The Prognostic Importance of ctDNA in Rectal Cancer: A Critical Reappraisal

The treatment of locally advanced rectal cancer (LARC) has evolved during the last decades, but recurrence remains a problem. Circulating tumor DNA (ctDNA) may result in an individualized treatment approach with improved survival and quality of life, but diverging results impede further development. In this systematic review, we addressed the quality of reporting and its impact on the interpretation of ctDNA results. We performed a systematic literature search using subject headings and search terms related to ctDNA and rectal cancer. The Quality of Prognostic Studies (QUIPS) tool was used to assess bias. Nine studies, with substantial heterogeneity, were included in the analysis. Three out of nine articles had moderate or high risk of bias. No association was found between treatment response and ctDNA status at baseline. There was a negative association between ctDNA positivity at baseline, before and after surgery and survival. The ctDNA status may be of importance to the long-term prognosis, but the area of research is new and is short of dedicated studies. There is an obvious need for standardization in ctDNA research, and the issue should be addressed in future research

I vilken utsträckning informerar sjuksköterskan om livsstilsfaktorer?

Bakgrund: Sjuksköterskans arbete präglas av att kunna arbeta preventivt gällande de olika livsstilsfaktorerna. Det preventiva arbetet anses vara en viktig faktor när det gäller hälsoutvecklingen hos Sveriges befolkning. Syfte: Syftet med studien var att beskriva sjuksköterskans undervisande arbete då det gäller frågor kring livsstil i arbetet med patienter som vårdas för hjärt- och kärl sjukdomar. Metod: Empirisk observationsstudie utifrån en kvalitativ ansats och enkätstudie utifrån en kvantitativ ansats. Resultatet analyserades med hjälp av en manifest innehållsanalys. Resultat: De rådgivande samtalen fungerade överlag bra. Vissa undantag föreföll dock. Under observationerna observerades det att alkohol var ett av de ämnen som diskuterades minst, då det uppgavs vara ett känsligt ämne. Samtalsstrategierna överensstämde med litteraturen om hur ett rådgivande samtal bör utformas. Slutsats: Resultatet tyder på att små förändringar bör ske vid de rådgivande samtalen. En öppnare inställning kring alkohol och rökning bör tillämpas då dessa är två av de störst bidragande faktorerna gällande hjärt- och kärl sjukdomar och många andra sjukdomstillstånd.Background: A nurse's work is characterized by working in a preventive manor concerning the different lifestyle factors. The preventive work is considered to be an important factor in the health development of the Swedish population. Objective: The purpose of the study was to describe the nurse's educational work concerning questions about lifestyle habits for patients who are treated for cardiovascular diseases. Method: Empirical observational study based on a qualitative approach and a survey based on a quantitative approach. The results were analyzed by using a manifest content analysis. Results: Overall, the consultative talks was working fine. Some exceptions appeared, however. During observations, it was noticed that alcohol was one of the subjects that was least frequently mentioned, as it was stated to be a sensitive topic. Call strategies were consistent with the literature and the recommendations for how consultative talks should be designed. Conclusions: The results suggest that small changes should be made at the consultative talks. A more open attitude should be applied about alcohol and smoking . This because these are two of the greatest contributing factors for cardiovascular disease and many other diseases

The Prognostic Importance of ctDNA in Rectal Cancer: A Critical Reappraisal

The treatment of locally advanced rectal cancer (LARC) has evolved during the last decades, but recurrence remains a problem. Circulating tumor DNA (ctDNA) may result in an individualized treatment approach with improved survival and quality of life, but diverging results impede further development. In this systematic review, we addressed the quality of reporting and its impact on the interpretation of ctDNA results. We performed a systematic literature search using subject headings and search terms related to ctDNA and rectal cancer. The Quality of Prognostic Studies (QUIPS) tool was used to assess bias. Nine studies, with substantial heterogeneity, were included in the analysis. Three out of nine articles had moderate or high risk of bias. No association was found between treatment response and ctDNA status at baseline. There was a negative association between ctDNA positivity at baseline, before and after surgery and survival. The ctDNA status may be of importance to the long-term prognosis, but the area of research is new and is short of dedicated studies. There is an obvious need for standardization in ctDNA research, and the issue should be addressed in future research

Reporting on circulating tumor DNA monitoring in metastatic cancer—From clinical validity to clinical utility

This commentary attempts to discuss the required standardization of circulating tumor DNA (ctDNA) analyses and thereby improve the clinical validity of ctDNA monitoring in the metastatic setting of solid tumors

The “Immunoscore” in rectal cancer: could we search quality beyond quantity of life?

International audienceBecause of the function and anatomical environment of the rectum, therapeutic strategies for local advanced rectal cancer (LARC) must deal with two challenging stressors that are a high-risk of local and distal recurrences and a high-risk of poor quality of life (QoL). Over the last three decades, advances in screening tests, therapies, and combined-modality treatment options and strategies have improved the prognosis of patients with LARC. However, owing to the heterogeneous nature of LARC and genetic status, the patient may not respond to a specific therapy and may be at increased risk of side-effects without the life-prolonging benefit. Indeed, each therapy can cause its own side-effects, which may worsen by a combination of treatments resulting in long-term poor QoL. In LARC, QoL has become even more essential with the increasing incidence of rectal cancer in young individuals. Herein, we analyzed the value of the Immunoscore-Biopsy (performed on tumor biopsy at diagnosis) in predicting outcomes, alone or in association with clinical and imaging data, for each therapy used in LARC

International Validation of the Immunoscore Biopsy in Patients With Rectal Cancer Managed by a Watch-and-Wait Strategy

PURPOSE: No biomarker capable of improving selection and monitoring of patients with rectal cancer managed by watch-and-wait (W&W) strategy is currently available. Prognostic performance of the Immunoscore biopsy (IS ) was recently suggested in a preliminary study. METHODS: This international validation study included 249 patients with clinical complete response (cCR) managed by W&W strategy. Intratumoral CD3+ and CD8+ T cells were quantified on pretreatment rectal biopsies by digital pathology and converted to IS . The primary end point was time to recurrence (TTR; the time from the end of neoadjuvant treatment to the date of local regrowth or distant metastasis). Associations between IS and outcomes were analyzed by stratified Cox regression adjusted for confounders. Immune status of tumor-draining lymph nodes (n = 161) of 17 additional patients treated by neoadjuvant chemoradiotherapy and surgery was investigated by 3'RNA-Seq and immunofluorescence. RESULTS: Recurrence-free rates at 5 years were 91.3% (82.4%-100.0%), 62.5% (53.2%-73.3%), and 53.1% (42.4%-66.5%) with IS High, IS Intermediate, and IS Low, respectively (hazard ratio [HR; Low High], 6.51; 95% CI, 1.99 to 21.28; log-rank = .0004). IS was also significantly associated with disease-free survival (log-rank = .0002), and predicted both local regrowth and distant metastasis. In multivariate analysis, IS was independent of patient age, sex, tumor location, cT stage (T, primary tumor; c, clinical), cN stage (N, regional lymph node; c, clinical), and was the strongest predictor for TTR (HR [IS High Low], 6.93; 95% CI, 2.08 to 23.15; = .0017). The addition of IS to a clinical-based model significantly improved the prediction of recurrence. Finally, B-cell proliferation and memory in draining lymph nodes was evidenced in the draining lymph nodes of patients with cCR. CONCLUSION: The IS is validated as a biomarker to predict both local regrowth and distant metastasis, with a gradual scaling of the risk of pejorative outcome