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. 2019 Apr;35(2):83-93.
doi: 10.3393/ac.2019.04.22.1. Epub 2019 Apr 30.

Oncologic Outcomes in Patients Who Undergo Neoadjuvant Chemoradiotherapy and Total Mesorectal Excision for Locally Advanced Rectal Cancer: A 14-Year Experience in a Single Institution

Min Jung Kim  1 , Seung-Yong Jeong  1 , Ji Won Park  1 , Seung-Bum Ryoo  1 , Sang Sik Cho  1 , Ki Young Lee  1 , Kyu Joo Park  1
Affiliations

Oncologic Outcomes in Patients Who Undergo Neoadjuvant Chemoradiotherapy and Total Mesorectal Excision for Locally Advanced Rectal Cancer: A 14-Year Experience in a Single Institution

Min Jung Kim et al. Ann Coloproctol. 2019 Apr.

Abstract

Purpose: This study evaluated the oncologic outcomes of locally advanced rectal cancer patients who underwent preoperative neoadjuvant chemoradiotherapy (CRT) followed by surgery and determined the prognostic significance of pathologic complete response (pCR).

Methods: Between January 2002 and December 2015, 580 patients with rectal cancer who underwent surgery after neoadjuvant CRT were identified. Survival according to tumor response to CRT and pathologic stage was analyzed using the Kaplan-Meier method, and the Cox proportional hazard model was used to identify factors associated with survival outcomes.

Results: A total of 111 patients (23.7%) achieved pCR while the other 469 patients showed residual disease. Patients with pCR had a lower pretreatment carcinoembryonic antigen level and earlier cT classification than those with residual disease. With a median follow-up of 78 months, disease-free survival (DFS) and overall survival (OS) were significantly better in the pCR group than in the residual disease group. The 5-year DFS and 5-year OS for patients with ypStage 0, I, II, or III were 92.5%, 85.1%, 72.2%, 54.3% (P < 0.001) and 94.5%, 91.0%, 83.1%, 69.3%, respectively (P < 0.001). Pathologic AJCC stage after CRT was the most statistically significant independent predictor of OS (HR, 6.97 [95% confidence interval, 3.16-15.39] for stage III vs. stage 0) and DFS (HR, 7.30 [95% confidence interval, 3.63-14.67] for stage III vs. stage 0).

Conclusion: Rectal cancer patients who achieved pCR showed improved survival compared to those with residual disease after preoperative CRT. Moreover, pCR was an independent indicator of OS and DFS, and pathologic AJCC stage was correlated with survival after preoperative CRT.

Keywords: Chemoradiotherapy; Pathologic complete response; Rectal neoplasms; Survival.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.
Study flow chart. SNUH, Seoul National University Hospital; PCRT, preoperative chemoradiotherapy.
Fig. 2.
Fig. 2.
Kaplan-Meier survival curves for disease-free survival (A), and overall survival (B) for patients with complete pathologic response (ypT0N0, blue line) compared to patients with residual disease (red line).
Fig. 3.
Fig. 3.
Kaplan-Meier survival curves for disease-free survival and overall survival according to ypT classification (A, B), ypN classification (C, D), and AJCC stage (E, F). *P < 0.05. **P < 0.01.
See this image and copyright information in PMC

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