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Short-term clinical outcomes of robotic-assisted total mesorectal excision in rectal cancer after concurrent chemoradiotherapy
abstracts
Annals of Oncology Results:
0.376 0.037 0.075 0.356 0.152 0.102 0.121 0.008
1.409 0.969 0.634 1.179 1.1 1.28 1.42 3.4
0.657 – 3.02 0.940 – 0.998 0.382 – 1.052 0.697 – 2.02 0.646 – 1.92 0.947 – 1.75 0.906 – 2.23 1.26 – 9.6
0.378 0.039 0.078 0.550 0.697 0.106 0.126 0.016
In the Kaplan and meier analysis, recurrence free survival (SLR) was P ¼ 0.03. Independent factors for recurrence were age and ECOG (95% CI 0.940 – 0.998¸ P ¼ 0.037, HR 3.4 95% IC 1.26 – 9.6, P ¼ 0.016). Our findings showed a better SLR in the low dINP subgroup, so we took it as a cutoff 5. Patients who presented a dINP less than 5, have a better SLR in relation to those who have a dINP > 5. P ¼ 0.013. Conclusions: The difference less than 5 between the nutritional index before and after neoadjuvant chemoradiotherapy in patients with locally advanced adenocarcinoma of the rectum is associated with an increase in SLR as an independent predictor of recurrence. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
547P
Short-term clinical outcomes of robotic-assisted total mesorectal excision in rectal cancer after concurrent chemoradiotherapy
P. Chen1, J-Y. Wang2 1 General Surgery, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan, 2 Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan Background: To evaluate the short-term oncological outcomes of robotic-assisted total mesorectal excision (TME) in patients with rectal cancer after neoadjuvant CCRT (concurrent chemoradiotherapy). Methods: We enrolled 120 patients with stages I-IV rectal cancer who underwent robotic-assisted total mesorectal excision (TME) after neoadjuvant concurrent chemoradiotherapy at a single institution between July 2013 and November 2017. Results: Of the 120 patients enrolled, all of them underwent preoperative concurrent chemoradiotherapy. Furthermore, among these 120 patients, 34 (28.3%) achieved a pathologic complete response and 19 people had local or distant recurrences. In a median follow up of 24 months, the 2-year disease-free survival(DFS) and overall survival(OS) were and 84% and 86%. Conclusions: The results demonstrate that robotic-assisted TME for patients with rectal cancer after neoadjuvant CCRT (concurrent chemoradiotherapy) is effective and for patient with tumor invaded to bladder, prostate or uterus, neoadjuvant chemotherapy is a safe and effective way for organ-preserving instead of salvage surgery. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
548P
Local immune status in cancer cell nests can be a predictor of survival for rectal cancer with neoadjuvant radiotherapy
549P
Impact of concomitant medications on disease free survival (DFS) and overall survival (OS) in patients from the PETACC8 study
B. Cle´mence1, J. Taieb2, M. Boulin3, K. Le Malicot4, L.M. Dourthe5, B. Avisse6, P. Laplaige7, C. Borel8, D. Arsene9, F. Kikolski10, B. Denis11, P. Geoffroy12, R. Coriat13, G. Piot14, C. Lepage1 1 Hepatogastroenterology Department, CHU Dijon, Dijon, France, 2Department of Gastroenterology and Digestive Oncology, Hopital European George Pompidou, Paris, France, 3Pharmacy Department, CHU Dijon, Dijon, France, 4Biostatistics, FFCD, Dijon, France, 5Oncology Department, Clinique Sainte Anne, Strasbourg, France, 6 Hepatogastroenterology Department, Centre Hospitalier Pierre Oudot, BourgoinJallieu, France, 7Medical Oncology Department, Polyclinique de Blois, La Chaussee St. Victor, France, 8Medical Oncology Department, Centre Paul Strauss Centre de Lutte Contre le Cancer, Strasbourg, France, 9Oncology Department, CHU de Caen, Caen, France, 10Gastroenterology and Hepatology, Hoˆpital Robert Boulin, Libourne, France, 11 Hepatogastroenterology Department, Hoˆpital Louis Pasteur, Colmar, France, 12 Hepatogastroenterology Department, Clinique Saint-Vincent, Epernay, France, 13 Gastroenterology Department and Digestive Oncology, Hoˆpital Cochin, Paris, France, 14 Oncology Department, Clinique des Ormeaux, Le Havre, France Background: Impact of comedications and comorbidities upon OS isn’t well described in cancer patients (pts). We aimed to evaluate their impacts on DFS and OS on pts resected from a stage III colon cancer and treated by adjuvant FOLFOX-4 þ/- cetuximab in the PETACC8 study. Methods: Treatments (trts) categories were defined according to the WHO ATC classification system. We focused on 4 medication classes: anticoagulant, cardiovascular, antidiarrheal and antidiabetic trts. We classified the 2559 pts in each category if they took trt at baseline or during study whatever the duration was. Kaplan-Meier method and Cox model were used to compare survival curves. Multivariate analyses were performed on the overall population and according to trt arm. Results: Only 1% of pts had no comedications. Comedications with anticoagulant, cardiovascular, antidiarrheal and antidiabetic trts were observed respectively in 18%, 40%, 30% and 9% of the cases. Patients with antidiabetic or cardiovascular trts had more comorbidities. For each other comedication categories, baseline characteristics were balanced between pts treated or not. All comedication categories, except antidiarrheals, were associated with a significant decrease of DFS and OS (Table). Dose-intensity was balanced and may not explain survival differences. For pts treated with at least one cardiac, diabetic or anticoagulant trts, severe events were more frequently reported, including 9 early deaths. The use of antidiarrheals is maybe associated to a better exposure to chemotherapy as reflected by a higher rate of grade 3 adverse events but also a potential better efficacy. Table. Comedications impact on DFS and OS.
X. Lin1, F. Lin2, Q. Zhuang2, X. Zhang2, Y. Huang2, L. Tang2, J. Li3, W. Junxin1 1 Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China, 2Radiation Oncology, Fujian Medical University Cancer Hospital, Fuzhou, China, 3Radiation, Xiamen Cancer Hospital, The First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen, China
Volume 30 | Supplement 5 | October 2019
doi:10.1093/annonc/mdz246 | v207
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_5/mdz246.024/5577075 by guest on 26 October 2019
Gender Age body mass index Degree Differentiation ypT ypN Diferencial INP ECOG
Background: Although neoadjuvant chemoradiotherapy is the standard treatment for locally advanced rectal cancer (LARC), it remains difficult to predict the prognosis of LARC patients. We aimed to explore the impacts of local immune status on survival of LARC after noeadjuvant radiotherapy (nRT). Methods: A total of 76 consecutive LARC patients were enrolled in our institute from February 2012 to September 2015. CD3þ T-cell and CD8þ T-cell count were determined from surgical specimens. Factors associated with disease-free survival (DFS) and overall survival (OS) were identified by univariate and multivariate Cox regression. SPSS 22.0 was used for statistical analyse. Results: The median follow-up time was 29.0 months (range 2.0-59). The Cutoff software identified an optimal CD3þ T-cell cutoff value of 12.5% and CD8þ Tcell value of 9% for our patients. According to the Kaplan-Meier analysis, CD3þ T-cell 12.5% was significantly related to favorable DFS (P ¼ 0.020), while there was no significant difference between CD3þ T-cell and OS (P ¼ 0.238). Meanwhile, CD8þ T-cell 9% was found to have a positive effect on DFS and OS (P ¼ 0.012 and P ¼ 0.035, respectively). In the multivariate Cox regression model, CD8þ T-cell <9% was independent risk factors for poor DFS (HR ¼ 0.492, 95%CI¼ 0.252-0.960, P ¼ 0.038). Furthermore, CD8þ T-cell (HR ¼ 0.268, 95%CI¼ 0.076-0.941, P ¼ 0.040) and T stage (HR ¼ 0.151, 95%CI¼ 0.030-0.7530, P ¼ 0.021) were independent predictors of OS. Conclusions: High CD8þ T-cell count were significantly related to good survival in LARC patients with nRT. Local immune status was suggested to be measured in order to predict the prognosis of patients with LACR after nRT. Legal entity responsible for the study: Xijin Lin. Funding: The Fujian Province Natural Science Foundation (2017J01260), Joint Funds for the Innovation of Science and Technology, Fujian province (2017Y9074), and the Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing (2017 Open Project-9). Disclosure: All authors have declared no conflicts of interest.
Annals of Oncology Results:
0.376 0.037 0.075 0.356 0.152 0.102 0.121 0.008
1.409 0.969 0.634 1.179 1.1 1.28 1.42 3.4
0.657 – 3.02 0.940 – 0.998 0.382 – 1.052 0.697 – 2.02 0.646 – 1.92 0.947 – 1.75 0.906 – 2.23 1.26 – 9.6
0.378 0.039 0.078 0.550 0.697 0.106 0.126 0.016
In the Kaplan and meier analysis, recurrence free survival (SLR) was P ¼ 0.03. Independent factors for recurrence were age and ECOG (95% CI 0.940 – 0.998¸ P ¼ 0.037, HR 3.4 95% IC 1.26 – 9.6, P ¼ 0.016). Our findings showed a better SLR in the low dINP subgroup, so we took it as a cutoff 5. Patients who presented a dINP less than 5, have a better SLR in relation to those who have a dINP > 5. P ¼ 0.013. Conclusions: The difference less than 5 between the nutritional index before and after neoadjuvant chemoradiotherapy in patients with locally advanced adenocarcinoma of the rectum is associated with an increase in SLR as an independent predictor of recurrence. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
547P
Short-term clinical outcomes of robotic-assisted total mesorectal excision in rectal cancer after concurrent chemoradiotherapy
P. Chen1, J-Y. Wang2 1 General Surgery, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan, 2 Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan Background: To evaluate the short-term oncological outcomes of robotic-assisted total mesorectal excision (TME) in patients with rectal cancer after neoadjuvant CCRT (concurrent chemoradiotherapy). Methods: We enrolled 120 patients with stages I-IV rectal cancer who underwent robotic-assisted total mesorectal excision (TME) after neoadjuvant concurrent chemoradiotherapy at a single institution between July 2013 and November 2017. Results: Of the 120 patients enrolled, all of them underwent preoperative concurrent chemoradiotherapy. Furthermore, among these 120 patients, 34 (28.3%) achieved a pathologic complete response and 19 people had local or distant recurrences. In a median follow up of 24 months, the 2-year disease-free survival(DFS) and overall survival(OS) were and 84% and 86%. Conclusions: The results demonstrate that robotic-assisted TME for patients with rectal cancer after neoadjuvant CCRT (concurrent chemoradiotherapy) is effective and for patient with tumor invaded to bladder, prostate or uterus, neoadjuvant chemotherapy is a safe and effective way for organ-preserving instead of salvage surgery. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
548P
Local immune status in cancer cell nests can be a predictor of survival for rectal cancer with neoadjuvant radiotherapy
549P
Impact of concomitant medications on disease free survival (DFS) and overall survival (OS) in patients from the PETACC8 study
B. Cle´mence1, J. Taieb2, M. Boulin3, K. Le Malicot4, L.M. Dourthe5, B. Avisse6, P. Laplaige7, C. Borel8, D. Arsene9, F. Kikolski10, B. Denis11, P. Geoffroy12, R. Coriat13, G. Piot14, C. Lepage1 1 Hepatogastroenterology Department, CHU Dijon, Dijon, France, 2Department of Gastroenterology and Digestive Oncology, Hopital European George Pompidou, Paris, France, 3Pharmacy Department, CHU Dijon, Dijon, France, 4Biostatistics, FFCD, Dijon, France, 5Oncology Department, Clinique Sainte Anne, Strasbourg, France, 6 Hepatogastroenterology Department, Centre Hospitalier Pierre Oudot, BourgoinJallieu, France, 7Medical Oncology Department, Polyclinique de Blois, La Chaussee St. Victor, France, 8Medical Oncology Department, Centre Paul Strauss Centre de Lutte Contre le Cancer, Strasbourg, France, 9Oncology Department, CHU de Caen, Caen, France, 10Gastroenterology and Hepatology, Hoˆpital Robert Boulin, Libourne, France, 11 Hepatogastroenterology Department, Hoˆpital Louis Pasteur, Colmar, France, 12 Hepatogastroenterology Department, Clinique Saint-Vincent, Epernay, France, 13 Gastroenterology Department and Digestive Oncology, Hoˆpital Cochin, Paris, France, 14 Oncology Department, Clinique des Ormeaux, Le Havre, France Background: Impact of comedications and comorbidities upon OS isn’t well described in cancer patients (pts). We aimed to evaluate their impacts on DFS and OS on pts resected from a stage III colon cancer and treated by adjuvant FOLFOX-4 þ/- cetuximab in the PETACC8 study. Methods: Treatments (trts) categories were defined according to the WHO ATC classification system. We focused on 4 medication classes: anticoagulant, cardiovascular, antidiarrheal and antidiabetic trts. We classified the 2559 pts in each category if they took trt at baseline or during study whatever the duration was. Kaplan-Meier method and Cox model were used to compare survival curves. Multivariate analyses were performed on the overall population and according to trt arm. Results: Only 1% of pts had no comedications. Comedications with anticoagulant, cardiovascular, antidiarrheal and antidiabetic trts were observed respectively in 18%, 40%, 30% and 9% of the cases. Patients with antidiabetic or cardiovascular trts had more comorbidities. For each other comedication categories, baseline characteristics were balanced between pts treated or not. All comedication categories, except antidiarrheals, were associated with a significant decrease of DFS and OS (Table). Dose-intensity was balanced and may not explain survival differences. For pts treated with at least one cardiac, diabetic or anticoagulant trts, severe events were more frequently reported, including 9 early deaths. The use of antidiarrheals is maybe associated to a better exposure to chemotherapy as reflected by a higher rate of grade 3 adverse events but also a potential better efficacy. Table. Comedications impact on DFS and OS.
X. Lin1, F. Lin2, Q. Zhuang2, X. Zhang2, Y. Huang2, L. Tang2, J. Li3, W. Junxin1 1 Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China, 2Radiation Oncology, Fujian Medical University Cancer Hospital, Fuzhou, China, 3Radiation, Xiamen Cancer Hospital, The First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen, China
Volume 30 | Supplement 5 | October 2019
doi:10.1093/annonc/mdz246 | v207
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_5/mdz246.024/5577075 by guest on 26 October 2019
Gender Age body mass index Degree Differentiation ypT ypN Diferencial INP ECOG
Background: Although neoadjuvant chemoradiotherapy is the standard treatment for locally advanced rectal cancer (LARC), it remains difficult to predict the prognosis of LARC patients. We aimed to explore the impacts of local immune status on survival of LARC after noeadjuvant radiotherapy (nRT). Methods: A total of 76 consecutive LARC patients were enrolled in our institute from February 2012 to September 2015. CD3þ T-cell and CD8þ T-cell count were determined from surgical specimens. Factors associated with disease-free survival (DFS) and overall survival (OS) were identified by univariate and multivariate Cox regression. SPSS 22.0 was used for statistical analyse. Results: The median follow-up time was 29.0 months (range 2.0-59). The Cutoff software identified an optimal CD3þ T-cell cutoff value of 12.5% and CD8þ Tcell value of 9% for our patients. According to the Kaplan-Meier analysis, CD3þ T-cell 12.5% was significantly related to favorable DFS (P ¼ 0.020), while there was no significant difference between CD3þ T-cell and OS (P ¼ 0.238). Meanwhile, CD8þ T-cell 9% was found to have a positive effect on DFS and OS (P ¼ 0.012 and P ¼ 0.035, respectively). In the multivariate Cox regression model, CD8þ T-cell <9% was independent risk factors for poor DFS (HR ¼ 0.492, 95%CI¼ 0.252-0.960, P ¼ 0.038). Furthermore, CD8þ T-cell (HR ¼ 0.268, 95%CI¼ 0.076-0.941, P ¼ 0.040) and T stage (HR ¼ 0.151, 95%CI¼ 0.030-0.7530, P ¼ 0.021) were independent predictors of OS. Conclusions: High CD8þ T-cell count were significantly related to good survival in LARC patients with nRT. Local immune status was suggested to be measured in order to predict the prognosis of patients with LACR after nRT. Legal entity responsible for the study: Xijin Lin. Funding: The Fujian Province Natural Science Foundation (2017J01260), Joint Funds for the Innovation of Science and Technology, Fujian province (2017Y9074), and the Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing (2017 Open Project-9). Disclosure: All authors have declared no conflicts of interest.