Yeungnam Univ J Med.  2019 May;36(2):124-135. 10.12701/yujm.2019.00157.

What are the most important prognostic factors in patients with residual rectal cancer after preoperative chemoradiotherapy?

• Kim SM
• Yoon G
• Seo AN

• KMID: 2449325
• DOI: http://doi.org/10.12701/yujm.2019.00157

Abstract

BACKGROUND
We aimed to establish robust histoprognostic predictors on residual rectal cancer after preoperative chemoradiotherapy (CRT).
METHODS
Analyzing known histoprognostic factors in 146 patients with residual disease allows associations with patient outcome to be evaluated.
RESULTS
The median follow-up time was 77.8 months, during which 59 patients (40.4%) experienced recurrence and 41 (28.1%) died of rectal cancer. On univariate analysis, residual tumor size, ypT category, ypN category, ypTNM stage, downstage, tumor regression grade, lymphatic invasion, perineural invasion, venous invasion, and circumferential resection margin (CRM) were significantly associated with recurrence free survival (RFS) or/and cancer-specific survival (CSS) (all p<0.005). On multivariate analysis, higher ypTNM stage and CRM positivity were identified as independent prognostic factors for RFS (ypTNM stage, p=0.024; CRM positivity, p<0.001) and CSS (p=0.022, p=0.017, respectively). Furthermore, CRM positivity was an independent predictor of reduced RFS and CSS, irrespective of subgrouping according to downstage (non-downstage, p<0.001 and p<0.001; downstage, p=0.002 and p=0.002) or lymph node metastasis (non-metastasis, p<0.001 and p=0.001; metastasis, p<0.001 and p<0.001).
CONCLUSION
CRM status may be as powerful as ypTNM stage as a prognostic indicator for patient outcome in patients with residual rectal cancer after preoperative CRT.

Keyword

Circumferential resection margin; Preoperative chemoradiotherapy; Prognosis; Rectal cancer; Stage; Tumor regression grade

MeSH Terms

Chemoradiotherapy*
Follow-Up Studies
Humans
Lymph Nodes
Multivariate Analysis
Neoplasm Metastasis
Neoplasm, Residual
Prognosis
Rectal Neoplasms*
Recurrence

Figure

• 

  Fig. 1. Survival estimates of representative histopathologic factors in residual rectal cancer after preoperative chemoradiotherapy using the Kaplan-Meier method. ypTNM stage for (A) RFS and (B) CSS; down stage for (C) RFS and (D) CSS; tumor regression grade (E) RFS and (F) CSS; and CRM for (G) RFS and (H) CSS. RFS, recurrence free survival; CSS, cancer specific survival; CRM, circumferential resection margin; TRG, tumor regression grade.

• 

  Fig. 2. Prognostic values of CRM on residual rectal cancer after preoperative chemoradiotherapy in subgroup analysis. Kaplan-Meier survival curves of (A) RFS and (B) CSS for patients without downstaging; and (C) RFS and (D) CSS for patients with downstaging. Kaplan-Meier survival curves of (E) RFS and (F) CSS for patients with pathologic N0 category; and (G) RFS and (H) CSS for patients with pathologic N1–3 category. CRM, circumferential resection margin; RFS, recurrence free survival; CSS, cancer specific survival;

Reference

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