Cancer Res Treat.  2016 Apr;48(2):567-573. 10.4143/crt.2015.195.

Endoscopic Criteria for Evaluating Tumor Stage after Preoperative Chemoradiation Therapy in Locally Advanced Rectal Cancer

• Han KS
• Sohn DK
• Kim DY
• Kim BC
• Hong CW
• Chang HJ
• Kim SY
• Baek JY
• Park SC
• Kim MJ
• Oh JH

• KMID: 2454334
• DOI: http://doi.org/10.4143/crt.2015.195

Abstract

PURPOSE
Local excision may be an another option for selected patients with markedly down-staged rectal cancer after preoperative chemoradiation therapy (CRT), and proper evaluation of post-CRT tumor stage (ypT) is essential prior to local excision of these tumors. This study was designed to determine the correlations between endoscopic findings and ypT of rectal cancer.
MATERIALS AND METHODS
In this study, 481 patients with locally advanced rectal cancer who underwent preoperative CRT followed by surgical resection between 2004 and 2013 at a single institution were evaluated retrospectively. Pathological good response (p-GR) was defined as ypT ≤ 1, and pathological minimal or no response (p-MR) as ypT ≥ 2. The patients were randomly classified according to two groups, a testing (n=193) and a validation (n=288) group. Endoscopic criteria were determined from endoscopic findings and ypT in the testing group and used in classifying patients in the validation group as achieving or not achieving p-GR.
RESULTS
Based on findings in the testing group, the endoscopic criteria for p-GR included scarring, telangiectasia, and erythema, whereas criteria for p-MR included nodules, ulcers, strictures, and remnant tumors. In the validation group, the kappa statistic was 0.965 (p < 0.001), and the sensitivity, specificity, positive predictive value, and negative predictive value were 0.362, 0.963, 0.654, and 0.885, respectively.
CONCLUSION
The endoscopic criteria presented are easily applicable for evaluation of ypT after preoperative CRT for rectal cancer. These criteria may be used for selection of patients for local excision of down-staged rectal tumors, because patients with p-MR could be easily ruled out.

Keyword

Rectal neoplasms; Chemoradiotherapy; Neoadjuvant therapy; Response Evaluation Criteria in Solid Tumors; Endoscopy

MeSH Terms

Chemoradiotherapy
Cicatrix
Constriction, Pathologic
Endoscopy
Erythema
Humans
Neoadjuvant Therapy
Rectal Neoplasms*
Response Evaluation Criteria in Solid Tumors
Retrospective Studies
Sensitivity and Specificity
Telangiectasis
Ulcer

Figure

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  Fig. 1. Endoscopic findings for evaluation of tumor response after preoperative chemoradiation. (A) Scarring. (B) Telangiectasia.(C) Erythema. (D) Nodule. (E) Ulcer. (F) Stricture. (G) Remnant tumor.

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  Fig. 2. Cases showing endoscopic findings not matching the pathological response. (A) Pathological good response (ypT0)showing endoscopic minimal or no response (ulcer). (B) Pathological poor response (ypT3) showing endoscopic good response (erythema).

Reference

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