Impact of glucocorticoids on the efficacy of neoadjuvant chemoradiotherapy and survival of patients with locally advanced rectal cancer: a retrospective study
Abstracts Background Preclinical studies suggest that glucocorticoids (GCs) promote the proliferation and development of colorectal cancer. Because GCs are broadly prescribed for treatment-related adverse events in patients with locally advanced rectal cancer (LARC) receiving neoadjuvant chemoradiot...
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-03-01
|
| Series: | BMC Cancer |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12885-023-10592-0 |
| _version_ | 1797864430350893056 |
|---|---|
| author | Xiaoxue Huang Zhiyuan Zheng Bangwei Zeng Han Xiao Hao Zheng Zhuangbin Lin Jianyuan Song Anchuan Li Pan Chi Yinghong Yang Benhua Xu Rong Zheng |
| author_facet | Xiaoxue Huang Zhiyuan Zheng Bangwei Zeng Han Xiao Hao Zheng Zhuangbin Lin Jianyuan Song Anchuan Li Pan Chi Yinghong Yang Benhua Xu Rong Zheng |
| author_sort | Xiaoxue Huang |
| collection | DOAJ |
| description | Abstracts Background Preclinical studies suggest that glucocorticoids (GCs) promote the proliferation and development of colorectal cancer. Because GCs are broadly prescribed for treatment-related adverse events in patients with locally advanced rectal cancer (LARC) receiving neoadjuvant chemoradiotherapy (NCRT), it’s essential to assess the effect of GCs on clinical outcomes. Methods LARC cases treated with NCRT followed by surgery were assessed retrospectively. Evaluation of the relationship between GCs use (GCs vs. non-GCs) and neoadjuvant rectal (NAR) score (as a three-level categorical dependent variable) was performed using multivariable multinomial logistic regression (MLR). We also examined the relationship between the accumulated dose of GCs and NAR using multivariate MLR. Survival analysis of disease-free survival (DFS) and overall survival (OS) was performed using the Kaplan–Meier method. Multivariate Cox regression was used to assess confounding factors that could influence OS and DFS. Results This retrospective cohort study included 790 patients with newly diagnosed non-metastatic LARC (T3-4/N + M0) who received NCRT followed by surgery between January 2012 and April 2017. The end of the follow-up period was May 11, 2022. Among the 790 patients with LARC, 342 (43.2%) received GCs treatment and 448 (56.8%) did not during the NCRT-to-surgery period. GCs medication was significantly different between mid-NAR (8–16) and low-NAR (< 8) (odds ratio [OR], 0.615; 95% CI, 0.420–0.901; P = 0.013), and the high-NAR (> 16) and low-NAR (0.563; 0.352–0.900; 0.016). Patients exposed to GCs, had a decreased 5-year OS (GCs vs. non-GCs = 80.01% (95% CI, 75.87%–84.37%) vs. 85.30% (82.06%–88.67%), P = 0.023) and poorer 5-year DFS (73.99% (69.45%–78.82%) vs. 78.7% (75.14%–82.78%), P = 0.045). The accumulated dose of GCs was an independent risk factor for OS (hazard ratio [HR], 1.007 [1.001–1.014], 0.036) and DFS (1.010 [1.004–1.017], 0.001). Conclusions and relevance Our study revealed that GCs were associated with reduced efficacy of NCRT and worse clinical outcomes in patients with LARC during the NCRT-to-surgery period. |
| first_indexed | 2024-04-09T22:51:37Z |
| format | Article |
| id | doaj.art-712b076e448f49cbbab5dcf9c08a7624 |
| institution | Directory Open Access Journal |
| issn | 1471-2407 |
| language | English |
| last_indexed | 2024-04-09T22:51:37Z |
| publishDate | 2023-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Cancer |
| spelling | doaj.art-712b076e448f49cbbab5dcf9c08a76242023-03-22T11:35:25ZengBMCBMC Cancer1471-24072023-03-0123111310.1186/s12885-023-10592-0Impact of glucocorticoids on the efficacy of neoadjuvant chemoradiotherapy and survival of patients with locally advanced rectal cancer: a retrospective studyXiaoxue Huang0Zhiyuan Zheng1Bangwei Zeng2Han Xiao3Hao Zheng4Zhuangbin Lin5Jianyuan Song6Anchuan Li7Pan Chi8Yinghong Yang9Benhua Xu10Rong Zheng11Department of Radiation Oncology, Fujian Medical University Union HospitalDepartment of Radiation Oncology, Fujian Medical University Union HospitalNosocomial Infection Control Branch, Fujian Medical University Union HospitalDepartment of Pathology, Fujian Medical University Union HospitalDepartment of Radiation Oncology, Fujian Medical University Union HospitalDepartment of Radiation Oncology, Fujian Medical University Union HospitalDepartment of Radiation Oncology, Fujian Medical University Union HospitalDepartment of Radiation Oncology, Fujian Medical University Union HospitalDepartment of Colorectal Surgery, Fujian Medical University Union HospitalNosocomial Infection Control Branch, Fujian Medical University Union HospitalDepartment of Radiation Oncology, Fujian Medical University Union HospitalDepartment of Radiation Oncology, Fujian Medical University Union HospitalAbstracts Background Preclinical studies suggest that glucocorticoids (GCs) promote the proliferation and development of colorectal cancer. Because GCs are broadly prescribed for treatment-related adverse events in patients with locally advanced rectal cancer (LARC) receiving neoadjuvant chemoradiotherapy (NCRT), it’s essential to assess the effect of GCs on clinical outcomes. Methods LARC cases treated with NCRT followed by surgery were assessed retrospectively. Evaluation of the relationship between GCs use (GCs vs. non-GCs) and neoadjuvant rectal (NAR) score (as a three-level categorical dependent variable) was performed using multivariable multinomial logistic regression (MLR). We also examined the relationship between the accumulated dose of GCs and NAR using multivariate MLR. Survival analysis of disease-free survival (DFS) and overall survival (OS) was performed using the Kaplan–Meier method. Multivariate Cox regression was used to assess confounding factors that could influence OS and DFS. Results This retrospective cohort study included 790 patients with newly diagnosed non-metastatic LARC (T3-4/N + M0) who received NCRT followed by surgery between January 2012 and April 2017. The end of the follow-up period was May 11, 2022. Among the 790 patients with LARC, 342 (43.2%) received GCs treatment and 448 (56.8%) did not during the NCRT-to-surgery period. GCs medication was significantly different between mid-NAR (8–16) and low-NAR (< 8) (odds ratio [OR], 0.615; 95% CI, 0.420–0.901; P = 0.013), and the high-NAR (> 16) and low-NAR (0.563; 0.352–0.900; 0.016). Patients exposed to GCs, had a decreased 5-year OS (GCs vs. non-GCs = 80.01% (95% CI, 75.87%–84.37%) vs. 85.30% (82.06%–88.67%), P = 0.023) and poorer 5-year DFS (73.99% (69.45%–78.82%) vs. 78.7% (75.14%–82.78%), P = 0.045). The accumulated dose of GCs was an independent risk factor for OS (hazard ratio [HR], 1.007 [1.001–1.014], 0.036) and DFS (1.010 [1.004–1.017], 0.001). Conclusions and relevance Our study revealed that GCs were associated with reduced efficacy of NCRT and worse clinical outcomes in patients with LARC during the NCRT-to-surgery period.https://doi.org/10.1186/s12885-023-10592-0Rectal cancerGlucocorticoidsNeoadjuvant chemoradiotherapy |
| spellingShingle | Xiaoxue Huang Zhiyuan Zheng Bangwei Zeng Han Xiao Hao Zheng Zhuangbin Lin Jianyuan Song Anchuan Li Pan Chi Yinghong Yang Benhua Xu Rong Zheng Impact of glucocorticoids on the efficacy of neoadjuvant chemoradiotherapy and survival of patients with locally advanced rectal cancer: a retrospective study BMC Cancer Rectal cancer Glucocorticoids Neoadjuvant chemoradiotherapy |
| title | Impact of glucocorticoids on the efficacy of neoadjuvant chemoradiotherapy and survival of patients with locally advanced rectal cancer: a retrospective study |
| title_full | Impact of glucocorticoids on the efficacy of neoadjuvant chemoradiotherapy and survival of patients with locally advanced rectal cancer: a retrospective study |
| title_fullStr | Impact of glucocorticoids on the efficacy of neoadjuvant chemoradiotherapy and survival of patients with locally advanced rectal cancer: a retrospective study |
| title_full_unstemmed | Impact of glucocorticoids on the efficacy of neoadjuvant chemoradiotherapy and survival of patients with locally advanced rectal cancer: a retrospective study |
| title_short | Impact of glucocorticoids on the efficacy of neoadjuvant chemoradiotherapy and survival of patients with locally advanced rectal cancer: a retrospective study |
| title_sort | impact of glucocorticoids on the efficacy of neoadjuvant chemoradiotherapy and survival of patients with locally advanced rectal cancer a retrospective study |
| topic | Rectal cancer Glucocorticoids Neoadjuvant chemoradiotherapy |
| url | https://doi.org/10.1186/s12885-023-10592-0 |
| work_keys_str_mv | AT xiaoxuehuang impactofglucocorticoidsontheefficacyofneoadjuvantchemoradiotherapyandsurvivalofpatientswithlocallyadvancedrectalcanceraretrospectivestudy AT zhiyuanzheng impactofglucocorticoidsontheefficacyofneoadjuvantchemoradiotherapyandsurvivalofpatientswithlocallyadvancedrectalcanceraretrospectivestudy AT bangweizeng impactofglucocorticoidsontheefficacyofneoadjuvantchemoradiotherapyandsurvivalofpatientswithlocallyadvancedrectalcanceraretrospectivestudy AT hanxiao impactofglucocorticoidsontheefficacyofneoadjuvantchemoradiotherapyandsurvivalofpatientswithlocallyadvancedrectalcanceraretrospectivestudy AT haozheng impactofglucocorticoidsontheefficacyofneoadjuvantchemoradiotherapyandsurvivalofpatientswithlocallyadvancedrectalcanceraretrospectivestudy AT zhuangbinlin impactofglucocorticoidsontheefficacyofneoadjuvantchemoradiotherapyandsurvivalofpatientswithlocallyadvancedrectalcanceraretrospectivestudy AT jianyuansong impactofglucocorticoidsontheefficacyofneoadjuvantchemoradiotherapyandsurvivalofpatientswithlocallyadvancedrectalcanceraretrospectivestudy AT anchuanli impactofglucocorticoidsontheefficacyofneoadjuvantchemoradiotherapyandsurvivalofpatientswithlocallyadvancedrectalcanceraretrospectivestudy AT panchi impactofglucocorticoidsontheefficacyofneoadjuvantchemoradiotherapyandsurvivalofpatientswithlocallyadvancedrectalcanceraretrospectivestudy AT yinghongyang impactofglucocorticoidsontheefficacyofneoadjuvantchemoradiotherapyandsurvivalofpatientswithlocallyadvancedrectalcanceraretrospectivestudy AT benhuaxu impactofglucocorticoidsontheefficacyofneoadjuvantchemoradiotherapyandsurvivalofpatientswithlocallyadvancedrectalcanceraretrospectivestudy AT rongzheng impactofglucocorticoidsontheefficacyofneoadjuvantchemoradiotherapyandsurvivalofpatientswithlocallyadvancedrectalcanceraretrospectivestudy |