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Ho SSK, Hon SSF, Hung E, Lee JFY, Mo F, Tong M, So C, Chu S, Ng DCK, Lam D, Cho C, Mak TWC, Ng SSM, Futaba K, Suen J, To KF, Chan AWH, Yeung WWK, Ma BBY. Prognostic implication of the neoadjuvant rectal score and other biomarkers of clinical outcome in Hong Kong Chinese patients with locally advanced rectal cancer undergoing neoadjuvant chemoradiotherapy. Hong Kong Med J 2022; 28:230-238. [PMID: 35667869 DOI: 10.12809/hkmj208969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Neoadjuvant chemoradiotherapy is a standard treatment for locally advanced rectal cancer, for which pathological complete response is typically used as a surrogate survival endpoint. Neoadjuvant rectal score is a new biomarker that has been shown to correlate with survival. The main objectives of this study were to investigate factors contributing to pathological complete response, to validate the prognostic significance of neoadjuvant rectal score, and to investigate factors associated with a lower neoadjuvant rectal score in a cohort of Hong Kong Chinese. METHODS Data of patients with locally advanced rectal cancer who received neoadjuvant chemoradiotherapy from August 2006 to October 2018 were retrieved from hospital records and retrospectively analysed. RESULTS Of 193 patients who had optimal response to neoadjuvant chemoradiotherapy and surgery, tumour down-staging was the only independent prognostic factor that predicted pathological complete response (P<0.0001). Neoadjuvant rectal score was associated with overall survival (hazard ratio [HR]=1.042, 95% confidence interval [CI]=1.021-1.064; P<0.0001), disease-free survival (HR=1.042, 95% CI=1.022-1.062; P<0.0001), locoregional recurrence-free survival (HR=1.070, 95% CI=1.039-1.102; P<0.0001) and distant recurrence-free survival (HR=1.034, 95% CI=1.012-1.056; P=0.002). Patients who had pathological complete response were associated with a lower neoadjuvant rectal score (P<0.0001), but pathological complete response was not associated with survival. For patients with intermediate neoadjuvant rectal scores, late recurrences beyond 72 months from diagnosis were observed. CONCLUSION Neoadjuvant rectal score is an independent prognostic marker of survival and disease recurrence in a cohort of Hong Kong Chinese patients who received neoadjuvant chemoradiotherapy for locally advanced rectal cancer.
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Affiliation(s)
- S S K Ho
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong
| | - S S F Hon
- Department of Surgery, Alice Ho Miu Ling Nethersole Hospital, Hong Kong
| | - E Hung
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Hong Kong
| | - J F Y Lee
- Department of Surgery, Prince of Wales Hospital, Hong Kong
| | - F Mo
- State Key Laboratory in Translational Oncology in South China, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - M Tong
- State Key Laboratory in Translational Oncology in South China, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - C So
- State Key Laboratory in Translational Oncology in South China, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - S Chu
- Department of Surgery, Prince of Wales Hospital, Hong Kong
| | - D C K Ng
- Department of Surgery, North District Hospital, Hong Kong
| | - D Lam
- Department of Clinical Oncology, Prince of Wales Hospital, Hong Kong
| | - C Cho
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Hong Kong
| | - T W C Mak
- Department of Surgery, Prince of Wales Hospital, Hong Kong
| | - S S M Ng
- Department of Surgery, Prince of Wales Hospital, Hong Kong
| | - K Futaba
- Department of Surgery, Prince of Wales Hospital, Hong Kong
| | - J Suen
- Department of Clinical Oncology, Prince of Wales Hospital, Hong Kong
| | - K F To
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong
| | - A W H Chan
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong
| | | | - B B Y Ma
- State Key Laboratory in Translational Oncology in South China, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
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Abstract
The change in patient population leads to an inevitable transformation among the healthcare system. Over the past decades, thoracic surgical technique has been evolving from conventional open thoracotomy to minimally invasive video assisted thoracoscopic surgery (VATS). Thoracic nursing team of Prince of Wales Hospital (PWH) grows together with the evolution and aims at providing holistic and quality care to patients require thoracic operation. In order to enhance patient post-operative recovery, few strategies have been implemented including early mobilization, staff training and clinical audit. On the other hand, nursing case management approach was proved to be a cost-effective method in managing patients. It is also suitable for thoracic patients, especially for those who are suffering from thoracic neoplasm. It is believed that, the introduction of nursing case management approach would provide a better holistic care to the thoracic patients.
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Affiliation(s)
- Wilfred Wai Kit Yeung
- Division of Cardiothoracic Unit, Department of Surgery, Prince of Wales Hospital, Hong Kong, China
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Tsang WK, Leung SF, Chiu SKW, Yeung WWK, Ng EKW, Yeo W, Lam KC, Chiu PWY, Ma BBY, Kwan WH, Chan ATC. Adjuvant Chemoradiation for Gastric Cancer: Experience in the Chinese Population. Clin Oncol (R Coll Radiol) 2007; 19:333-40. [PMID: 17434719 DOI: 10.1016/j.clon.2007.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2006] [Revised: 02/14/2007] [Accepted: 02/15/2007] [Indexed: 10/23/2022]
Abstract
AIMS The role of adjuvant chemoradiation for gastric cancer after curative R0 gastrectomy was first established by the US Intergroup 0116 study. Although confirmatory studies are in progress, few data are available regarding its application to the Chinese population. We describe our radiotherapy technique and report the treatment results in Hong Kong. MATERIALS AND METHODS This was a single centre retrospective study on 63 Chinese patients who underwent adjuvant chemoradiation for gastric adenocarcinoma between June 2000 and December 2004. The treatment protocol was based on that of the Intergroup study. Computed tomography planned anteroposterior opposing field arrangement and treatment under breath hold at deep inspiration position were adopted. RESULTS In total, 63 patients, mean age 50 years, with gastric cancer stage IB to limited metastatic IV disease were analysed. The median follow-up time was 27.2 months. The relapse-free survival and overall survival at 3 years were 50 and 54%, respectively. The recurrence pattern was dominated by distant failure and only one patient developed isolated locoregional recurrence. Of the 10 patients who had positive microscopic surgical margins after surgery, seven had recurred and died. On multivariate analysis, margin status was the only significant prognosticator for survival. Thirty per cent of patients experienced grade 3 or above acute toxicity (24% haematological, 14% gastrointestinal) and one patient died of neutropenic sepsis. There was one case of grade 3 late toxicity. CONCLUSIONS The outcome after adjuvant chemoradiation for gastric cancer seemed to be favourable, with manageable toxicities, in the Chinese population. Locoregional failure was uncommon. Patients with microscopic surgical margin involvement had a very high failure rate despite adjuvant chemoradiation.
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Affiliation(s)
- W K Tsang
- Department of Clinical Oncology, Prince of Wales Hospital, Medical Faculty, The Chinese University of Hong Kong, China.
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