen, Wim P. .

COCHRANE DATABASE OF SYSTEMATIC REVIEWS, 2013, (02)

[9] Impact of pre-treatment patient-related selection parameters on outcome in rectal cancer [J].

Elliot, A. H. ;

Martling, A. ;

Glimelius, B. ;

Johansson, H. ;

Nilsson, P. J. .

EJSO, 2016, 42 (11) :1667-1673

[10]

Fritz AG., 2000, International Classification of disease for Oncology

← 1 2 3 →