Risk stratification of stage II rectal mucinous adenocarcinoma to predict the benefit of adjuvant chemotherapy following neoadjuvant chemoradiation and surgery
BackgroundThe treatment strategy for stage II rectal mucinous adenocarcinoma (RMA) recommends neoadjuvant chemoradiotherapy (NCR) followed by total mesorectal excision (TME). However, the necessity of adjuvant chemotherapy (AC) remains controversial.Materials and methodsChi-square test was used to a...
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| Format: | Article |
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Frontiers Media S.A.
2024-03-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2024.1352660/full |
| _version_ | 1797277247527190528 |
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| author | Yahang Liang Yahang Liang Hualin Liao Hualin Liao Haoran Shi Tao Li Tao Li Yaxiong Liu Yaxiong Liu Yuli Yuan Yuli Yuan Mingming Li Mingming Li Aidi Li Aidi Li Yang Liu Yang Liu Yao Yao Yao Yao Taiyuan Li Taiyuan Li |
| author_facet | Yahang Liang Yahang Liang Hualin Liao Hualin Liao Haoran Shi Tao Li Tao Li Yaxiong Liu Yaxiong Liu Yuli Yuan Yuli Yuan Mingming Li Mingming Li Aidi Li Aidi Li Yang Liu Yang Liu Yao Yao Yao Yao Taiyuan Li Taiyuan Li |
| author_sort | Yahang Liang |
| collection | DOAJ |
| description | BackgroundThe treatment strategy for stage II rectal mucinous adenocarcinoma (RMA) recommends neoadjuvant chemoradiotherapy (NCR) followed by total mesorectal excision (TME). However, the necessity of adjuvant chemotherapy (AC) remains controversial.Materials and methodsChi-square test was used to assess the relationship between pathological classification, AC and clinicopathological characteristics. Kaplan-Meier (KM) curves and the log-rank test were utilized to analyze differences in overall survival (OS) and cancer-specific survival (CSS) among different groups. Cox regression identified prognostic factors. Nomogram was established utilizing the independent prognostic factors. X-tile divided patients into three risk subgroups.ResultsCompared to RMA, rectal adenocarcinoma (RA) demonstrates longer OS and CSS in all and non-AC stage II patients, with no difference in OS and CSS for AC stage II patients. Propensity score matching analyses yielded similar results. Stratified analysis found that AC both improve OS of RA and RMA patients. Age, gender, pathologic T stage, regional nodes examined, and tumor size were identified as independent prognostic factors for RMA patients without AC. A nomogram was constructed to generate risk scores and categorize RMA patients into three subgroups based on these scores. KM curves revealed AC benefits for moderate and high-risk groups but not for the low-risk group. The external validation cohort yielded similar results.ConclusionsIn summary, our study suggests that, compared to stage II RA patients, stage II RMA patients benefit more from AC after NCR. AC is recommended for moderate and high-risk stage II RMA patients after NCR, whereas low-risk patients do not require AC. |
| first_indexed | 2024-03-07T15:44:55Z |
| format | Article |
| id | doaj.art-cd9b511850ed4e1db43bc7bf86b756c4 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-03-07T15:44:55Z |
| publishDate | 2024-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-cd9b511850ed4e1db43bc7bf86b756c42024-03-05T04:49:05ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2024-03-011410.3389/fonc.2024.13526601352660Risk stratification of stage II rectal mucinous adenocarcinoma to predict the benefit of adjuvant chemotherapy following neoadjuvant chemoradiation and surgeryYahang Liang0Yahang Liang1Hualin Liao2Hualin Liao3Haoran Shi4Tao Li5Tao Li6Yaxiong Liu7Yaxiong Liu8Yuli Yuan9Yuli Yuan10Mingming Li11Mingming Li12Aidi Li13Aidi Li14Yang Liu15Yang Liu16Yao Yao17Yao Yao18Taiyuan Li19Taiyuan Li20Department of General Surgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, ChinaGastrointestinal Surgical Institute, Nanchang University, Nanchang Jiangxi, ChinaDepartment of General Surgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, ChinaGastrointestinal Surgical Institute, Nanchang University, Nanchang Jiangxi, ChinaJiangxi Medical College, Nanchang University, Nanchang, Jiangxi, ChinaDepartment of General Surgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, ChinaGastrointestinal Surgical Institute, Nanchang University, Nanchang Jiangxi, ChinaDepartment of General Surgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, ChinaGastrointestinal Surgical Institute, Nanchang University, Nanchang Jiangxi, ChinaDepartment of General Surgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, ChinaGastrointestinal Surgical Institute, Nanchang University, Nanchang Jiangxi, ChinaDepartment of General Surgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, ChinaGastrointestinal Surgical Institute, Nanchang University, Nanchang Jiangxi, ChinaDepartment of General Surgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, ChinaGastrointestinal Surgical Institute, Nanchang University, Nanchang Jiangxi, ChinaDepartment of General Surgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, ChinaGastrointestinal Surgical Institute, Nanchang University, Nanchang Jiangxi, ChinaDepartment of General Surgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, ChinaGastrointestinal Surgical Institute, Nanchang University, Nanchang Jiangxi, ChinaDepartment of General Surgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, ChinaGastrointestinal Surgical Institute, Nanchang University, Nanchang Jiangxi, ChinaBackgroundThe treatment strategy for stage II rectal mucinous adenocarcinoma (RMA) recommends neoadjuvant chemoradiotherapy (NCR) followed by total mesorectal excision (TME). However, the necessity of adjuvant chemotherapy (AC) remains controversial.Materials and methodsChi-square test was used to assess the relationship between pathological classification, AC and clinicopathological characteristics. Kaplan-Meier (KM) curves and the log-rank test were utilized to analyze differences in overall survival (OS) and cancer-specific survival (CSS) among different groups. Cox regression identified prognostic factors. Nomogram was established utilizing the independent prognostic factors. X-tile divided patients into three risk subgroups.ResultsCompared to RMA, rectal adenocarcinoma (RA) demonstrates longer OS and CSS in all and non-AC stage II patients, with no difference in OS and CSS for AC stage II patients. Propensity score matching analyses yielded similar results. Stratified analysis found that AC both improve OS of RA and RMA patients. Age, gender, pathologic T stage, regional nodes examined, and tumor size were identified as independent prognostic factors for RMA patients without AC. A nomogram was constructed to generate risk scores and categorize RMA patients into three subgroups based on these scores. KM curves revealed AC benefits for moderate and high-risk groups but not for the low-risk group. The external validation cohort yielded similar results.ConclusionsIn summary, our study suggests that, compared to stage II RA patients, stage II RMA patients benefit more from AC after NCR. AC is recommended for moderate and high-risk stage II RMA patients after NCR, whereas low-risk patients do not require AC.https://www.frontiersin.org/articles/10.3389/fonc.2024.1352660/fullneoadjuvant chemoradiationstage II rectal mucinous adenocarcinomaadjuvant chemotherapynomogramsurvival |
| spellingShingle | Yahang Liang Yahang Liang Hualin Liao Hualin Liao Haoran Shi Tao Li Tao Li Yaxiong Liu Yaxiong Liu Yuli Yuan Yuli Yuan Mingming Li Mingming Li Aidi Li Aidi Li Yang Liu Yang Liu Yao Yao Yao Yao Taiyuan Li Taiyuan Li Risk stratification of stage II rectal mucinous adenocarcinoma to predict the benefit of adjuvant chemotherapy following neoadjuvant chemoradiation and surgery Frontiers in Oncology neoadjuvant chemoradiation stage II rectal mucinous adenocarcinoma adjuvant chemotherapy nomogram survival |
| title | Risk stratification of stage II rectal mucinous adenocarcinoma to predict the benefit of adjuvant chemotherapy following neoadjuvant chemoradiation and surgery |
| title_full | Risk stratification of stage II rectal mucinous adenocarcinoma to predict the benefit of adjuvant chemotherapy following neoadjuvant chemoradiation and surgery |
| title_fullStr | Risk stratification of stage II rectal mucinous adenocarcinoma to predict the benefit of adjuvant chemotherapy following neoadjuvant chemoradiation and surgery |
| title_full_unstemmed | Risk stratification of stage II rectal mucinous adenocarcinoma to predict the benefit of adjuvant chemotherapy following neoadjuvant chemoradiation and surgery |
| title_short | Risk stratification of stage II rectal mucinous adenocarcinoma to predict the benefit of adjuvant chemotherapy following neoadjuvant chemoradiation and surgery |
| title_sort | risk stratification of stage ii rectal mucinous adenocarcinoma to predict the benefit of adjuvant chemotherapy following neoadjuvant chemoradiation and surgery |
| topic | neoadjuvant chemoradiation stage II rectal mucinous adenocarcinoma adjuvant chemotherapy nomogram survival |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2024.1352660/full |
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