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Current and future cancer staging after neoadjuvant treatment for solid tumors. ​

Literature Information ​

DOI10.3322/caac.21640
PMID33156543
JournalCA: a cancer journal for clinicians
Impact Factor232.4
JCR QuartileQ1
Publication Year2021
Times Cited35
Keywordscancer registries, cancer stage, clinical stage, neoadjuvant, pathological stage
Literature TypeJournal Article, Review
ISSN0007-9235
Pages140-148
Issue71(2)
AuthorsDavid R Byrd, James D Brierley, Thomas P Baker, Daniel C Sullivan, Donna M Gress

TL;DR ​

This study highlights the need for cancer registries to incorporate staging data after neoadjuvant therapy (NAT), as current practices only partially capture this information, potentially leading to misunderstandings regarding treatment effectiveness. By reviewing pathological and imaging changes in breast, rectal, and esophageal cancers post-NAT, the research underscores the importance of standardized data collection to better assess clinical responses and improve population-level treatment outcomes.

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cancer registries · cancer stage · clinical stage · neoadjuvant · pathological stage

Abstract ​

Until recently, cancer registries have only collected cancer clinical stage at diagnosis, before any therapy, and pathological stage after surgical resection, provided no treatment has been given before the surgery, but they have not collected stage data after neoadjuvant therapy (NAT). Because NAT is increasingly being used to treat a variety of tumors, it has become important to make the distinction between both the clinical and the pathological assessment without NAT and the assessment after NAT to avoid any misunderstanding of the significance of the clinical and pathological findings. It also is important that cancer registries collect data after NAT to assess response and effectiveness of this treatment approach on a population basis. The prefix y is used to denote stage after NAT. Currently, cancer registries of the American College of Surgeons' Commission on Cancer only partially collect y stage data, and data on the clinical response to NAT (yc or posttherapy clinical information) are not collected or recorded in a standardized fashion. In addition to NAT, nonoperative management after radiation and chemotherapy is being used with increasing frequency in rectal cancer and may be expanded to other treatment sites. Using examples from breast, rectal, and esophageal cancers, the pathological and imaging changes seen after NAT are reviewed to demonstrate appropriate staging.

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Primary Questions Addressed ​

  1. How does the implementation of standardized data collection for y stage impact the overall understanding of treatment effectiveness in cancer registries?
  2. What are the challenges faced by cancer registries in transitioning to include post-neoadjuvant treatment staging data?
  3. In what ways could the findings from the assessment of pathological and imaging changes after neoadjuvant therapy influence future treatment protocols for solid tumors?
  4. How does the distinction between clinical and pathological staging after neoadjuvant therapy affect treatment decisions for patients with solid tumors?
  5. What role does the evolving practice of nonoperative management in rectal cancer play in shaping future cancer staging guidelines across different tumor types?

Key Findings ​

Key Insights ​

  1. Research Background and Purpose: The study addresses a significant gap in cancer staging practices, particularly concerning the management of solid tumors post-neoadjuvant therapy (NAT). Traditionally, cancer registries have only collected staging data at the time of diagnosis and after surgical resection, neglecting the crucial period following NAT. With the increasing application of NAT across various tumor types, there is a pressing need to differentiate between clinical and pathological assessments pre- and post-NAT. The primary objective is to highlight the importance of collecting standardized data on cancer stages post-NAT, which is critical for evaluating treatment responses and outcomes at a population level.

  2. Main Methods and Findings: The authors reviewed existing practices in cancer staging and identified the current limitations within cancer registries, particularly those maintained by the American College of Surgeons' Commission on Cancer. While there is partial collection of "y" stage data (which denotes the stage following NAT), systematic data on the clinical response to NAT, referred to as "yc" or posttherapy clinical information, is not consistently recorded. The study synthesizes examples from breast, rectal, and esophageal cancers to outline the pathological and imaging changes that occur after NAT. These examples underscore the necessity for a refined staging system that captures the dynamics introduced by NAT.

  3. Core Conclusion: The research concludes that there is an urgent need for cancer registries to implement standardized protocols for collecting and recording staging data following NAT. This includes the adoption of the "y" prefix to denote post-NAT stages and a systematic approach to gather clinical response data. By refining the staging process to incorporate changes due to NAT, clinicians and researchers can better assess treatment effectiveness and improve patient management strategies.

  4. Research Significance and Impact: The implications of this study are profound, as accurate staging post-NAT is essential for guiding treatment decisions and predicting patient outcomes. With the increasing trend toward nonoperative management strategies, especially in rectal cancer, the findings advocate for an evolution in cancer staging practices to reflect contemporary treatment paradigms. The standardization of post-NAT data collection is not only vital for individual patient care but also enhances the overall understanding of cancer treatment effectiveness on a broader scale, ultimately informing future clinical guidelines and improving cancer patient management.

Literatures Citing This Work ​

  1. Perioperative Safety and Effectiveness of Neoadjuvant Therapy with Fluorouracil, Leucovorin, Oxaliplatin, and Docetaxel Plus Apatinib in Locally Advanced Gastric Cancer. - Yonglei Zhang;Bin Zhang;Jinpo Yang;Jindai Zhang;Wei Zhang - Cancer management and research (2021)
  2. The safety and efficacy of neoadjuvant programmed death 1 inhibitor therapy with surgical resection in stage IIIA non-small cell lung cancer. - Jiangfeng Wang;Jianqiang Li;Lei Cai;Sheng Chen;Youhua Jiang - Annals of translational medicine (2021)
  3. Autophagy Blockade by Ai Du Qing Formula Promotes Chemosensitivity of Breast Cancer Stem Cells Via GRP78/β-Catenin/ABCG2 Axis. - Mianmian Liao;Caiwei Wang;Bowen Yang;Danping Huang;Yifeng Zheng;Shengqi Wang;Xuan Wang;Juping Zhang;Chunbian Tang;Zheng Xu;Yu He;Ruolin Huang;Fengxue Zhang;Zhiyu Wang;Neng Wang - Frontiers in pharmacology (2021)
  4. Apatinib with doxorubicin and ifosfamide as neoadjuvant therapy for high-risk soft tissue sarcomas: a retrospective cohort study. - Zhichao Tian;Jiaqiang Wang;Jinpo Yang;Peng Zhang;Xin Wang;Fan Zhang;Po Li;Weitao Yao - Investigational new drugs (2021)
  5. [Pan-cancer analysis of the expression pattern of long non-coding RNA MIR22HG]. - H Wang;W Li;D Zhang - Nan fang yi ke da xue xue bao = Journal of Southern Medical University (2022)
  6. Effects of N6-Methyladenosine Modification on Cancer Progression: Molecular Mechanisms and Cancer Therapy. - Yong-Fu Zhu;Shu-Jie Wang;Jie Zhou;Ye-Han Sun;You-Mou Chen;Jia Ma;Xing-Xing Huo;Hang Song - Frontiers in oncology (2022)
  7. Black phosphorous nanomaterials as a new paradigm for postoperative tumor treatment regimens. - Yanhua Hou;Yang Fei;Zehong Liu;Yingqi Liu;Menghuan Li;Zhong Luo - Journal of nanobiotechnology (2022)
  8. Cell Division Cycle-Associated Protein 3 (CDCA3) Is a Potential Biomarker for Clinical Prognosis and Immunotherapy in Pan-Cancer. - Yingkun Xu;Meiying Shen;Yang Peng;Li Liu;Lingfeng Tang;Ting Yang;Dongyao Pu;Wenhao Tan;Wenjie Zhang;Shengchun Liu - BioMed research international (2022)
  9. Direct and indirect effects of IFN-α2b in malignancy treatment: not only an archer but also an arrow. - Fei Xiong;Qi Wang;Guan-Hua Wu;Wen-Zheng Liu;Bing Wang;Yong-Jun Chen - Biomarker research (2022)
  10. Non-Invasive and Real-Time Monitoring of the Breast Cancer Metastasis Degree via Metabolomics. - Wanfang Zhu;Wenxin Qian;Wenting Liao;Xiaoxian Huang;Jiawen Xu;Wei Qu;Jingwei Xue;Feng Feng;Wenyuan Liu;Fulei Liu;Lingfei Han - Cancers (2022)

... (25 more literatures)

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