{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T16:24:57Z","timestamp":1785428697021,"version":"3.56.0"},"reference-count":20,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2025,3,1]],"date-time":"2025-03-01T00:00:00Z","timestamp":1740787200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Beijing Li Huanying Medical Foundation"},{"DOI":"10.13039\/501100005024","name":"Beijing Postdoctoral Research Foundation","doi-asserted-by":"publisher","award":["2023-ZZ-038"],"award-info":[{"award-number":["2023-ZZ-038"]}],"id":[{"id":"10.13039\/501100005024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100009601","name":"Beijing Hospitals Authority","doi-asserted-by":"publisher","award":["ZLRK202302"],"award-info":[{"award-number":["ZLRK202302"]}],"id":[{"id":"10.13039\/501100009601","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005088","name":"Beijing Municipal Health Commission","doi-asserted-by":"publisher","award":["2022-2-1112"],"award-info":[{"award-number":["2022-2-1112"]}],"id":[{"id":"10.13039\/501100005088","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Clinical Centre for Colorectal Cancer of Capital Medical University","award":["1192070313"],"award-info":[{"award-number":["1192070313"]}]},{"DOI":"10.13039\/501100012165","name":"National Key Technologies R&D Programme","doi-asserted-by":"publisher","award":["2015BAI13B09"],"award-info":[{"award-number":["2015BAI13B09"]}],"id":[{"id":"10.13039\/501100012165","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82374190"],"award-info":[{"award-number":["82374190"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100018537","name":"National Science and Technology Major Project","doi-asserted-by":"publisher","award":["2024ZD0520302"],"award-info":[{"award-number":["2024ZD0520302"]}],"id":[{"id":"10.13039\/501100018537","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100017239","name":"BeiGene, Ltd","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100017239","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,3,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The addition of PD1 blockade to neoadjuvant chemoradiotherapy (CRT) has been shown to significantly increase pCR rates in locally advanced rectal cancer (LARC). Yet, its impact on total mesorectal excision (TME) remains unknown.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A post-hoc analysis of the randomized POLARSTAR trial, which enrolled patients with LARC at eight major colorectal cancer centres in Beijing to compare neoadjuvant CRT plus PD1 blockade with CRT alone, was undertaken. Patients received one of three combinations of neoadjuvant treatments before TME surgery: CRT plus concurrent PD1 blockade (concurrent group), CRT plus sequential PD1 blockade (sequential group), and CRT alone (control group). Several parameters related to TME surgery were studied.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>For the concurrent group, the sequential group, and the control group, 52, 46, and 45 patients respectively were included in this analysis. The proportion of patients undergoing sphincter-saving plus one-stage anastomosis surgery was 92% (48 of 52), 96% (44 of 46), and 87% (39 of 45) respectively. The proportion of patients without a stoma was 21% (11 of 52), 17% (8 of 46), and 11% (5 of 45) respectively. The grade 3\/4 surgical complication rate was 4% (2 of 52), 7% (3 of 46), and 4% (2 of 45) respectively. Significant differences were observed between the sequential group and the control group with respect to the proportion of patients with TRG0 (37% versus 18% respectively; P = 0.040), ypT0\/is ypN0 (39% versus 20% respectively; P = 0.046), and a low neoadjuvant rectal (NAR) score (54% versus 31% respectively; P = 0.025).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Neoadjuvant CRT plus PD1 blockade enhances pathological tumour regression and is beneficial to the successful implementation of TME in patients with LARC. Validations with larger sample sizes are warranted.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/bjs\/znaf057","type":"journal-article","created":{"date-parts":[[2025,3,23]],"date-time":"2025-03-23T11:30:00Z","timestamp":1742729400000},"source":"Crossref","is-referenced-by-count":3,"title":["Impact of PD1 blockade added to neoadjuvant chemoradiotherapy on rectal cancer surgery: post-hoc analysis of the randomized POLARSTAR trial"],"prefix":"10.1093","volume":"112","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-1945-2870","authenticated-orcid":false,"given":"Kai","family":"Pang","sequence":"first","affiliation":[{"name":"Department of General Surgery, Beijing Friendship Hospital, Capital Medical University , Beijing ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinzhi","family":"Liu","sequence":"additional","affiliation":[{"name":"Gastrointestinal Cancer Centre, Unit III, Peking University Cancer Hospital & Institute , Beijing ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3995-6520","authenticated-orcid":false,"given":"Hongwei","family":"Yao","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Beijing Friendship Hospital, Capital Medical University , Beijing ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6225-3028","authenticated-orcid":false,"given":"Guole","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Peking Union Medical College Hospital , Beijing ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanyuan","family":"Kong","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology & EBM Unit, Beijing Friendship Hospital, Capital Medical University , Beijing ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ang","family":"Li","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Xuanwu Hospital, Capital Medical University , Beijing ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiagang","family":"Han","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University , Beijing ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guoju","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Beijing Hospital , Beijing ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Peking University First Hospital , Beijing ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingjiang","family":"Ye","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery, Peking University People\u2019s Hospital , Beijing ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Radiology, Beijing Friendship Hospital, Capital Medical University , Beijing ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guangyong","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Pathology, Beijing Friendship Hospital, Capital Medical University , Beijing ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aiwen","family":"Wu","sequence":"additional","affiliation":[{"name":"Gastrointestinal Cancer Centre, Unit III, Peking University Cancer Hospital & Institute , Beijing ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4309-1227","authenticated-orcid":false,"given":"Yi","family":"Xiao","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Peking Union Medical College Hospital , Beijing ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingchi","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Beijing Friendship Hospital, Capital Medical University , Beijing ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhongtao","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Beijing Friendship Hospital, Capital Medical University , Beijing ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,3,22]]},"reference":[{"key":"2025032211294621000_znaf057-B1","doi-asserted-by":"crossref","first-page":"229","DOI":"10.3322\/caac.21834","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J Clin"},{"key":"2025032211294621000_znaf057-B2","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1016\/S2468-1253(22)00044-9","article-title":"Global, regional, and national burden of colorectal cancer and its risk factors, 1990\u20132019: a systematic analysis for the global burden of disease study 2019","volume":"7","author":"GBD 2019 Colorectal Cancer Collaborators","year":"2022","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"2025032211294621000_znaf057-B3","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1097\/JS9.0000000000000293","article-title":"Changing trends, clinicopathological characteristics, surgical treatment patterns, and prognosis of schistosomiasis-associated versus non-schistosomiasis-associated colorectal cancer: a large retrospective cohort study of 31 153 cases in Shanghai, China (2001\u20132021)","volume":"109","author":"Zheng","year":"2023","journal-title":"Int J Surg"},{"key":"2025032211294621000_znaf057-B4","first-page":"3003","article-title":"Incidence, prevention, risk factors, and prediction of venous thromboembolism in Chinese patients after colorectal cancer surgery: a prospective, multicenter cohort study","volume":"109","author":"Wei","year":"2023","journal-title":"Int J Surg"},{"key":"2025032211294621000_znaf057-B5","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1186\/s12957-022-02816-7","article-title":"Chemoradiation and consolidation chemotherapy for rectal cancer provides a high rate of organ preservation with a very good long-term oncological outcome: a single-center cohort series","volume":"20","author":"Asoglu","year":"2022","journal-title":"World J Surg Oncol"},{"key":"2025032211294621000_znaf057-B6","doi-asserted-by":"crossref","first-page":"1851","DOI":"10.1007\/s13304-022-01396-1","article-title":"Robotic vs. laparoscopic intersphincteric resection for low rectal cancer: a case matched study reporting a median of 7-year long-term oncological and functional outcomes","volume":"74","author":"Aliyev","year":"2022","journal-title":"Updates Surg"},{"key":"2025032211294621000_znaf057-B7","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1016\/S1470-2045(15)00004-2","article-title":"Effect of adding mFOLFOX6 after neoadjuvant chemoradiation in locally advanced rectal cancer: a multicentre, phase 2 trial","volume":"16","author":"Garcia-Aguilar","year":"2015","journal-title":"Lancet Oncol"},{"key":"2025032211294621000_znaf057-B8","doi-asserted-by":"crossref","first-page":"1681","DOI":"10.1200\/JCO.21.01667","article-title":"Multicenter, randomized, phase III trial of short-term radiotherapy plus chemotherapy versus long-term chemoradiotherapy in locally advanced rectal cancer (STELLAR)","volume":"40","author":"Jin","year":"2022","journal-title":"J Clin Oncol"},{"key":"2025032211294621000_znaf057-B9","doi-asserted-by":"crossref","first-page":"2363","DOI":"10.1056\/NEJMoa2201445","article-title":"PD-1 Blockade in mismatch repair-deficient, locally advanced rectal cancer","volume":"386","author":"Cercek","year":"2022","journal-title":"N Engl J Med"},{"key":"2025032211294621000_znaf057-B10","doi-asserted-by":"crossref","first-page":"19","DOI":"10.21037\/jgo.2018.10.01","article-title":"Low prevalence of deficient mismatch repair (dMMR) protein in locally advanced rectal cancers (LARC) and treatment outcomes","volume":"10","author":"Ostwal","year":"2019","journal-title":"J Gastrointest Oncol"},{"key":"2025032211294621000_znaf057-B11","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1186\/s12885-023-11525-7","article-title":"Survival outcomes in locally advanced dMMR rectal cancer: surgery plus adjunctive treatment vs. surgery alone","volume":"23","author":"Ni","year":"2023","journal-title":"BMC Cancer"},{"key":"2025032211294621000_znaf057-B12","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1038\/s41591-024-03360-5","article-title":"Neoadjuvant chemoradiation with or without PD-1 blockade in locally advanced rectal cancer: a randomized phase 2 trial","volume":"31","author":"Yang","year":"2025","journal-title":"Nat Med"},{"key":"2025032211294621000_znaf057-B13","doi-asserted-by":"crossref","first-page":"e069499","DOI":"10.1136\/bmjopen-2022-069499","article-title":"Long-course chemoradiation plus concurrent\/sequential PD-1 blockade as neoadjuvant treatment for MMR-status-unscreened locally advanced rectal cancer: protocol of a multicentre, phase 2, randomised controlled trial (the POLAR-STAR trial)","volume":"13","author":"Pang","year":"2023","journal-title":"BMJ Open"},{"key":"2025032211294621000_znaf057-B14","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1016\/j.ejca.2008.10.026","article-title":"New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1)","volume":"45","author":"Eisenhauer","year":"2009","journal-title":"Eur J Cancer"},{"key":"2025032211294621000_znaf057-B15","doi-asserted-by":"crossref","first-page":"dju248","DOI":"10.1093\/jnci\/dju248","article-title":"Comparison of tumor regression grade systems for locally advanced rectal cancer after multimodality treatment","volume":"106","author":"Trakarnsanga","year":"2014","journal-title":"J Natl Cancer Inst"},{"key":"2025032211294621000_znaf057-B16","doi-asserted-by":"crossref","first-page":"1521","DOI":"10.1093\/annonc\/mdy143","article-title":"Neoadjuvant rectal score as individual-level surrogate for disease-free survival in rectal cancer in the CAO\/ARO\/AIO-04 randomized phase III trial","volume":"29","author":"Fokas","year":"2018","journal-title":"Ann Oncol"},{"key":"2025032211294621000_znaf057-B17","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/S1470-2045(20)30555-6","article-title":"Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open-label, phase 3 trial","volume":"22","author":"Bahadoer","year":"2021","journal-title":"Lancet Oncol"},{"key":"2025032211294621000_znaf057-B18","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.radonc.2020.03.011","article-title":"Compliance and tolerability of short-course radiotherapy followed by preoperative chemotherapy and surgery for high-risk rectal cancer - results of the international randomized RAPIDO-trial","volume":"147","author":"van der Valk","year":"2020","journal-title":"Radiother Oncol"},{"key":"2025032211294621000_znaf057-B19","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1093\/annonc\/mdw062","article-title":"Long-course oxaliplatin-based preoperative chemoradiation versus 5 \u00d7 5\u2005Gy and consolidation chemotherapy for cT4 or fixed cT3 rectal cancer: results of a randomized phase III study","volume":"27","author":"Bujko","year":"2016","journal-title":"Ann Oncol"},{"key":"2025032211294621000_znaf057-B20","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1016\/S1470-2045(21)00079-6","article-title":"Neoadjuvant chemotherapy with FOLFIRINOX and preoperative chemoradiotherapy for patients with locally advanced rectal cancer (UNICANCER-PRODIGE 23): a multicentre, randomised, open-label, phase 3 trial","volume":"22","author":"Conroy","year":"2021","journal-title":"Lancet Oncol"}],"container-title":["British Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/bjs\/article-pdf\/112\/3\/znaf057\/62522758\/znaf057.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/bjs\/article-pdf\/112\/3\/znaf057\/62522758\/znaf057.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,23]],"date-time":"2025-03-23T11:39:08Z","timestamp":1742729948000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/bjs\/article\/doi\/10.1093\/bjs\/znaf057\/8090306"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3]]},"references-count":20,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,3,22]]},"published-print":{"date-parts":[[2025,3,4]]}},"URL":"https:\/\/doi.org\/10.1093\/bjs\/znaf057","relation":{},"ISSN":["0007-1323","1365-2168"],"issn-type":[{"value":"0007-1323","type":"print"},{"value":"1365-2168","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,3]]},"published":{"date-parts":[[2025,3]]},"article-number":"znaf057"}}