Tsuyoshi Konishi

PURPOSE: The incidence of young-onset colorectal cancer is increasing, and affected patients experience distinct challenges. Patients with young-onset colorectal cancer may benefit from a dedicated care coordinator who systematically assesses their unmet needs and facilitates referrals to multidimensional specialty support services. METHODS: In this pragmatic trial, we assigned patients with newly diagnosed colorectal cancer younger than 50 years who presented to a tertiary academic institution between 2023 and 2025 to standard care versus standard care plus additional encounter(s) with a dedicated young-onset colorectal cancer care coordinator. Patient-reported concerns and distress were collected at initial presentation. The primary end point was utilization frequency of support services. Multivariable regression identified predictors of service utilization. RESULTS: Among 1,250 patients with young-onset colorectal cancer (mean age 42.8 ± 6.0 years; 45.4% female), 46.3% had rectal cancer. Emotional concerns were most common (41.0%), followed by physical (36.1%), practical (27.8%), and social (9.4%) concerns. Overall, clinically significant distress (distress score ≥4) was reported by 27.4%. The young-onset colorectal cancer coordinator successfully established contact with 604 individuals. Unmet service needs were reported by 39.1% in the intervention group, of whom 80.5% subsequently accessed corresponding support services. Patients who established contact with the young-onset colorectal cancer coordinator were more likely to access support services (72.5% v 44.7%, P < .001). On multivariable analysis, coordinator contact (adjusted odds ratios [aOR], 1.48, 95% CI, 1.22 to 1.80), rectal cancer diagnosis (aOR, 1.36, 95% CI, 1.13 to 1.62), and clinically significant distress (aOR, 1.23, 95% CI, 1.01 to 1.50) predicted greater multidimensional service utilization. CONCLUSION: Patients with young-onset colorectal cancer experience substantial emotional concerns and unmet needs. Proactive integration of a dedicated care coordinator was associated with significantly increased utilization of multidimensional support services. This pragmatic trial supports a personalized, needs-driven care delivery model that integrates patient-reported outcomes as the basis for patient-centric cancer care.

Anastomotic leakage after sphincter-preserving proctectomy is a serious postoperative complication. It is unclear whether diverting ostomy prevents anastom

Associations between baseline HPV ctDNA quantification and clinical features

Recurrence outcomes after chemoradiation according to HPV ctDNA detection

Associations between recurrence after chemoradiation and clinical/pathologic features

Purpose: Although detection of ctDNA weeks after surgery is linked to recurrence for other solid tumors, the optimal time point for ctDNA assessment as a prognostic biomarker following chemoradiation for anal cancer is undefined. Experimental Design: Patients with stages I to III anal cancer treated with chemoradiation between December 2020 and March 2024 were evaluated for human papillomavirus (HPV) ctDNA status at baseline, at the end of chemoradiation, and during surveillance using a droplet digital HPV ctDNA PCR assay, targeting HPV E6 and E7 oncogenes for 13 oncogenic HPV types. Median recurrence-free survival (RFS) according to HPV ctDNA status was estimated via Kaplan–Meier and compared using a log-rank test. Results: Detection of HPV ctDNA at ≥3 months after chemoradiation was associated with recurrence (80% vs. 2%; OR, 168; 95% confidence interval (CI), 13.6–2,080; P < 0.0001) and inferior RFS [4.9 months vs. not reached; HR, 39.2; 95% CI, 4.6–330; P < 0.0001] relative to HPV ctDNA–negative status. Sensitivity and specificity for recurrence according to HPV ctDNA detection were 89% and 95%, respectively, with positive and negative predictive values of 80% and 98%, respectively. Differences in RFS according to HPV ctDNA status were not observed at the end of treatment (median RFS, not reached for both; HR, 1.6; 95% CI, 0.35–7.4; P = 0.48). Conclusions: With a novel, highly sensitive assay, detection of HPV ctDNA at least 3 months after chemoradiation was associated with unfavorable survival. Future clinical trials should incorporate this 3-month post-treatment time point to identify patients with HPV-positive anal cancer at elevated recurrence risk according to HPV ctDNA status. See related commentary by Bercz et al., p. 2261

Introduction Inadequate treatment of enlarged lateral lymph nodes (LLNs) in rectal cancer patients is associated with an increased lateral local recurrence (LLR) risk, despite neoadjuvant treatment and total mesorectal excision (TME) surgery. There is a promising role for LLN dissection (LLND) to lower this risk, but this challenging procedure requires appropriate training. This study protocol describes a prospective evaluation of oncological outcomes after standardised treatment based on multidisciplinary training, thereby aiming for a 50% reduction in LLR rate. Methods and analysis A prospective registration study will be opened in hospitals in which the involved multidisciplinary team members (radiologists, radiation oncologists, surgeons and pathologists) have received dedicated training to enhance knowledge and awareness of LLNs and in which standardised treatment including LLND has been implemented. Patients with rectal cancer and at least one enlarged LLN (short-axis ≥7.0 mm), or intermediate LLN (short-axis 5.0–6.9 mm) with at least one malignant feature on primary MRI, evaluated by a trained radiologist, are eligible. Patients will undergo neoadjuvant treatment by trained radiation oncologists, followed by TME surgery in combination with a minimally invasive, nerve-sparing LLND performed by trained surgeons. LLND specimens are evaluated by trained pathologists or grossing assistants. The primary outcome is LLR rate 3 years postoperatively. Secondary outcomes are morbidity, disease-free survival, overall survival and quality of life. To demonstrate a significant reduction in LLR rate from 13% (based on historical control data) to 6% after optimised treatment, 200 patients with enlarged LLNs are required. Ethics and dissemination The medical ethics board of the Vrije Universiteit Medical Centre (VUMC), the Netherlands, approved the study on 23 November 2022 (reference: 2021.0524). Participating centres must obtain local approval and participants are required to provide written informed consent. Results obtained from this study will be communicated via peer-reviewed medical journals and presentations at conferences. Trail registration number NCT04486131, 24 July 2020, https://clinicaltrials.gov/ct2/show/NCT04486131.