Association between neoadjuvant chemoradiation and survival for patients with locally advanced rectal cancer
Aim To examine the overall survival differences for the following neoadjuvant therapy modalities – no therapy, chemotherapy alone, radiation alone and chemoradiation – in a large cohort of patients with locally advanced rectal cancer. Method Adults with clinical Stage II and III rectal adenocarcinom...
Gespeichert in:
| Veröffentlicht in: | Colorectal disease 2017-12, Vol.19 (12), p.1058-1066 |
|---|---|
| Hauptverfasser: | , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 1066 |
|---|---|
| container_issue | 12 |
| container_start_page | 1058 |
| container_title | Colorectal disease |
| container_volume | 19 |
| creator | Sun, Z. Adam, M. A. Kim, J. Turner, M. C. Fisher, D. A. Choudhury, K. R. Czito, B. G. Migaly, J. Mantyh, C. R. |
| description | Aim
To examine the overall survival differences for the following neoadjuvant therapy modalities – no therapy, chemotherapy alone, radiation alone and chemoradiation – in a large cohort of patients with locally advanced rectal cancer.
Method
Adults with clinical Stage II and III rectal adenocarcinoma were selected from the National Cancer Database and grouped by type of neoadjuvant therapy received: no therapy, chemotherapy only, radiotherapy only or chemoradiation. Multivariable regression methods were used to compare adjusted differences in perioperative outcomes and overall survival.
Results
Among 32 978 patients included, 9714 (29.5%) received no neoadjuvant therapy, 890 (2.7%) chemotherapy only, 1170 (3.5%) radiotherapy only and 21 204 (64.3%) chemoradiation. Compared with no therapy, chemotherapy or radiotherapy alone were not associated with any adjusted differences in surgical margin positivity, permanent colostomy rate or overall survival (all P > 0.05). With adjustment, neoadjuvant chemoradiation vs no therapy was associated with a lower likelihood of surgical margin positivity (OR 0.74, P |
| doi_str_mv | 10.1111/codi.13754 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1907003934</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1970515320</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3574-fceb9aee65ec13b826228d8ffde0ccfc4351f5f61202da5979eee80c3580ad653</originalsourceid><addsrcrecordid>eNp90U1PwyAYB3BiNG5OL34AQ-LFmHRCKS09LvNtyZJd9NwweMi6sDKh3bJvL3vRgwe58JLf8w_wIHRLyZDG8aScroeUFTw7Q32a5SyhjIrzwzpNRElJD12FsCSE5gUVl6iXCi5yTso-sqMQnKplW7sGz6HdAjS4ASf1stvIpsVqASvnpT4R2WgcOr-pN9Ji4zxex3No2oC3dbvA1ilp7Q5LHYsVaOxBtVGq_c5fowsjbYCb0zxAn68vH-P3ZDp7m4xH00QxXmSJUTAvJUDOQVE2F2mepkILYzQQpYzKGKeGm5ymJNWSl0UJAILEYkGkzjkboIdj7tq7rw5CW63qoMBaGV_WhYqWpCCElSyL9P4PXbrON_F2URWEU85SEtXjUSnvQvBgqrWvV9LvKkqqfQ-qfQ-qQw8ivjtFdvMV6F_68-kR0CPY1hZ2_0RV49nz5Bj6Dbu3k4w</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1970515320</pqid></control><display><type>article</type><title>Association between neoadjuvant chemoradiation and survival for patients with locally advanced rectal cancer</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Sun, Z. ; Adam, M. A. ; Kim, J. ; Turner, M. C. ; Fisher, D. A. ; Choudhury, K. R. ; Czito, B. G. ; Migaly, J. ; Mantyh, C. R.</creator><creatorcontrib>Sun, Z. ; Adam, M. A. ; Kim, J. ; Turner, M. C. ; Fisher, D. A. ; Choudhury, K. R. ; Czito, B. G. ; Migaly, J. ; Mantyh, C. R.</creatorcontrib><description>Aim
To examine the overall survival differences for the following neoadjuvant therapy modalities – no therapy, chemotherapy alone, radiation alone and chemoradiation – in a large cohort of patients with locally advanced rectal cancer.
Method
Adults with clinical Stage II and III rectal adenocarcinoma were selected from the National Cancer Database and grouped by type of neoadjuvant therapy received: no therapy, chemotherapy only, radiotherapy only or chemoradiation. Multivariable regression methods were used to compare adjusted differences in perioperative outcomes and overall survival.
Results
Among 32 978 patients included, 9714 (29.5%) received no neoadjuvant therapy, 890 (2.7%) chemotherapy only, 1170 (3.5%) radiotherapy only and 21 204 (64.3%) chemoradiation. Compared with no therapy, chemotherapy or radiotherapy alone were not associated with any adjusted differences in surgical margin positivity, permanent colostomy rate or overall survival (all P > 0.05). With adjustment, neoadjuvant chemoradiation vs no therapy was associated with a lower likelihood of surgical margin positivity (OR 0.74, P < 0.001), decreased rate of permanent colostomy (OR 0.77, P < 0.001) and overall survival [hazard ratio (HR) 0.79, P < 0.001]. When compared with chemotherapy or radiotherapy alone, chemoradiation remained associated with improved overall survival (vs chemotherapy alone HR 0.83, P = 0.04; vs radiotherapy alone HR 0.83, P < 0.019).
Conclusion
Neoadjuvant chemoradiation, not chemotherapy or radiotherapy alone, is important for sphincter preservation, R0 resection and survival for patients with locally advanced rectal cancer. Despite this finding, one‐third of patients in the United States with locally advanced rectal cancer fail to receive stage‐appropriate chemoradiation.</description><identifier>ISSN: 1462-8910</identifier><identifier>EISSN: 1463-1318</identifier><identifier>DOI: 10.1111/codi.13754</identifier><identifier>PMID: 28586509</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Adenocarcinoma ; Aged ; Cancer therapies ; Chemoradiation ; Chemoradiotherapy ; Chemoradiotherapy - methods ; Chemoradiotherapy - mortality ; Chemotherapy ; Colostomy - statistics & numerical data ; Combined Modality Therapy ; Databases, Factual ; Disease-Free Survival ; Female ; Humans ; Male ; Margins of Excision ; Middle Aged ; Neoadjuvant Therapy - methods ; Neoadjuvant Therapy - mortality ; Neoplasm Staging ; Ostomy ; Preservation ; Proportional Hazards Models ; Radiation ; Radiation therapy ; rectal cancer ; Rectal Neoplasms - mortality ; Rectal Neoplasms - pathology ; Rectal Neoplasms - therapy ; Rectum ; Retrospective Studies ; Sphincter ; Survival ; Treatment Outcome ; United States</subject><ispartof>Colorectal disease, 2017-12, Vol.19 (12), p.1058-1066</ispartof><rights>Colorectal Disease © 2017 The Association of Coloproctology of Great Britain and Ireland</rights><rights>Colorectal Disease © 2017 The Association of Coloproctology of Great Britain and Ireland.</rights><rights>Copyright © 2017 The Association of Coloproctology of Great Britain and Ireland</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3574-fceb9aee65ec13b826228d8ffde0ccfc4351f5f61202da5979eee80c3580ad653</citedby><cites>FETCH-LOGICAL-c3574-fceb9aee65ec13b826228d8ffde0ccfc4351f5f61202da5979eee80c3580ad653</cites><orcidid>0000-0003-0779-4141</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fcodi.13754$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fcodi.13754$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27903,27904,45553,45554</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28586509$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sun, Z.</creatorcontrib><creatorcontrib>Adam, M. A.</creatorcontrib><creatorcontrib>Kim, J.</creatorcontrib><creatorcontrib>Turner, M. C.</creatorcontrib><creatorcontrib>Fisher, D. A.</creatorcontrib><creatorcontrib>Choudhury, K. R.</creatorcontrib><creatorcontrib>Czito, B. G.</creatorcontrib><creatorcontrib>Migaly, J.</creatorcontrib><creatorcontrib>Mantyh, C. R.</creatorcontrib><title>Association between neoadjuvant chemoradiation and survival for patients with locally advanced rectal cancer</title><title>Colorectal disease</title><addtitle>Colorectal Dis</addtitle><description>Aim
To examine the overall survival differences for the following neoadjuvant therapy modalities – no therapy, chemotherapy alone, radiation alone and chemoradiation – in a large cohort of patients with locally advanced rectal cancer.
Method
Adults with clinical Stage II and III rectal adenocarcinoma were selected from the National Cancer Database and grouped by type of neoadjuvant therapy received: no therapy, chemotherapy only, radiotherapy only or chemoradiation. Multivariable regression methods were used to compare adjusted differences in perioperative outcomes and overall survival.
Results
Among 32 978 patients included, 9714 (29.5%) received no neoadjuvant therapy, 890 (2.7%) chemotherapy only, 1170 (3.5%) radiotherapy only and 21 204 (64.3%) chemoradiation. Compared with no therapy, chemotherapy or radiotherapy alone were not associated with any adjusted differences in surgical margin positivity, permanent colostomy rate or overall survival (all P > 0.05). With adjustment, neoadjuvant chemoradiation vs no therapy was associated with a lower likelihood of surgical margin positivity (OR 0.74, P < 0.001), decreased rate of permanent colostomy (OR 0.77, P < 0.001) and overall survival [hazard ratio (HR) 0.79, P < 0.001]. When compared with chemotherapy or radiotherapy alone, chemoradiation remained associated with improved overall survival (vs chemotherapy alone HR 0.83, P = 0.04; vs radiotherapy alone HR 0.83, P < 0.019).
Conclusion
Neoadjuvant chemoradiation, not chemotherapy or radiotherapy alone, is important for sphincter preservation, R0 resection and survival for patients with locally advanced rectal cancer. Despite this finding, one‐third of patients in the United States with locally advanced rectal cancer fail to receive stage‐appropriate chemoradiation.</description><subject>Adenocarcinoma</subject><subject>Aged</subject><subject>Cancer therapies</subject><subject>Chemoradiation</subject><subject>Chemoradiotherapy</subject><subject>Chemoradiotherapy - methods</subject><subject>Chemoradiotherapy - mortality</subject><subject>Chemotherapy</subject><subject>Colostomy - statistics & numerical data</subject><subject>Combined Modality Therapy</subject><subject>Databases, Factual</subject><subject>Disease-Free Survival</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Margins of Excision</subject><subject>Middle Aged</subject><subject>Neoadjuvant Therapy - methods</subject><subject>Neoadjuvant Therapy - mortality</subject><subject>Neoplasm Staging</subject><subject>Ostomy</subject><subject>Preservation</subject><subject>Proportional Hazards Models</subject><subject>Radiation</subject><subject>Radiation therapy</subject><subject>rectal cancer</subject><subject>Rectal Neoplasms - mortality</subject><subject>Rectal Neoplasms - pathology</subject><subject>Rectal Neoplasms - therapy</subject><subject>Rectum</subject><subject>Retrospective Studies</subject><subject>Sphincter</subject><subject>Survival</subject><subject>Treatment Outcome</subject><subject>United States</subject><issn>1462-8910</issn><issn>1463-1318</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp90U1PwyAYB3BiNG5OL34AQ-LFmHRCKS09LvNtyZJd9NwweMi6sDKh3bJvL3vRgwe58JLf8w_wIHRLyZDG8aScroeUFTw7Q32a5SyhjIrzwzpNRElJD12FsCSE5gUVl6iXCi5yTso-sqMQnKplW7sGz6HdAjS4ASf1stvIpsVqASvnpT4R2WgcOr-pN9Ji4zxex3No2oC3dbvA1ilp7Q5LHYsVaOxBtVGq_c5fowsjbYCb0zxAn68vH-P3ZDp7m4xH00QxXmSJUTAvJUDOQVE2F2mepkILYzQQpYzKGKeGm5ymJNWSl0UJAILEYkGkzjkboIdj7tq7rw5CW63qoMBaGV_WhYqWpCCElSyL9P4PXbrON_F2URWEU85SEtXjUSnvQvBgqrWvV9LvKkqqfQ-qfQ-qQw8ivjtFdvMV6F_68-kR0CPY1hZ2_0RV49nz5Bj6Dbu3k4w</recordid><startdate>201712</startdate><enddate>201712</enddate><creator>Sun, Z.</creator><creator>Adam, M. A.</creator><creator>Kim, J.</creator><creator>Turner, M. C.</creator><creator>Fisher, D. A.</creator><creator>Choudhury, K. R.</creator><creator>Czito, B. G.</creator><creator>Migaly, J.</creator><creator>Mantyh, C. R.</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TM</scope><scope>7TO</scope><scope>H94</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-0779-4141</orcidid></search><sort><creationdate>201712</creationdate><title>Association between neoadjuvant chemoradiation and survival for patients with locally advanced rectal cancer</title><author>Sun, Z. ; Adam, M. A. ; Kim, J. ; Turner, M. C. ; Fisher, D. A. ; Choudhury, K. R. ; Czito, B. G. ; Migaly, J. ; Mantyh, C. R.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3574-fceb9aee65ec13b826228d8ffde0ccfc4351f5f61202da5979eee80c3580ad653</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adenocarcinoma</topic><topic>Aged</topic><topic>Cancer therapies</topic><topic>Chemoradiation</topic><topic>Chemoradiotherapy</topic><topic>Chemoradiotherapy - methods</topic><topic>Chemoradiotherapy - mortality</topic><topic>Chemotherapy</topic><topic>Colostomy - statistics & numerical data</topic><topic>Combined Modality Therapy</topic><topic>Databases, Factual</topic><topic>Disease-Free Survival</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Margins of Excision</topic><topic>Middle Aged</topic><topic>Neoadjuvant Therapy - methods</topic><topic>Neoadjuvant Therapy - mortality</topic><topic>Neoplasm Staging</topic><topic>Ostomy</topic><topic>Preservation</topic><topic>Proportional Hazards Models</topic><topic>Radiation</topic><topic>Radiation therapy</topic><topic>rectal cancer</topic><topic>Rectal Neoplasms - mortality</topic><topic>Rectal Neoplasms - pathology</topic><topic>Rectal Neoplasms - therapy</topic><topic>Rectum</topic><topic>Retrospective Studies</topic><topic>Sphincter</topic><topic>Survival</topic><topic>Treatment Outcome</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sun, Z.</creatorcontrib><creatorcontrib>Adam, M. A.</creatorcontrib><creatorcontrib>Kim, J.</creatorcontrib><creatorcontrib>Turner, M. C.</creatorcontrib><creatorcontrib>Fisher, D. A.</creatorcontrib><creatorcontrib>Choudhury, K. R.</creatorcontrib><creatorcontrib>Czito, B. G.</creatorcontrib><creatorcontrib>Migaly, J.</creatorcontrib><creatorcontrib>Mantyh, C. R.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Colorectal disease</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sun, Z.</au><au>Adam, M. A.</au><au>Kim, J.</au><au>Turner, M. C.</au><au>Fisher, D. A.</au><au>Choudhury, K. R.</au><au>Czito, B. G.</au><au>Migaly, J.</au><au>Mantyh, C. R.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Association between neoadjuvant chemoradiation and survival for patients with locally advanced rectal cancer</atitle><jtitle>Colorectal disease</jtitle><addtitle>Colorectal Dis</addtitle><date>2017-12</date><risdate>2017</risdate><volume>19</volume><issue>12</issue><spage>1058</spage><epage>1066</epage><pages>1058-1066</pages><issn>1462-8910</issn><eissn>1463-1318</eissn><abstract>Aim
To examine the overall survival differences for the following neoadjuvant therapy modalities – no therapy, chemotherapy alone, radiation alone and chemoradiation – in a large cohort of patients with locally advanced rectal cancer.
Method
Adults with clinical Stage II and III rectal adenocarcinoma were selected from the National Cancer Database and grouped by type of neoadjuvant therapy received: no therapy, chemotherapy only, radiotherapy only or chemoradiation. Multivariable regression methods were used to compare adjusted differences in perioperative outcomes and overall survival.
Results
Among 32 978 patients included, 9714 (29.5%) received no neoadjuvant therapy, 890 (2.7%) chemotherapy only, 1170 (3.5%) radiotherapy only and 21 204 (64.3%) chemoradiation. Compared with no therapy, chemotherapy or radiotherapy alone were not associated with any adjusted differences in surgical margin positivity, permanent colostomy rate or overall survival (all P > 0.05). With adjustment, neoadjuvant chemoradiation vs no therapy was associated with a lower likelihood of surgical margin positivity (OR 0.74, P < 0.001), decreased rate of permanent colostomy (OR 0.77, P < 0.001) and overall survival [hazard ratio (HR) 0.79, P < 0.001]. When compared with chemotherapy or radiotherapy alone, chemoradiation remained associated with improved overall survival (vs chemotherapy alone HR 0.83, P = 0.04; vs radiotherapy alone HR 0.83, P < 0.019).
Conclusion
Neoadjuvant chemoradiation, not chemotherapy or radiotherapy alone, is important for sphincter preservation, R0 resection and survival for patients with locally advanced rectal cancer. Despite this finding, one‐third of patients in the United States with locally advanced rectal cancer fail to receive stage‐appropriate chemoradiation.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>28586509</pmid><doi>10.1111/codi.13754</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0003-0779-4141</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1462-8910 |
| ispartof | Colorectal disease, 2017-12, Vol.19 (12), p.1058-1066 |
| issn | 1462-8910 1463-1318 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1907003934 |
| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Adenocarcinoma Aged Cancer therapies Chemoradiation Chemoradiotherapy Chemoradiotherapy - methods Chemoradiotherapy - mortality Chemotherapy Colostomy - statistics & numerical data Combined Modality Therapy Databases, Factual Disease-Free Survival Female Humans Male Margins of Excision Middle Aged Neoadjuvant Therapy - methods Neoadjuvant Therapy - mortality Neoplasm Staging Ostomy Preservation Proportional Hazards Models Radiation Radiation therapy rectal cancer Rectal Neoplasms - mortality Rectal Neoplasms - pathology Rectal Neoplasms - therapy Rectum Retrospective Studies Sphincter Survival Treatment Outcome United States |
| title | Association between neoadjuvant chemoradiation and survival for patients with locally advanced rectal cancer |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-21T10%3A17%3A23IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Association%20between%20neoadjuvant%20chemoradiation%20and%20survival%20for%20patients%20with%20locally%20advanced%20rectal%20cancer&rft.jtitle=Colorectal%20disease&rft.au=Sun,%20Z.&rft.date=2017-12&rft.volume=19&rft.issue=12&rft.spage=1058&rft.epage=1066&rft.pages=1058-1066&rft.issn=1462-8910&rft.eissn=1463-1318&rft_id=info:doi/10.1111/codi.13754&rft_dat=%3Cproquest_cross%3E1970515320%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1970515320&rft_id=info:pmid/28586509&rfr_iscdi=true |