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BACKGROUND@#In light of the significant clinical benefits of antibody-drug conjugates in clinical trials, the human epidermal growth factor receptor 2 (HER2)-low category in breast cancers has gained increasing attention. Therefore, we studied the clinicopathological characteristics of Chinese patients with hormone receptor (HR)-positive/HER2-low early-stage breast cancer and developed a recurrence risk prediction model.@*METHODS@#Female patients with HR-positive/HER2-low early-stage breast cancer treated in 29 hospitals of the Chinese Society of Breast Surgery (CSBrS) from Jan 2015 to Dec 2016 were enrolled. Their clinicopathological data and prognostic information were collected, and machine learning methods were used to analyze the prognostic factors.@*RESULTS@#In total, 25,096 patients were diagnosed with breast cancer in 29 hospitals of CSBrS from Jan 2015 to Dec 2016, and clinicopathological data for 6486 patients with HER2-low early-stage breast cancer were collected. Among them, 5629 patients (86.79%) were HR-positive. The median follow-up time was 57 months (4, 76 months); the 5-year disease-free survival (DFS) rate was 92.7%, and the 5-year overall survival (OS) rate was 97.7%. In total, 412 cases (7.31%) of metastasis were observed, and 124 (2.20%) patients died. Multivariate Cox regression analysis revealed that T stage, N stage, lymphovascular thrombosis, Ki-67 index, and prognostic stage were associated with recurrence and metastasis ( P <0.05). A recurrence risk prediction model was established using the random forest method and exhibited a sensitivity of 81.1%, specificity of 71.7%, positive predictive value of 74.1%, and negative predictive value of 79.2%.@*CONCLUSION@#Most of patients with HER2-low early-stage breast cancer were HR-positive, and patients had favorable outcome; tumor N stage, lymphovascular thrombosis, Ki-67 index, and tumor prognostic stage were prognostic factors. The HR-positive/HER2-low early-stage breast cancer recurrence prediction model established based on the random forest method has a good reference value for predicting 5-year recurrence events.@*REGISTRITATION@#ChiCTR.org.cn, ChiCTR2100046766.
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Humanos , Femenino , Neoplasias de la Mama/diagnóstico , Antígeno Ki-67 , Receptor ErbB-2 , Pronóstico , Trombosis , Receptores de ProgesteronaRESUMEN
Neoadjuvant therapy has been continuously improved the outcomes of early breast cancer patients, and more patients with positive axillary lymph node achieve complete pathological responds. The timing of sentinel lymph node biopsy for patients receiving neoadjuvant therapy has also had a new strategy, especially for the patients with clinical positive axillary lymph node before treatment and become clinical negative after neoadjuvant therapy, sentinel lymph node biopsy after neoadjuvant therapy has gradually become a standard axillary surgery procedure. However, there are still many differences in clinical practice domestic in China and abroad. This article discussed the timing of sentinel lymph node biopsy in patients with early breast cancer undergoing neoadjuvant therapy, in order to draw the attention of domestic surgical colleagues to this issue and promote standardized surgery and multidisciplinary cooperation.
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BACKGROUND@#: Breast cancer with low-positive human epidermal growth factor receptor 2 (HER2) expression has triggered further refinement of evaluation criteria for HER2 expression. We studied the clinicopathological features of early-stage breast cancer with low-positive HER2 expression in China and analyzed prognostic factors.@*METHODS@#: Clinical and pathological data and prognostic information of patients with early-stage breast cancer with low-positive HER2 expression treated by the member units of the Chinese Society of Breast Surgery and Chinese Society of Surgery of Chinese Medical Association, from January 2015 to December 2016 were collected. The prognostic factors of these patients were analyzed.@*RESULTS@#: Twenty-nine hospitals provided valid cases. From 2015 to 2016, a total of 25,096 cases of early-stage breast cancer were treated, 7642 (30.5%) of which had low-positive HER2 expression and were included in the study. After ineligible cases were excluded, 6486 patients were included in the study. The median follow-up time was 57 months (4-76 months). The disease-free survival rate was 92.1% at 5 years, and the overall survival rate was 97.4% at 5 years. At the follow-up, 506 (7.8%) cases of metastasis and 167 (2.6%) deaths were noted. Multivariate Cox regression analysis showed that tumor stage, lymphvascular invasion, and the Ki67 index were related to recurrence and metastasis (P < 0.05). The recurrence risk prediction model was established using a machine learning model and showed that the area under the receiving operator characteristic curve was 0.815 (95% confidence interval: 0.750-0.880).@*CONCLUSIONS@#: Early-stage breast cancer patients with low-positive HER2 expression account for 30.5% of all patients. Tumor stage, lymphvascular invasion, and the Ki67 index are factors affecting prognosis. The recurrence prediction model for breast cancer with low-positive HER2 expression based on a machine learning model had a good clinical reference value for predicting the recurrence risk at 5 years.@*TRIAL REGISTRATION@#: ChiCTR.org.cn, ChiCTR2100046766.
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Femenino , Humanos , Neoplasias de la Mama/metabolismo , Antígeno Ki-67 , Mastectomía , Receptor ErbB-2/metabolismoRESUMEN
The improvement of comprehensive therapy of breast cancer, not only improve the prognosis of patients, but also affect the strategy of surgical treatment, especially the widespread development of preoperative neoadjuvant chemotherapy. The timing of sentinel lymph node biopsy and the incision margin of breast-conserving surgery in patients treated with neoadjuvant chemotherapy are hot topics for surgeons. And for patients who cannot accept total breast resection, stage I reconstruction after mastectomy is the best surgical method to preserve the cosmetic breast shape. Methods and materials of reconstruction are another hot topic of surgical treatment. This article reviews the hot issues of surgical treatment of breast cancer in 2019, with a view to arousing the thinking of surgical colleagues on standardized treatment of breast cancer and strengthening multidisciplinary collaboration.
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The improvement of comprehensive therapy of breast cancer,not only improve the prognosis of patients,but also affect the strategy of surgical treatment,especially the widespread development of preoperative neoadjuvant chemotherapy.The timing of sentinel lymph node biopsy and the incision margin of breast-conserving surgery in patients treated with neoadjuvant chemotherapy are hot topics for surgeons.And for patients who cannot accept total breast resection,stage Ⅰ reconstruction after mastectomy is the best surgical method to preserve the cosmetic breast shape.Methods and materials of reconstruction are another hot topic of surgical treatment.This article reviews the hot issues of surgical treatment of breast cancer in 2019,with a view to arousing the thinking of surgical colleagues on standardized treatment of breast cancer and strengthening multidisciplinary collaboration.
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Objective To discuss the androgen receptor (AR expresion and its association with clinicopathological features and prognosis in early stage triple-negative breast cancer patients (TNBC).Methods The present study retrospectively analyzed the clinic data of 1 018 patients with early-stage invasive breast cancer treated at the Breast Disease Center at Peking University First Hospital between January 2014 and December 2016,including 1 011 females and 7 males;the age range was 21 to 92 years,and the median age was 57 years.Patients with TNBC were enrolled,and divided into AR positive group and AR negative group according to the expression of AR.The clinicopathological features were analysed,including menopause status,pathological type,T staging,lymph node involvement,anatomic staging,prognostic staging,Ki-67 index,histological grade,vascular tumor thrombus and neuroinvation,and the correlation between the expression of AR and clinicopathological features,curative effect of neoadjuvant chemotherapy and prognosis were calculated.The Student's t test was used to compare continuous data,the Pearsonx2 test or Fisher exact test was used to compare categorical variables,and the Mann-Whitney U test was used for quantitative data.The Kaplan-Meier method was used to analyze survival status,and comparisons between groups were calculated by the log-rank test.Results This study included 148 TNBC,accounting for 14.5％ of all patients,in which all patients were females,and the median age was 55 years,ranging from 27 years to 75 years.The number of AR-positive TNBC was 59,accounted for 39.9％ of all TNBC patients,and the numbers of AR-negative were 89,accounted for 60.1％.Ki-67 index,histological grade and prognostic stage were significantly different in AR-positive and AR-negative TNBC (P ＜ 0.05).There was no statistically significant difference between AR-positive TNBC and AR-negative TNBC in OS (98.3％ vs 95.4％,P =0.830) or in DFS (91.4％ vs 91.0％,P =0.812).Among TNBC who received neoadjuvant chemotherapy,AR-positive patients showed a lower pCR rate than AR-negative patients (x2 =4.381,P =0.046).Conclusions AR expression is associated with lower respond to neoadjuvant chemotherapy in TNBC.However,the association between AR expression and prognosis in TNBCs was still not clear.
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Objective@#To investigate the clinical relevance of prognostic staging according to the AJCC Breast Cancer Staging System, Eighth Edition for evaluation of the prognosis of triple-negative breast cancer.@*Methods@#The clinical data of 293 patients with triple-negative breast cancer who were treated at the Breast Disease Center, Peking University First Hospital, between January 2008 and December 2014, were retrospectively analyzed. All patients were female, with age of 53(16) years (M(QR)). The patients were staged according to the AJCC Breast Cancer Staging System, Eighth Edition. Survival analysis was performed by Kaplan-Meier method and Log-rank test. The role of clinical staging and prognostic staging in prognostic evaluation was investigated.@*Results@#In all, 293 patients with triple-negative invasive breast cancer with complete clinical data and follow-up data were treated over a 7-year period. The follow-up time was 64.5(32.8) months, the 5-year overall survival (OS) rate was 83.9%, and the 5-year disease-free survival (DFS) rate was 84.1%. The results showed that clinical staging and prognostic staging were correlated with the DFS rate and OS rate of patients with triple-negative breast cancer (χ2 were 15.395 to 50.084,P=0.00). However, these two staging systems yielded different results. The prognostic stage of 91.8%(269/293) patients was higher than that of the original anatomical stage. There were significant differences in disease-free survival rate (χ2=22.357,P=0.00) and overall survival rate (χ2=50.084, P=0.00) among patients with different clinical stages. There were significant differences in disease-free survival rate (χ2=15.395,P=0.00) and overall survival rate (χ2=29.187,P=0.00)among patients with different prognostic stages.@*Conclusions@#The prognostic stage according to the AJCC Breast Cancer Staging System, Eighth Edition complements the clinical stage. It has a good predictive value for the prognosis of triple-negative breast cancer.
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In recent years, with the improvement of screening and early diagnosis, the overall prognosis of breast cancer patients has been greatly improved in China. Breast reconstruction is an option to improve cosmetic outcomes and quality of life for the patients received mastectomy, this procedure has attracted a lot of attention. The breast reconstruction surgery is recommended by the 2018 NCCN Clinical Practice Guidelines in Oncology for Breast Cancer in patients with appropriate indications. Despite the high proportion of breast reconstruction after mastectomy in western countries, Chinese breast surgeon should objectively understand the differences in breast structure and cultural backgrounds between Chinese and foreign women, and conduct rigorous clinical practice on the basis of calm thinking. In particular, it should be clearly recognized that we have more local advanced and high-risk cases in newly diagnosed breast cancer patients. Making efforts to improve the overall survival for patients with breast cancer must be the top priority for our surgeon. Breast reconstruction for all patients without identifying the distinction of personal characters and indications should be avoided, and the pursuing of high proportion of clinical data with no consideration of the realities of clinical practice in China should also be avoided. The indication of breast reconstruction for breast cancer patients received mastectomy must be strictly determined by the surgeon.
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Objective@#To discuss the androgen receptor (AR) expresion and its association with clinicopathological features and prognosis in early stage triple-negative breast cancer patients (TNBC).@*Methods@#The present study retrospectively analyzed the clinic data of 1 018 patients with early-stage invasive breast cancer treated at the Breast Disease Center at Peking University First Hospital between January 2014 and December 2016, including 1 011 females and 7 males; the age range was 21 to 92 years, and the median age was 57 years. Patients with TNBC were enrolled, and divided into AR positive group and AR negative group according to the expression of AR.The clinicopathological features were analysed, including menopause status, pathological type, T staging, lymph node involvement, anatomic staging, prognostic staging, Ki-67 index, histological grade, vascular tumor thrombus and neuroinvation, and the correlation between the expression of AR and clinicopathological features, curative effect of neoadjuvant chemotherapy and prognosis were calculated. The Student’s t test was used to compare continuous data, the Pearson χ2 test or Fisher exact test was used to compare categorical variables, and the Mann-Whitney U test was used for quantitative data. The Kaplan-Meier method was used to analyze survival status, and comparisons between groups were calculated by the log-rank test.@*Results@#This study included 148 TNBC, accounting for 14.5% of all patients, in which all patients were females, and the median age was 55 years, ranging from 27 years to 75 years. The number of AR-positive TNBC was 59, accounted for 39.9% of all TNBC patients, and the numbers of AR-negative were 89, accounted for 60.1%. Ki-67 index, histological grade and prognostic stage were significantly different in AR-positive and AR-negative TNBC(P<0.05). There was no statistically significant difference between AR-positive TNBC and AR-negative TNBC in OS (98.3% vs 95.4%, P=0.830) or in DFS (91.4% vs 91.0%, P=0.812). Among TNBC who received neoadjuvant chemotherapy, AR-positive patients showed a lower pCR rate than AR-negative patients(χ2=4.381, P=0.046).@*Conclusions@#AR expression is associated with lower respond to neoadjuvant chemotherapy in TNBC. However, the association between AR expression and prognosis in TNBCs was still not clear.
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Objective@#To study the clinicopathological characteristics and the prognostic determinants of the invasive lobular carcinoma breast cancer.@*Methods@#This was a retrospective single-center study of invasive lobular breast cancer cases diagnosed from January 2008 to December 2014 at Peking University First Hospital Breast Disease Center. The study enrolled 68 invasive lobular breast cancer patients, which represented 3.64% (68/1 870) of total invasive breast cancer. The median age of all selected patients was 46 years ranging from 36 to 83 years. All patients were restaged based on the 8th edition of AJCC cancer staging system and follow-up data including disease-free survival (DFS) and overall survival (OS) were analyzed to explore the prognostic determinants. The 5-year OS and DFS were calculated using Kaplan-Meier method; the significance of correlations between clinicopathological features and prognostic factors was estimated using log-rank test.@*Results@#There were significant differences in OS between patients with different anatomic stage, prognostic stage, lymph node metastasis, progesterone receptor (PR) expression, lymphvascular invasion and perineural invasion (χ2: 4.318 to 32.394, all P<0.05); significant differences in DFS were also observed between patients with different anatomic stage, prognostic stage, lymph node metastasis, PR expression, human epidermal growth factor receptor-2 expression, Ki-67 level, histological grade and lymphvascular invasion (χ2: 4.347 to 27.369, all P<0.05). Prognostic stages of 52.9% patients changed compared with anatomic stage, among which Luminal subtype mainly downstaged (22/30), however, triple negative subtype mainly upstaged (6/6).@*Conclusions@#Anatomic stage, prognostic stage, lymph node metastasis, PR expression, lymphvascular invasion are the prognostic factors of invasive lobular breast cancer. Regard to invasive lobular breast cancer patients, clinicians should pay close attention to the differences between prognostic stage and anatomic stage.
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Liquid biopsy is a diagnostic approach by analyzing body fluid samples. Peripheral blood is the most common sample. Urine, saliva, pleural effusion and ascites are also used. Now liquid biopsy is mainly used in the area of neoplasm diagnosis and treatment. Compared with traditional tissue biopsy, liquid biopsy is minimally invasive, convenient to sample and easy to repeat. Liquid biopsy mainly includes circulating tumor cells and circulating tumor DNA (ctDNA) detection. Detection of ctDNA requires sensitive and accurate methods. The progression of next-generation sequencing (NGS) and digital PCR promote the process of studies in ctDNA. In 2016, Nature published the result of whole-genome sequencing study of breast cancer. The study found 1 628 mutations of 93 protein-coding genes which may be driver mutations of breast cancer. The result of this study provided a new platform for breast cancer ctDNA studies. In recent years, there were many studies using ctDNA detection to monitor therapeutic effect and guide treatment. NGS is a promising technique in accessing genetic information and guiding targeted therapy. It must be emphasized that ctDNA detection using NGS is still at research stage. It is important to standardize ctDNA detection technique and perform prospective clinical researches. The time is not ripe for using ctDNA detection to guide large-scale breast cancer clinical practice at present.
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Objective To evaluate the incidental irradiation to the axillary levels Ⅰ,Ⅱ and Ⅲduring the whole breast radiotherapy after breast conserving surgery(BCS)without axillary lymph node dissection(ALND)in breast cancer(BC)patients.Methods A retrospective analysis was performed on the consecutive 42 cases of T1-2N0M0stage BC patients with sentinel lymphnode biopsy(SLNB)and BCS but without ALND.The axillary lymph nodes of Ⅰ,Ⅱ and Ⅲ were delineated according to RTOG atlas guideline.Three radiotherapy plans including conventional tangential field(CTF),three-dimensional conformal radiotherapy(3D-CRT)and forward-planned intensity-modulated radiotherapy(IMRT)for whole breast irradiation were devised for each case.The Prescription dose was 50 Gy per 25 fractions.Doses to axillary levels(Ⅰ-Ⅲ)were evaluated.Results The mean doses delivered to axillary by the three techniques(CTF,3D-CRT and IMRT)were(40.1 ±6.8),(35.4 ±8.3),(32.9 ±7.0)Gy for level Ⅰ(F＝10.269,P＜0.05),(33.2 ±7.1),(30.6 ±6.7),(30.4 ±7.0)Gy for level Ⅱ(P＞0.05)and(9.6 ±6.8),(6.4 ±4.5),(5.2 ±3.7)Gy for level Ⅲ(F ＝8.377,P ＜0.05),respectively.V50(volume receiving 50 Gy)for the three techniques were 21.3％,27.6％,9.6％for level Ⅰ(F＝13.161,P＜0.05),12.9％,15.9％,8.3％for level Ⅱ(F＝2.750,P＜0.05)and 0.4％,0.1％and 0％for level Ⅲ(P＞0.05),respectively.Conclusions The doses coverage to axillary levelsⅠ-Ⅲwere all limited in the three techniques.Therefore,it is necessary to assess the risk of axillary lymph node metastasis adequately to develop individualized radiotherapy plans.
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Objective To study the clinical significance for expression of serum matrix metalloproteinase and HER-2 extracellular domain in primary breast cancer.Methods Two hundred and forty two early breast cancer patients were enrolled as research group who met the criteria in Peking University Shenzhen Hospital from May 2015 to October 2017.They were divided into HER-2 positive breast cancer group (n =53) and HER-2 negative breast cancer group (n =189) according to HER-2 status.At the came time,non breast cancer women were recruited in outpatient as control group.The concentrations of serum MMP-2,MMP-9 and HER-2 ECD were detected by ELISA,and the differences of concentration in each grup were compared.Measurement data were expressed by mean and standard deviation,t test was used between two groups of parameters.A single factor analysis of variance was used among the multiple groups of parameters,and LSD test was used in the comparison between every two groups.Results The serum levels of MMP-2,MMP-9 and HER-2 ECD were (12.07 ± 1.23) ng/ml,(25.20 ±3.53) ng/ml and (10.42 ± 6.08) ng/ml in research group,HER-2 positive group were (13.43 ± 4.63) ng/ml,(25.24 ± 2.12) ng/ml and (13.25 ± 3.42) ng/ml,HER-2 negative group were (10.55 ± 3.72) ng/ml,(23.16 ±3.21) ng/ml and (6.33 ±4.11) ng/ml.The serum levels of MMP-2,MMP-9 and HER-2 ECD in the control group were (9.03 ± 1.15) ng/ml,(21.15 ±2.12) ng/ml and (4.71 ± 1.93) ng/ml.There were significant differences in MMP-2,MMP-9 and HER-2 ECD concentration between research group and control group (all P ＜ 0.0001).There was significant difference between HER-2 positive group and HER-2 negative group,HER-2 positive group and control group in the HER-2 ECD (P ＜ 0.0001).There were significant difference between control group and HER-2 positive group,control group and HER-2 negative group in the MMP-2 and MMP-9(P ＜ 0.000 1).In the HER-2 positive group,there was significant difference between HER-2 ECD positive and HER-2 ECD negative subgroup of MMP-2 and MMP-9(P ＜ 0.000 1).Conclusions In early breast cancer,HER-2 positive is an important condition for HER-2 ECD positive,and associated with abnormal activation of MMP.Combined detection of serum HER-2 ECD,MMP-2 and MMP-9 contributes to the determination of HER-2 status in tissues.
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Objective To investigate the difference of the expression of estrogen receptor,progesterone receptor,human epidermal growth factor receptor 2 and Ki-67 protein between primary lesions of breast cancer and its synchronous ipsilateral lymph node metastasis,as well as its clinical implications.Methods Retrospectively analyze invasive breast cancer patients treated in Peking University First Hospital from January 2012 to May 2016.The IHC expressions of estrogen receptor,progesterone receptor,human epidermal growth factor receptor 2 and Ki-67 protein in both the primary and lymph node metastatic lesions are compared and analyzed statistically.The count data were represented as n(％),and comparsion between groups were evaluated using the McNemar test.Results One hundred and fifty-six patients were included,of which on 2 cases (1.3％),estrogen receptor status of primary lesions is different from that of lymph node metastases(P =0.500);on 10 cases (6.4％),progesterone receptor status of primary lesions is different from that of lymph node metastases (P =0.344);on 28 cases (18.0％),Ki-67 protein status of primary lesions is different from that of lymph node metastases (P =0.000 18);on 3 cases (1.9％),human epidermal growth factor receptor 2 status of primary lesions is different from that of lymph node metastases (P =1.000).Conclusion There may be difference between primary lesions and lymph node metastases in the expression of estrogen receptor,progesterone receptor,human epidermal growth factor receptor 2 and Ki-67 protein,which can provide a reference for individualized treatment of breast cancer patients.
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Objective@#To explore the utility of circulating tumor DNA detection in early breast cancer by using next-generation sequencing.@*Methods@#This exploratory study of circulating tumor DNA detection is for early invasive breast cancer patients treated in Breast Disease Center, Peking University First Hospital from December 2015 to July 2016. Plasma samples were collected and were used to isolate plasma cell-free DNA.Exons or hotspots of 247 cancer related genes were sequenced by next-generation sequencing. Mutations and their correlation with clinic-pathological factors were analyzed. The correlation between mutations and clinic-pathological factors was evaluated by χ2 test or Fisher′s exact test.@*Results@#Seventy-five patients were enrolled in this study. All patients were female and aged from 31 to 88 years with median age of 58 years. All patients′ clinic-pathological records were complete. Sixty-four mutations in 18 genes (ALK, BCR, ERBB2, ROS1, PDGFRA, EGFR, FGFR2, CYP1B1, CALR, CASP7, BRAF, FGFR1, FGFR3, MET, NRAS, PTEN, KIT, SOD2) were detected in 47 (62.7%) among all 75 patients.Exons were captured in 10 genes, and mutations in 2 of 3 genes analyzed were clustered. Gene mutations were not correlated with menopausal status, histological type, primary tumor (T), regional lymph nodes (N), TNM stage, histological grade, estrogen receptor status, progesterone receptor status, human epidermal growth factor receptor 2 status, Ki-67 and molecular subtype (all P>0.05).@*Conclusion@#Circulating tumor DNA sequencing by next-generation sequencing was useful for detecting breast cancer-related mutations.
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Neo-adjuvant chemoradiotherapy (NACRT) combined with total mesorectal excision (TME) surgery is the main treatment for locally advanced middle-low rectal cancer, and NACRT significantly improves the local control rate of rectal cancer. According to the current guidelines, patients who receive clinical complete response (cCR) after NACRT are recommended for treatment with TME surgery. A few studies have shown that the watch-and-wait (WAW) policy is safe and could ensure anorectal function and quality of life in patients with cCR. In addition, such patients must be closely observed and followed up so as to enable salvage surgery for long periods of tumor re-growth. However, there is not enough evidence to provide a clear answer to the oncological effect of the WAW policy. As a result, WAW policy is not widely available in clinical practice, and further prospective studies are needed to assess its risk and benefit for the patients.
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The progress of gene detection technologies represented by next generation sequencing (NGS) and digital PCR laid a foundation for studies of circulating tumor DNA (ctDNA) in breast cancer. In 2014, the NGS workgroup organized by the College of American Pathologists (CAP) published the College of American Pathologists′ Laboratory Standards for Next-Generation Sequencing Clinical Tests, which provides a blueprint for the standardization of gene testing. In 2015, the Guidelines for Diagnostic Next-generation Sequencing published by the European Society of Human Genetics claimed that NGS is unacceptable in clinical practice before studies guided by guidelines are approved. Although existing studies show the benefits of ctDNA testing in disease monitoring and prognosis analyzing, we have a ways to go to normalize the procedure and build strict detection criteria.
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Laparoscopic surgery of rectal cancer has experienced more than 20 years of technical development and clinical research. Based on the published high-level clinical trials such as COREAN, COLOR Ⅱ, ACOSOG Z6051 and ALacaRT, laparoscopic surgery is recommended as method to treat rectal cancer by the NCCN Clinical Practice Guideline on Rectal Cancer (version 1.2016) with class 2A evidence. But it is also suggested that the surgeons should have experiences of performing minimally invasive proctectomy with total mesorectal excision. It is not recommended for the cases of locally advanced disease with a threatened or high risk circumferential resection margin based on staging. For those patients with high risk tumors, open surgery is preferred. Further analysis of the clinical trials has shown that surgical technique and circumferential resection margin are the key factors that affect the outcomes of laparoscopic rectal cancer surgery. Therefore, the wide application of laparoscopic surgery in the treatment of rectal cancer still needs more evidence-based clinical trials to test and prove.
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The eighth edition of cancer staging system published by AJCC will be implemented all over the world in January 1, 2018. In addition to strengthening the traditional TNM staging system, the introduction of new molecular markers, is a major advance in the eighth edition, and is expected to play a more valuable role in the"individualized" clinical practice. The most important update in the eighth edition of AJCC colorectal cancer staging system is"non-anatomic" prognostic and predictive evaluation system based on the molecular detection. The system is useful for better understanding the pathogenesis of colorectal cancer, and guide clinicians to provide individualized treatment for the patients even in the same stage of colorectal cancer.
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Compared with patients with high-middle rectal cancer,local recurrent rate of low rectal cancer in patients is worse.The poor outcome of low rectal cancer is due to the unique anatomical features of the low rectum and the lack of clearly defined anatomical excision planes.Therefore,how to use the appropriate imaging methods,evaluate accurately preoperative cancer staging,plan feasible surgical plane and select the appropriate surgical approach,these will be very important for radical resection of rectal cancer.Therefore,the quality of life and long-term survival of the patients will be improved.
