Second primary cancers and recurrence in patients after resection of colorectal cancer: An integrated analysis of trials by Japan Clinical Oncology Group: JCOG1702A

Incidence, Risk and Trends of Multiple Primary Cancers in Patients With Colorectal Cancer: Evidence From the South Australian Cancer Registry

BACKGROUND

Colorectal cancer (CRC) is the fourth most diagnosed cancer in Australia. With advancements in treatment and an increase in survival rates, CRC survivors face an elevated risk of developing multiple primary cancers (MPCs), presenting a clinical challenge. Therefore, this study aimed to estimate the incidence, trend and risk of MPCs after a diagnosis of CRC in the South Australian population.

METHODS

This study analysed South Australian Cancer Registry data on individuals diagnosed with CRC as their first cancer from 1982 to 2017. The incidence of MPCs was assessed using cumulative incidence functions, and age-standardised rates were estimated. Poisson regression was used to determine the risk, and standardised incidence ratios (SIR) and absolute excess risks (AER) were estimated. Trends over time were analysed using Joinpoint regression.

RESULTS

The study included 26,729 CRC survivors. Of the cohort, 15% (3917) developed 4453 MPCs, with 96% diagnosed six or more months after index CRC. The cumulative incidence of MPCs was 22.5% (95% CI: 21.6-23.4). The median follow-up time until MPC diagnosis was 6.4 years. Common MPCs included prostate (18.9%), subsequent CRC (13.1%), lung (10.8%), haematological (10.2%) and breast (8.0%) cancers. The overall risk of MPCs was higher in CRC survivors (SIR: 1.12, 95% CI: 1.09-1.16; AER: 22.6 per 10,000) compared to the incidence in the general South Australian population. The incidence of MPCs has increased over time (annual percentage change = 1.95, 95% CI: 1.33-2.51).

CONCLUSIONS

CRC survivors are at increased risk of subsequent cancers, highlighting the need for targeted surveillance, particularly for prostate, lung, breast and blood cancers, for early detection and treatment.

Delivery of short chain fatty acid butyrate to overcome Fusobacterium nucleatum-induced chemoresistance

The gut microbiota is closely associated with the progression of colorectal cancer (CRC) in which Fusobacterium nucleatum (F. nucleatum) was found to induce cancer resistance to chemotherapeutics. To relieve F. nucleatum-induced drug resistance, herein, we found that short-chain fatty acid butyrate can inhibit the growth, enrichment and adhesion of F. nucleatum in colorectal cancer tissues by downregulating the expression of adhesion-associated outer membrane proteins, including RadD, FomA, and FadA, to reduce the colonization and invasion of F. nucleatum and relieve the chemoresistance induced by F. nucleatum. Leveraging the killing effect of butyrate on F. nucleatum, sodium butyrate (NaBu) was encapsulated in liposomes or prepared as NaBu tablets with Eudragit S100 coating and administered by intravenous injection or oral administration, respectively. Interestingly, both intravenous administration of NaBu liposomes and oral delivery of NaBu tablets could effectively inhibit the proliferation of F. nucleatum and significantly improve the therapeutic efficacy of oxaliplatin in mice with subcutaneous colorectal tumors, orthotopic colorectal tumors and even spontaneously formed colorectal tumors. Thus, our work provides a simple but effective formulation of NaBu to relieve F. nucleatum-induced chemoresistance, exhibiting ideal clinical application prospects.

Clinical outcome of non-curative endoscopic submucosal dissection for early colorectal cancer

OBJECTIVE

Endoscopic submucosal dissection (ESD) in a curative intent for submucosa-invasive early (T1) colorectal cancers (T1-CRCs) often leads to subsequent surgical resection in case of histologic parameters indicating higher risk of nodal involvement. In some cases, however, the expected benefit may be offset by the surgical risks, suggesting a more conservative approach.

DESIGN

Retrospective analysis of consecutive patients with T1-CRC who underwent ESD at 13 centres ending inclusion in 2019 (n=3373). Cases with high risk of nodal involvement (non-curative ESD: G3, submucosal invasion>1000 µm, lymphovascular involvement, budding or incomplete resection/R1) were analysed if follow-up data (endoscopy/imaging) were available, regardless of the postendoscopic management (follow-up vs surgery) selected by the multidisciplinary teams in these institutions. Comorbidities were classified according to Charlson Comorbidity Index (CCI). Outcomes were disease recurrence, death and disease-related death rates in the two groups. Rate of residual disease (RD) at both the previous resection site and regional lymph nodes was assessed in the surgical cases as well as from follow-up in the follow-up group.

RESULTS

Of 604 patients treated by colorectal ESD for submucosally invasive cancer, 207 non-curative resections (34.3%) were included (138 male; mean age 67.6±10.9 years); in 65.2% of cases, no complete resection was achieved (R1). Of the 207 cases, 60.9% (n=126; median CCI: 3; IQR: 2-4) underwent surgical treatment with RD in 19.8% (25/126), while 39.1% (n=81, median CCI: 5; IQR: 4-6) were followed up by endoscopy in all cases. Patients in the follow-up group had a higher overall mortality (HR=3.95) due to non-CRC causes (n=9, mean survival after ESD 23.7±13.7 months). During this follow-up time, tumour recurrence and disease-specific survival rates were not different between the groups (median follow-up 30 months; range: 6-105).

CONCLUSION

Following ESD for a lesion at high risk of RD, follow-up only may be a reasonable choice in patients at high risk for surgery. Also, endoscopic resection quality should be improved.

TRIAL REGISTRATION NUMBER

NCT03987828.

The risk of developing second primary malignancies among colorectal cancer patients

Background: The increasing number of young colorectal cancer (CRC) survivors has led to ongoing concerns about the risk of secondary primary malignancies (SPMs). Here, we intended to comprehensively explore the pooled standardized incidence rates (SIRs) for total and site-specific SPMs in CRC survivors with different restriction to lag period.

Methods: Pubmed, Embase, Cochrane Library, and Web of science databases were searched to identify any studies reporting the SIRs of SPM following CRC until August 2021. Total and site-specific SIRs with different restriction to lag period were pooled using fixed/random effect models.

Results: A total of 42 full-text publications with more than 1, 524, 236 CRC survivors and 166, 210 SPM patients were included in the meta-analysis. Pooled data showed an increased SIRs for all SPMs in CRC survivors with different restriction to lag period (no restriction to lag period, SIR = 1.15, 95% CI = [1.08–1.23]; 1-year lag, 1.16 [1.10–1.23]; 5-year lag, 1.18 [1.09–1.28]; 10-year lag, 1.24 [1.11–1.39]). The conclusions were consistent for neoplasms of colorectum, corpus uteri, and small intestine with different restriction to lag period. However, limited evidence was presented for associations between CRC survivors and SPM for prostate, breast (female), ovarian, stomach, urinary bladder, kidney, thyroid, bone and soft tissue.

Conclusion: CRC survivors are associated with an increased risk of SPMs, especially neoplasms of colorectum, corpus uteri, and small intestine. Further studies should explore the risks for these neoplasms in CRC survivors, thus providing the reference for future follow-up care.