Oncologic impact of pathologic response on clinical outcome after preoperative chemoradiotherapy in locally advanced rectal cancer.
10.4174/astr.2015.88.1.15
- Author:
Wook Hyeon YOON
1
;
Hun Jin KIM
;
Chang Hyun KIM
;
Jae Kyoon JOO
;
Young Jin KIM
;
Hyeong Rok KIM
Author Information
1. Division of Colorectal Surgery, Department of Surgery, Chonnam National University Medical School, Gwangju, Korea. drkhr@jnu.ac.kr
- Publication Type:Original Article
- Keywords:
Rectal neoplasms;
Chemoradiotherapy;
Pathologic y-staging
- MeSH:
Chemoradiotherapy*;
Fluorouracil;
Follow-Up Studies;
Humans;
Leucovorin;
Multivariate Analysis;
Prevalence;
Rectal Neoplasms*;
Recurrence;
Retrospective Studies;
Survival Rate
- From:Annals of Surgical Treatment and Research
2015;88(1):15-20
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: Downstaging after chemoradiotherapy (CRT) for rectal cancer usually occurs. The present study aimed to evaluate pathologic y-stage (yp-stage) and its influence on local recurrence and systemic recurrence in rectal cancer patients treated with CRT followed by surgical resection. METHODS: We retrospectively analyzed 261 patients underwent preoperative CRT and radical resection for rectal cancer between August 2004 and December 2010. Patients received preoperative CRT consisting of 5-fluorouracil and leucovorin delivered with concurrent pelvic radiation of 45.0-50.4 Gy, followed by radical surgery at 6-8 weeks after CRT. RESULTS: Of the 261 patients, 24 (9.2%) had yp-stage 0, 83 (31.8%) had yp-stage I, 86 (32.9%) had yp-stage II, and 68 (26.1%) had yp-stage III. Patients with yp-stage III had a greater prevalence of preoperative CEA, poorly differentiated tumor, lymphovascular invasion (LVI) and perineural invasion (PNI) than patients with lower yp-stages. We found that yp-stage, preoperative CEA, LVI, PNI and tumor regression grade were significant prognostic factors for both local and systemic recurrence. In multivariate analysis, yp-stage, LVI and PNI were significant factors for local and systemic recurrence. During the median follow-up of 37.5 months, the five-year local recurrence-free survival rate was 100.0%, 95.0%, 89.3%, and 80.6% of yp-stage 0-III, respectively. The five-year systemic recurrence-free survival was 95.8%, 75.3%, 71.4%, and 48.8% of yp-stages 0-III, respectively. CONCLUSION: The yp-stage after preoperative CRT for rectal cancer is closely correlated with local and systemic recurrence-free survival. Therefore, yp-stage should be considered as a prognostic factor for rectal cancer patients having a course of preoperative CRT.
