Cancer Res Treat.  2018 Apr;50(2):506-517. 10.4143/crt.2016.607.

Redefining the Positive Circumferential Resection Margin by Incorporating Preoperative Chemoradiotherapy Treatment Response in Locally Advanced Rectal Cancer: A Multicenter Validation Study

• Lee JH
• Chie EK
• Jeong SY
• Kim TY
• Kim DY
• Kim TH
• Kim SY
• Baek JY
• Chang HJ
• Kim MJ
• Park SC
• Oh JH
• Kim SH
• Lee JH
• Choi DH
• Park HC
• Kang SB
• Kim JS

• KMID: 2411139
• DOI: http://doi.org/10.4143/crt.2016.607

Abstract

PURPOSE
This study was conducted to validate the prognostic influence of treatment response among patients with positive circumferential resection margin for locally advanced rectal cancer.
MATERIALS AND METHODS
Clinical data of 197 patientswith positive circumferential resection margin defined as ≤ 2 mm after preoperative chemoradiotherapy followed by total mesorectal excision between 2004 and 2009 were collected for this multicenter validation study. All patients underwent median 50.4 Gy radiation with concurrent fluoropyrimidine based chemotherapy. Treatment response was dichotomized to good response, including treatment response of grade 2 or 3, and poor response, including grade 0 or 1.
RESULTS
After 52 months median follow-up, 5-year overall survival (OS) for good responders and poor responders was 79.1% and 48.4%, respectively (p < 0.001). In multivariate analysis, circumferential resection margin involvement and treatment response were a prognosticator for OS and locoregional recurrence-free survival. In subgroup analysis, good responders with close margin showed significantly better survival outcomes for survival. Good responders with involved margin and poor responders with close margin shared similar results, whereas poor responders with involved margin had worst survival (5-year OS, 81.2%, 57.0%, 50.0%, and 32.4%, respectively; p < 0.001).
CONCLUSION
Among patients with positive circumferential resection margin after preoperative chemoradiotherapy, survival of the good responders was significantly better than poor responders. Subgroup analysis revealed that definition of positive circumferential resection margin may be individualized as involvement for good responders, whereas ≤ 2 mm for poor responders.

Keyword

Rectal neoplasms; Chemoradiotherapy; Neoadjvant therapy; Margins of excision; Treatment response

MeSH Terms

Chemoradiotherapy*
Drug Therapy
Follow-Up Studies
Humans
Multivariate Analysis
Radiation Dosage
Rectal Neoplasms*

Figure

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  Fig. 1. Survival curve according to treatment response. Good responders, treatment response of grade 2 or 3; poor responders, grade 0 or 1. (A) Overall survival. (B) Locoregional recurrence-free survival.

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  Fig. 2. Subgroup analysis according to circumferential resection margin (CRM) status and treatment response. Good responders, treatment response grade 2 and 3; poor responders, treatment response grade 0 and 1. *p < 0.05 (Kaplan-Meier analysis). (A) Overall survival. (B) Locoregional recurrence-free survival.

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  Fig. 3. Subgroup analysis according to risk stratification by poor treatment response and involved margin risk factors include the involvement of circumferential resection margin and treatment response. (A) Overall survival. (B) Locoregional recurrence-free survival. *p < 0.05 (Kaplan-Meier analysis).

Reference

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