Effect of neoadjuvant regimens on prognosis in patients with rectal cancer: a real<b>-</b>world study based on DACCA_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

MOU Min ¹ , LIU Hanlin ² , BAI Yuying ² , WANG Xiaodong ² ,  HUANG Mingjun ¹ ,  JIANG Xiaolian ³

1. West China School of Nursing, Sichuan University/Day Surgery Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University/ West China School of Medicine in Sichuan University, Chengdu 610041, P. R. China;
3. West China School of Nursing, Sichuan University/ West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding?author：

HUANG Mingjun, Email: hmj123123@126.com; JIANG Xiaolian, Email: jiang_xiaolian@126.com

Keywords：

neoadjuvant therapy; rectal cancer; database from colorectal cancer; overall survival; disease specific survival

DOI：

10.7507/1007-9424.202401031

Video：

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Objective To analyze the impact of neoadjuvant regimens on prognosis in patients with rectal cancer in the current version of the Database from Colorectal Cancer (DACCA) database. Methods Patient information was extracted from the updated version of DACCA on November 24, 2022 according to the established screening criteria, and the following items were analyzed: gender, age, body mass index (BMI), marriage, economic conditions, degree of differentiation, neoadjuvant treatment regimen, and pTNM staging. According to the neoadjuvant treatment regimen, the patients were divided into three groups: chemotherapy group, chemotherapy combined radiotherapy group, and chemotherapy combined targeted therapy group, and the overall survival (OS) and disease-specific survival (DSS) of patients in the three groups were analyzed, and the influencing factors of OS and DSS were analyzed by univariate and multivariate Cox proportional hazard regression models. Results According to the screening criteria, 1 716 valid data were obtained from the DACCA database, of which 954 (55.6%) were in the chemotherapy group, 332 (19.3%) in the chemotherapy combined radiotherapy group, and 430 (25.1%) in the chemotherapy combined targeted therapy group. The differences in the Kaplan-Merier survival curves of patients with different neoadjuvant regimens for OS and DSS in the three groups were statistically significant (χ²=142.142, P＜0.001; χ²=129.528, P＜0.001). There were significant differences in OS rate and DSS rate between the three groups in 3 years and 5 years (P<0.001). Further comparison of different neoadjuvant therapy groups showed that the OS of the chemotherapy combined targeted therapy group was slightly better than that of the chemotherapy group in 3 years, however, OS and DSS in 5 years were slightly worse than those the chemotherapy group, but the difference were not statistically significant (P>0.05). The OS and DSS of the chemotherapy group and the chemotherapy combined targeted therapy group were better than those of the chemotherapy combined radiotherapy group in 3 years and 5 years, and the differences were statistically significant (P<0.01). The results of multivariate analysis showed that patients’ age, economic conditions, degree of tumor differentiation, new auxiliary scheme and pTNM staging were the influencing factors of OS and DSS. Conclusion Neoadjuvant treatment regimen will affect the long-term survival prognosis of rectal cancer patients.

Citation： MOU Min, LIU Hanlin, BAI Yuying, WANG Xiaodong, HUANG Mingjun, JIANG Xiaolian. Effect of neoadjuvant regimens on prognosis in patients with rectal cancer: a real-world study based on DACCA. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(3): 301-308. doi: 10.7507/1007-9424.202401031 Copy

1.	中華醫學會腫瘤學分會, 國家衛生健康委員會醫政司. 中國直腸癌診療規范(2023版). 協和醫學雜志, 2023, 14(4): 706-733.
2.	汪曉東, 劉健博, 李立. 數據庫建設第六部分: 直腸癌分期的標簽與結構化. 中國普外基礎與臨床雜志, 2020, 27(7): 873-879.
3.	汪曉東, 曾渝, 李立. 數據庫建設第十部分: 直腸癌輔助治療的標簽與結構化. 中國普外基礎與臨床雜志, 2021, 28(8): 1070-1077.
4.	汪曉東, 朱佳怡, 李立. 數據庫建設第十一部分: 直腸癌隨訪的標簽與結構化. 中國普外基礎與臨床雜志, 2021, 28(10): 1353-1359.
5.	余衛, 張在竹. 醫學領域年齡人群劃分標準淺析. 中國醫學科學院學報, 2023, 45(2): 285-289.
6.	Wang PH, Yang ST, Liu CH. Neoadjuvant therapy. J Chin Med Assoc, 2023, 86(2): 133-134.
7.	Custers PA, van der Sande ME, Grotenhuis BA, et al. Long-term quality of life and functional outcome of patients with rectal cancer following a watch-and-wait approach. JAMA Surg, 2023, 158(5): e230146.
8.	Bascoul-Mollevi C, Gourgou S, Borg C, et al. Neoadjuvant chemotherapy with FOLFIRINOX and preoperative chemoradiotherapy for patients with locally advanced rectal cancer (UNICANCER PRODIGE 23): Health-related quality of life longitudinal analysis. Eur J Cancer, 2023, 186: 151-165.
9.	Mei WJ, Wang XZ, Li YF, et al. Neoadjuvant chemotherapy with CAPOX versus chemoradiation for locally advanced rectal cancer with uninvolved mesorectal fascia (CONVERT): initial results of a phase Ⅲ trial. Ann Surg, 2023, 277(4): 557-564.
10.	Dijkstra EA, Hospers GAP, Kranenbarg EM, et al. Quality of life and late toxicity after short-course radiotherapy followed by chemotherapy or chemoradiotherapy for locally advanced rectal cancer — The RAPIDO trial. Radiotherapy and Oncology, 2022, 171: 69-76.
11.	Koukourakis IM, Kouloulias V, Tiniakos D, et al. Current status of locally advanced rectal cancer therapy and future prospects. Crit Rev Oncol Hematol, 2023, 186: 103992.
12.	李紹堂. [評論]新輔助化療后延遲手術影響結直腸癌腹膜轉移患者的生存: 一項BIG-RENAPE網絡多中心研究. 結直腸肛門外科, 2023, 29(3): 285-286.
13.	Amin MB, Edge SB, Greene FL, et al. AJCC Cancer Staging Manual. 8th ed. New York: Springer-Verlag, 2017: 252-254.
14.	韓晶, 王貴英, 張難, 等. 腫瘤部位及臨床病理特征對不同TNM分期行結直腸癌根治性切除術患者預后的影響研究. 中國全科醫學, 2020, 23(18): 2275-2283.
15.	Lee L, Jannapureddy M, Albo D, et al. Outcomes of Veterans Affairs patients older than age 80 after surgical procedures for colon malignancies. Am J Surg, 2007, 194(5): 646-651.
16.	Ahmed S, Howel D, Debrah S. The influence of age on the outcome of treatment of elderly patients with colorectal cancer. J Geriatr Oncol, 2014, 5(2): 133-140.
17.	Nigri G, de’Angelis N, Baldini C, et al. Surgical and regional treatments for colorectal cancer metastases in older patients: A systematic review and meta-analysis. Plos One, 2020, 15(4): e0230914.
18.	鄒雨恒, 廖偉豪, 劉瑩, 等. 結直腸癌患者年齡對長期生存預后可能有影響: 基于DACCA 數據庫的真實世界分析. 中國普外基礎與臨床雜志, 2022, 29(6): 795-802.
19.	黃坤, 何運勝, 趙攀, 等. 手術治療對直腸小細胞神經內分泌癌患者預后影響的SEER數據庫分析. 中國普外基礎與臨床雜志, 2023, 30(2): 179-184.
20.	O’Connell JB, Maggard MA, Liu JH, et al. Are survival rates different for young and older patients with rectal cancer? Dis Colon Rectum, 2004, 47(12): 2064-2069.
21.	Brody JP, Li Q, Cai G, et al. Better long-term survival in young patients with non-metastatic colorectal cancer after surgery, an analysis of 69 835 patients in SEER database. PLoS ONE, 2014, 9(4): e93756.
22.	Simmonds PD, Best L, George S, et al. Surgery for colorectal cancer in elderly patients: a systematic review. Lancet, 2000, 356(9234): 968-974.
23.	van Leeuwen BL, P?hlman L, Gunnarsson U, et al. The effect of age and gender on outcome after treatment for colon carcinoma. Crit Rev Oncol Hematol, 2008, 67(3): 229-236.
24.	Serra-Rexach JA, Jimenez AB, García-Alhambra MA, et al. Differences in the therapeutic approach to colorectal cancer in young and elderly patients. Oncologist, 2012, 17(10): 1277-1285.
25.	Calle EE, Rodriguez C, Walker-Thurmond K, et al. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U. S. adults. N Engl J Med, 2003, 348(17): 1625-1638.
26.	Murphy TK, Calle EE, Rodriguez C, et al. Body mass index and colon cancer mortality in a large prospective study. Am J Epidemiol, 2000, 152(9): 847-854.
27.	Meyerhardt JA, Tepper JE, Niedzwiecki D, et al. Impact of body mass index on outcomes and treatment-related toxicity in patients with stageⅡand Ⅲ rectal cancer: Findings from intergroup trial 0114. J Clin Oncol, 2004, 22(4): 648-657.
28.	Jaspan V, Lin K, Popov V. The impact of anthropometric parameters on colorectal cancer prognosis: A systematic review and meta-analysis. Crit Rev Oncol Hematol, 2021, 159: 103232.
29.	Moon HG, Ju YT, Jeong CY, et al. Visceral obesity may affect oncologic outcome in patients with colorectal cancer. Ann Surg Oncol, 2008, 15(7): 1918-1922.
30.	Lennon H, Sperrin M, Badrick E, et al. The obesity paradox in cancer: a review. Curr Oncol Rep, 2016, 18(9): 56.
31.	Kwak HD, Ju JK, Kang DW, et al. Outcomes according to body mass index following laparoscopic surgery in patients with colorectal cancer. J Minim Access Surg, 2018, 14(2): 134-139.
32.	Prizment AE, Flood A, Anderson KE, et al. Survival of women with colon cancer in relation to precancer anthropometric characteristics: the Iowa Women’s Health Study. Cancer Epidemiol Biomarkers Prev, 2010, 19(9): 2229-2237.
33.	Zafar SY, Abernethy AP. Financial toxicity, PartⅠ: a new name for a growing problem. Oncology (Williston Park), 2013, 27(2): 80-81, 149.
34.	Shankaran V, Unger JM, Darke AK, et al. S1417CD: a prospective multicenter cooperative group-led study of financial hardship in metastatic colorectal cancer patients. J Natl Cancer Inst, 2022, 114(3): 372-380.
35.	Smith GL, Lopez-Olivo MA, Advani PG, et al. Financial burdens of cancer treatment: a systematic review of risk factors and outcomes. J Natl Compr Canc Netw, 2019, 17(10): 1184-1192.

1. 中華醫學會腫瘤學分會, 國家衛生健康委員會醫政司. 中國直腸癌診療規范(2023版). 協和醫學雜志, 2023, 14(4): 706-733.
2. 汪曉東, 劉健博, 李立. 數據庫建設第六部分: 直腸癌分期的標簽與結構化. 中國普外基礎與臨床雜志, 2020, 27(7): 873-879.
3. 汪曉東, 曾渝, 李立. 數據庫建設第十部分: 直腸癌輔助治療的標簽與結構化. 中國普外基礎與臨床雜志, 2021, 28(8): 1070-1077.
4. 汪曉東, 朱佳怡, 李立. 數據庫建設第十一部分: 直腸癌隨訪的標簽與結構化. 中國普外基礎與臨床雜志, 2021, 28(10): 1353-1359.
5. 余衛, 張在竹. 醫學領域年齡人群劃分標準淺析. 中國醫學科學院學報, 2023, 45(2): 285-289.
6. Wang PH, Yang ST, Liu CH. Neoadjuvant therapy. J Chin Med Assoc, 2023, 86(2): 133-134.
7. Custers PA, van der Sande ME, Grotenhuis BA, et al. Long-term quality of life and functional outcome of patients with rectal cancer following a watch-and-wait approach. JAMA Surg, 2023, 158(5): e230146.
8. Bascoul-Mollevi C, Gourgou S, Borg C, et al. Neoadjuvant chemotherapy with FOLFIRINOX and preoperative chemoradiotherapy for patients with locally advanced rectal cancer (UNICANCER PRODIGE 23): Health-related quality of life longitudinal analysis. Eur J Cancer, 2023, 186: 151-165.
9. Mei WJ, Wang XZ, Li YF, et al. Neoadjuvant chemotherapy with CAPOX versus chemoradiation for locally advanced rectal cancer with uninvolved mesorectal fascia (CONVERT): initial results of a phase Ⅲ trial. Ann Surg, 2023, 277(4): 557-564.
10. Dijkstra EA, Hospers GAP, Kranenbarg EM, et al. Quality of life and late toxicity after short-course radiotherapy followed by chemotherapy or chemoradiotherapy for locally advanced rectal cancer — The RAPIDO trial. Radiotherapy and Oncology, 2022, 171: 69-76.
11. Koukourakis IM, Kouloulias V, Tiniakos D, et al. Current status of locally advanced rectal cancer therapy and future prospects. Crit Rev Oncol Hematol, 2023, 186: 103992.
12. 李紹堂. [評論]新輔助化療后延遲手術影響結直腸癌腹膜轉移患者的生存: 一項BIG-RENAPE網絡多中心研究. 結直腸肛門外科, 2023, 29(3): 285-286.
13. Amin MB, Edge SB, Greene FL, et al. AJCC Cancer Staging Manual. 8th ed. New York: Springer-Verlag, 2017: 252-254.
14. 韓晶, 王貴英, 張難, 等. 腫瘤部位及臨床病理特征對不同TNM分期行結直腸癌根治性切除術患者預后的影響研究. 中國全科醫學, 2020, 23(18): 2275-2283.
15. Lee L, Jannapureddy M, Albo D, et al. Outcomes of Veterans Affairs patients older than age 80 after surgical procedures for colon malignancies. Am J Surg, 2007, 194(5): 646-651.
16. Ahmed S, Howel D, Debrah S. The influence of age on the outcome of treatment of elderly patients with colorectal cancer. J Geriatr Oncol, 2014, 5(2): 133-140.
17. Nigri G, de’Angelis N, Baldini C, et al. Surgical and regional treatments for colorectal cancer metastases in older patients: A systematic review and meta-analysis. Plos One, 2020, 15(4): e0230914.
18. 鄒雨恒, 廖偉豪, 劉瑩, 等. 結直腸癌患者年齡對長期生存預后可能有影響: 基于DACCA 數據庫的真實世界分析. 中國普外基礎與臨床雜志, 2022, 29(6): 795-802.
19. 黃坤, 何運勝, 趙攀, 等. 手術治療對直腸小細胞神經內分泌癌患者預后影響的SEER數據庫分析. 中國普外基礎與臨床雜志, 2023, 30(2): 179-184.
20. O’Connell JB, Maggard MA, Liu JH, et al. Are survival rates different for young and older patients with rectal cancer? Dis Colon Rectum, 2004, 47(12): 2064-2069.
21. Brody JP, Li Q, Cai G, et al. Better long-term survival in young patients with non-metastatic colorectal cancer after surgery, an analysis of 69 835 patients in SEER database. PLoS ONE, 2014, 9(4): e93756.
22. Simmonds PD, Best L, George S, et al. Surgery for colorectal cancer in elderly patients: a systematic review. Lancet, 2000, 356(9234): 968-974.
23. van Leeuwen BL, P?hlman L, Gunnarsson U, et al. The effect of age and gender on outcome after treatment for colon carcinoma. Crit Rev Oncol Hematol, 2008, 67(3): 229-236.
24. Serra-Rexach JA, Jimenez AB, García-Alhambra MA, et al. Differences in the therapeutic approach to colorectal cancer in young and elderly patients. Oncologist, 2012, 17(10): 1277-1285.
25. Calle EE, Rodriguez C, Walker-Thurmond K, et al. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U. S. adults. N Engl J Med, 2003, 348(17): 1625-1638.
26. Murphy TK, Calle EE, Rodriguez C, et al. Body mass index and colon cancer mortality in a large prospective study. Am J Epidemiol, 2000, 152(9): 847-854.
27. Meyerhardt JA, Tepper JE, Niedzwiecki D, et al. Impact of body mass index on outcomes and treatment-related toxicity in patients with stageⅡand Ⅲ rectal cancer: Findings from intergroup trial 0114. J Clin Oncol, 2004, 22(4): 648-657.
28. Jaspan V, Lin K, Popov V. The impact of anthropometric parameters on colorectal cancer prognosis: A systematic review and meta-analysis. Crit Rev Oncol Hematol, 2021, 159: 103232.
29. Moon HG, Ju YT, Jeong CY, et al. Visceral obesity may affect oncologic outcome in patients with colorectal cancer. Ann Surg Oncol, 2008, 15(7): 1918-1922.
30. Lennon H, Sperrin M, Badrick E, et al. The obesity paradox in cancer: a review. Curr Oncol Rep, 2016, 18(9): 56.
31. Kwak HD, Ju JK, Kang DW, et al. Outcomes according to body mass index following laparoscopic surgery in patients with colorectal cancer. J Minim Access Surg, 2018, 14(2): 134-139.
32. Prizment AE, Flood A, Anderson KE, et al. Survival of women with colon cancer in relation to precancer anthropometric characteristics: the Iowa Women’s Health Study. Cancer Epidemiol Biomarkers Prev, 2010, 19(9): 2229-2237.
33. Zafar SY, Abernethy AP. Financial toxicity, PartⅠ: a new name for a growing problem. Oncology (Williston Park), 2013, 27(2): 80-81, 149.
34. Shankaran V, Unger JM, Darke AK, et al. S1417CD: a prospective multicenter cooperative group-led study of financial hardship in metastatic colorectal cancer patients. J Natl Cancer Inst, 2022, 114(3): 372-380.
35. Smith GL, Lopez-Olivo MA, Advani PG, et al. Financial burdens of cancer treatment: a systematic review of risk factors and outcomes. J Natl Compr Canc Netw, 2019, 17(10): 1184-1192.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Effect of neoadjuvant regimens on prognosis in patients with rectal cancer: a real-world study based on DACCA

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