Prognostic significance of clinical and pathological stages on locally advanced rectal carcinoma after neoadjuvant chemoradiotherapy

Abstract

ObjectiveTo investigate prognostic significance of clinical and pathological stages in patients with locally advanced rectal carcinoma treated with neoadjuvant chemoradiotherapy (neo-CRT) and total mesorectal excision.Patients and methods210 patients with locally advanced rectal carcinoma (cT3-4 or cN+) treated with neo-CRT followed by total mesorectal excision. Treatment outcomes were compared according to clinical and pathological stage. Overall survival (OS), disease free survival (DFS) among patients with different clinical stage and pathological stage after neo-CRT.ResultsThe median follow-up time was 47 months (range, 14–98 months). Clinical T stage was associated with 5 year OS (p = 0.042) and 5 year DFS (p = 0.014) while clinical N stage was not associated with 5 year OS (p = 0.440), 5 year DFS (p = 0.711). Pathological T stage was associate with 5 year OS (p = 0.001) and 5 year DFS (p = 0.046); and N stage was associated with 5 year OS (p = 0.001), 5 year DFS (p = 0.002). The pathological stage was further classified into three groups: ypT0–2N0 in 91 patients (43.3 %), ypT3–4N0 in 69 patients (32.9 %) and ypT0–4N+ in 50 patients (23.8 %). While pathological stage (ypT0–2 vs ypT3–4N0 vs ypT0–4N+) was associated with 5 year OS (87.9 %, 75.5 %, 56.7 %, p = 0.000), 5 year DFS (74.5 %, 77.4 %, 50.5 %, p = 0.003). Multivariate analysis showed that ypN stage was an independent prognostic factor for patients 5 year DFS.ConclusionsPathological stage is strongly associated with treatment outcomes in patients with locally advanced rectal carcinoma treated with neo-CRT followed by total mesorectal excision, which may be used as guidance for further individualized treatment.

Impact of Tumor Regression Grade as a Major Prognostic Factor in Locally Advanced Rectal Cancer after Neoadjuvant Chemoradiotherapy: A Proposal for a Modified Staging System

“…Clinical and pathological staging were determined according to the AJCC TNM staging system, 7th edition [ 43 ]. For further analysis, we combined ypStages 0 and I, as was done in previous studies [ 44 , 45 , 46 ].…”

Analysis of Clinical characteristics to predict pathologic complete response for patients with locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy

“…It has been reported in the literature that 18.1 to 30.2 percent of patients with locally advanced rectal cancer may achieve pathologic complete response (pCR) after neo-CRT which leads to a better clinical prognosis 6 - 9 . Patients with locally advanced rectal cancer have been shown to present different treatment response to neo-CRT ranging from pCR to resistance to neo-CRT; whereas pathological TNM stage has been reported to be of prognostic significance in treatment outcomes after neo-CRT when compared to clinical TNM stage.…”

Role of quantitative intravoxel incoherent motion parameters in the preoperative diagnosis of nodal metastasis in patients with rectal carcinoma

“…Rectal carcinoma is one of the most common malignant neoplasms in morbidity and mortality in China . Involvement of lymph nodes in rectal carcinoma has been shown to be an important determinant of postoperative survival and local recurrence …”