Ann Surg Treat Res.  2015 Jan;88(1):15-20. 10.4174/astr.2015.88.1.15.

Oncologic impact of pathologic response on clinical outcome after preoperative chemoradiotherapy in locally advanced rectal cancer

Affiliations
  • 1Division of Colorectal Surgery, Department of Surgery, Chonnam National University Medical School, Gwangju, Korea. drkhr@jnu.ac.kr

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.

Keyword

Rectal neoplasms; Chemoradiotherapy; Pathologic y-staging

MeSH Terms

Chemoradiotherapy*
Fluorouracil
Follow-Up Studies
Humans
Leucovorin
Multivariate Analysis
Prevalence
Rectal Neoplasms*
Recurrence
Retrospective Studies
Survival Rate
Fluorouracil
Leucovorin

Figure

  • Fig. 1 (A) MRI imaging of patient before receiving preoperative chemoradiotherapy. (B) MRI imaging of patient after receiving preoperative chemoradiotherapy.

  • Fig. 2 Proportion of five-year local recurrence-free survival. yp-stage, pathologic y-stage.

  • Fig. 3 Proportion of five-year systemic recurrence-free survival. yp-stage, pathologic y-stage.


Cited by  3 articles

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Jeong Yeon Kim, Sung Gil Park, Kyung-Sub Kim, Yong Hee Choi, Nam Kyu Kim
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Oncologic comparison between nonradical management and total mesorectal excision in good responders after chemoradiotherapy in patients with mid-to-low rectal cancer
Ja Kyung Lee, Jung Rae Cho, Kwang-Seop Song, Jae Hwan Oh, Seung-Yong Jeong, Min Jung Kim, Jeehye Lee, Min Hyun Kim, Heung-Kwon Oh, Duck-Woo Kim, Sung-Bum Kang,
Ann Surg Treat Res. 2021;101(2):93-101.    doi: 10.4174/astr.2021.101.2.93.

Impact of circumferential tumor location of mid to low rectal cancer on oncologic outcomes after preoperative chemoradiotherapy
Hyeong-min Park, Ook Song, Jaram Lee, Soo Young Lee, Chang Hyun Kim, Hyeong Rok Kim
Ann Surg Treat Res. 2022;103(2):87-95.    doi: 10.4174/astr.2022.103.2.87.


Reference

1. Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wiggers T, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med. 2001; 345:638–646.
2. Sauer R, Becker H, Hohenberger W, Rodel C, Wittekind C, Fietkau R, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004; 351:1731–1740.
3. Huh JW, Kim HR, Kim YJ. Clinical prediction of pathological complete response after preoperative chemoradiotherapy for rectal cancer. Dis Colon Rectum. 2013; 56:698–703.
4. Lee YC, Hsieh CC, Chuang JP. Prognostic significance of partial tumor regression after preoperative chemoradiotherapy for rectal cancer: a meta-analysis. Dis Colon Rectum. 2013; 56:1093–1101.
5. Roy P, Serra S, Kennedy E, Chetty R. The prognostic value of grade of regression and oncocytic change in rectal adenocarcinoma treated with neo-adjuvant chemoradiotherapy. J Surg Oncol. 2012; 105:130–134.
6. Rullier A, Gourgou-Bourgade S, Jarlier M, Bibeau F, Chassagne-Clement C, Hennequin C, et al. Predictive factors of positive circumferential resection margin after radiochemotherapy for rectal cancer: the French randomised trial ACCORD12/0405 PRODIGE 2. Eur J Cancer. 2013; 49:82–89.
7. Kuo LJ, Liu MC, Jian JJ, Horng CF, Cheng TI, Chen CM, et al. Is final TNM staging a predictor for survival in locally advanced rectal cancer after preoperative chemoradiation therapy. Ann Surg Oncol. 2007; 14:2766–2772.
8. Mason AY. President's address. Rectal cancer: the spectrum of selective surgery. Proc R Soc Med. 1976; 69:237–244.
9. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, editors. AJCC cancer staging manual. 7th ed. New York: Springer;2010.
10. Dworak O, Keilholz L, Hoffmann A. Pathological features of rectal cancer after preoperative radiochemotherapy. Int J Colorectal Dis. 1997; 12:19–23.
11. Improved survival with preoperative radiotherapy in resectable rectal cancer. Swedish Rectal Cancer Trial. N Engl J Med. 1997; 336:980–987.
12. Suarez J, Vera R, Balen E, Gomez M, Arias F, Lera JM, et al. Pathologic response assessed by Mandard grade is a better prognostic factor than down staging for disease-free survival after preoperative radiochemotherapy for advanced rectal cancer. Colorectal Dis. 2008; 10:563–568.
13. Park YJ, Oh BR, Lim SW, Huh JW, Joo JK, Kim YJ, et al. Clinical significance of tumor regression grade in rectal cancer with preoperative chemoradiotherapy. J Korean Soc Coloproctol. 2010; 26:279–286.
14. Abdul-Jalil KI, Sheehan KM, Kehoe J, Cummins R, O'Grady A, McNamara DA, et al. The prognostic value of tumour regression grade following neoadjuvant chemoradiation therapy for rectal cancer. Colorectal Dis. 2014; 16:O16–O25.
15. Topova L, Hellmich G, Puffer E, Schubert C, Christen N, Boldt T, et al. Prognostic value of tumor response to neoadjuvant therapy in rectal carcinoma. Dis Colon Rectum. 2011; 54:401–411.
16. Garcia-Aguilar J, Hernandez de Anda E, Sirivongs P, Lee SH, Madoff RD, Rothenberger DA. A pathologic complete response to preoperative chemoradiation is associated with lower local recurrence and improved survival in rectal cancer patients treated by mesorectal excision. Dis Colon Rectum. 2003; 46:298–304.
17. Lee JH, Jang HS, Kim JG, Cho HM, Shim BY, Oh ST, et al. Lymphovascular invasion is a significant prognosticator in rectal cancer patients who receive preoperative chemoradiotherapy followed by total mesorectal excision. Ann Surg Oncol. 2012; 19:1213–1221.
18. Liebig C, Ayala G, Wilks J, Verstovsek G, Liu H, Agarwal N, et al. Perineural invasion is an independent predictor of outcome in colorectal cancer. J Clin Oncol. 2009; 27:5131–5137.
19. Rodel C, Martus P, Papadoupolos T, Fuzesi L, Klimpfinger M, Fietkau R, et al. Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer. J Clin Oncol. 2005; 23:8688–8696.
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