Evaluation of treatment response and tissue necrosis as prognostic indicators following neoadjuvant chemoradiotherapy in rectal cancer patients.
10.3904/kjim.2016.31.1.134
- Author:
Ji Han JUNG
1
;
Ho Jung AN
;
Hyung Jin KIM
;
Jonghoon LEE
;
Kang Moon LEE
;
Sung Hwan KIM
;
Hyeon Min CHO
;
Byoung Yong SHIM
Author Information
1. Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea.
- Publication Type:Comparative Study ; Original Article
- Keywords:
Rectal neoplasms;
Chemoradiotherapy;
Necrosis
- MeSH:
Aged;
Biopsy;
*Chemoradiotherapy, Adjuvant/adverse effects/mortality;
Chi-Square Distribution;
Disease Progression;
Disease-Free Survival;
Female;
Humans;
Kaplan-Meier Estimate;
*Laparoscopy/adverse effects/mortality;
Male;
Middle Aged;
Multivariate Analysis;
Necrosis;
*Neoadjuvant Therapy/adverse effects/mortality;
Neoplasm Recurrence, Local;
Neoplasm Staging;
Proportional Hazards Models;
Rectal Neoplasms/mortality/pathology/*therapy;
Remission Induction;
Retrospective Studies;
Risk Factors;
Time Factors;
Treatment Outcome
- From:The Korean Journal of Internal Medicine
2016;31(1):134-144
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND/AIMS: The objective of this study was to assess the prognostic roles of treatment response and tissue necrosis after chemoradiotherapy (CRT) in locally advanced rectal cancer. METHODS: A total of 243 patients with locally advanced rectal cancer who underwent neoadjuvant CRT were included. Three treatment response groups were classified by their pathological stage results: complete treatment response (CTR), intermediate treatment response (ITR), and poor treatment response (PTR). Three tissue necrosis groups were classified based on tissue pathological results: complete necrosis response (CNR), intermediate necrosis response (INR), and poor necrosis response (PNR). RESULTS: Overall survival (OS) and recurrence-free survival (RFS) rate at three years were 74.5% and 61.3%, respectively. The 3-year OS rates of the CTR, ITR, and PTR groups were 83.7%, 75.9%, and 69.7%, respectively (p < 0.001); the 3-year RFS rates were 76.7%, 69.0%, and 52.1%, respectively (p < 0.001). The 3-year OS rates of the CNR, INR, and PNR groups were 83.7%, 80.6%, and 61.8%, respectively (p < 0.001); the 3-year RFS rates were 76.7%, 68.9%, and 44.3%, respectively (p < 0.001). When compared to CTR/CNR, PTR/PNR was strongly related to an increased risk of recurrence (hazard ratio [HR], 5.53; 95% confidence interval [CI], 2.01 to 15.23 vs. HR, 6.37; 95% CI, 2.29 to 17.74, respectively) in univariate Cox regression. Both PTR and PNR were strongly associated with shorter RFS and OS when compared with CTR and CNR in the multivariate Cox regression. CONCLUSIONS: Tissue necrosis is an equally important prognostic marker as treatment response for oncologic outcomes in locally advanced rectal cancer.
