A C Lord1, C Graham Martínez2, N D'Souza3, P H Pucher4, G Brown3, I D Nagtegaal2. 1. Royal Marsden NHS Foundation Trust, London, UK. Electronic address: amylord@nhs.net. 2. Radboud University Medical Centre, Nijmegen, the Netherlands. 3. Royal Marsden NHS Foundation Trust, London, UK. 4. Imperial College London, UK.
Abstract
BACKGROUND: Tumour deposits (TDs) are a poor prognostic marker in colorectal cancer, but their significance after neoadjuvant chemoradiotherapy is less certain because this group of patients is excluded in most studies. Post-treatment TD might even be a sign of tumour response. No previous reviews have assessed outcomes in this group. MATERIALS AND METHODS: A systematic review and meta-analysis was undertaken according to Preferred Reporting for Systematic Reviews and Meta-Analyses guidelines to determine the relevance of post-treatment TD. Inclusion criteria were studies assessing TD in patients who had undergone pre-operative treatment with radiotherapy and/or chemotherapy and reporting prevalence and survival outcomes. Studies that did not include histological review of cases were excluded. RESULTS: Eight studies and 1283 patients were included in the review. Prevalence of TDs varied from 11.8% to 44.2% (mean 23.7%), similar to untreated patients. The presence of TDs after chemoradiotherapy was associated with invasion depth, lymph node involvement, perineural invasion and synchronous metastases. The pooled hazard ratio for 5-year adverse disease-free survival was 2.3 (95% confidence interval [CI]: 1.8-2.9), and that for overall survival was 2.5 (95% CI: 1.9-3.3). One study showed a survival benefit with adjuvant therapy in the TD-positive group. CONCLUSIONS: In analogy with untreated patients, the presence of TDs in patients with rectal cancer after neoadjuvant treatment is associated with advanced disease and a poor outcome.
BACKGROUND:Tumour deposits (TDs) are a poor prognostic marker in colorectal cancer, but their significance after neoadjuvant chemoradiotherapy is less certain because this group of patients is excluded in most studies. Post-treatment TD might even be a sign of tumour response. No previous reviews have assessed outcomes in this group. MATERIALS AND METHODS: A systematic review and meta-analysis was undertaken according to Preferred Reporting for Systematic Reviews and Meta-Analyses guidelines to determine the relevance of post-treatment TD. Inclusion criteria were studies assessing TD in patients who had undergone pre-operative treatment with radiotherapy and/or chemotherapy and reporting prevalence and survival outcomes. Studies that did not include histological review of cases were excluded. RESULTS: Eight studies and 1283 patients were included in the review. Prevalence of TDs varied from 11.8% to 44.2% (mean 23.7%), similar to untreated patients. The presence of TDs after chemoradiotherapy was associated with invasion depth, lymph node involvement, perineural invasion and synchronous metastases. The pooled hazard ratio for 5-year adverse disease-free survival was 2.3 (95% confidence interval [CI]: 1.8-2.9), and that for overall survival was 2.5 (95% CI: 1.9-3.3). One study showed a survival benefit with adjuvant therapy in the TD-positive group. CONCLUSIONS: In analogy with untreated patients, the presence of TDs in patients with rectal cancer after neoadjuvant treatment is associated with advanced disease and a poor outcome.
Authors: K van den Berg; D P Schaap; E L K Voogt; T E Buffart; H M W Verheul; J W B de Groot; C Verhoef; J Melenhorst; J M L Roodhart; J H W de Wilt; H L van Westreenen; A G J Aalbers; M van 't Veer; C A M Marijnen; J Vincent; L H J Simkens; N A J B Peters; M Berbée; I M Werter; P Snaebjornsson; H M U Peulen; I G van Lijnschoten; M J Roef; G A P Nieuwenhuijzen; J G Bloemen; J M W E Willems; G J M Creemers; J Nederend; H J T Rutten; J W A Burger Journal: BMC Cancer Date: 2022-09-06 Impact factor: 4.638