What are the most important prognostic factors in patients with residual rectal cancer after preoperative chemoradiotherapy?
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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.
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.
참고문헌 (29)
- Sannier A, "Pathological prognostic factors in locally advanced rectal carcinoma after neoadjuvant radiochemotherapy: analysis of 113 cases", Histopathology, 65, pp.623~630 (2014)
- Quah HM, "Pathologic stage is most prognostic of disease-free survival in locally advanced rectal cancer patients after preoperative chemoradiation", Cancer, 113, pp.57~64 (2008)
- Rödel C, "Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer", J Clin Oncol, 23, pp.8688~8696 (2005)
- Medich D, "Preoperative chemoradiotherapy and radical surgery for locally advanced distal rectal adenocarcinoma: pathologic findings and clinical implications", Dis Colon Rectum, 44, pp.1123~1128 (2001)
- Guillem JG, "Long-term oncologic outcome following preoperative combined modality therapy and total mesorectal excision of locally advanced rectal cancer", Ann Surg, 241, pp.829~836 (2005)
- Duldulao MP, "Distribution of residual cancer cells in the bowel wall after neoadjuvant chemoradiation in patients with rectal cancer", Dis Colon Rectum, 56, pp.142~149 (2013)
- Das P, "Clinical and pathologic predictors of locoregional recurrence, distant metastasis, and overall survival in patients treated with chemoradiation and mesorectal excision for rectal cancer", Am J Clin Oncol, 29, pp.219~224 (2006)
- Bernstein TE, "Circumferential resection margin as a prognostic factor in rectal cancer", Br J Surg, 96, pp.1348~1357 (2009)
- Rullier A, "Impact of tumor response on survival after radiochemotherapy in locally advanced rectal carcinoma", Am J Surg Pathol, 34, pp.562~568 (2010)
- Gosens MJ, "Circumferential margin involvement is the crucial prognostic factor after multimodality treatment in patients with locally advanced rectal carcinoma", Clin Cancer Res, 13, pp.6617~6623 (2007)
- Gosens MJ, "Improvement of staging by combining tumor and treatment parameters: the value for prognostication in rectal cancer", Clin Gastroenterol Hepatol, 5, pp.997~1003 (2007)
- Huebner M, "Partial pathologic response and nodal status as most significant prognostic factors for advanced rectal cancer treated with preoperative chemoradiotherapy", World J Surg, 36, pp.675~683 (2012)
- Lee JH, "The influence of the treatment response on the impact of resection margin status after preoperative chemoradiotherapy in locally advanced rectal cancer", BMC Cancer, 13, pp.576~ (2013)
- Beddy D, "A simplified tumor regression grade correlates with survival in locally advanced rectal carcinoma treated with neoadjuvant chemoradiotherapy", Ann Surg Oncol, 15, pp.3471~3477 (2008)
- Edge SB, "The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM", Ann Surg Oncol, 17, pp.1471~1474 (2010)
- Kim HJ, "Clinical significance of thrombocytosis before preoperative chemoradiotherapy in rectal cancer: predicting pathologic tumor response and oncologic outcome", Ann Surg Oncol, 22, pp.513~519 (2015)
- Park JS, "Laparoscopic versus open intersphincteric resection and coloanal anastomosis for low rectal cancer: intermediate-term oncologic outcomes", Ann Surg, 254, pp.941~946 (2011)
- Park JS, "A circumferential resection margin of 1 mm is a negative prognostic factor in rectal cancer patients with and without neoadjuvant chemoradiotherapy", Dis Colon Rectum, 57, pp.933~940 (2014)
- Hwang MR, "Prognostic impact of circumferential resection margin in rectal cancer treated with preoperative chemoradiotherapy", Ann Surg Oncol, 21, pp.1345~1351 (2014)
- Kwon MJ, "Frequency of KRAS, BRAF, and PIK3CA mutations in advanced colorectal cancers: Comparison of peptide nucleic acid-mediated PCR clamping and direct sequencing in formalin-fixed, paraffin-embedded tissue", Pathol Res Pract, 207, pp.762~768 (2011)
- Nagtegaal ID, "What is the role for the circumferential margin in the modern treatment of rectal cancer?", J Clin Oncol, 26, pp.303~312 (2008)
- Quirke P, "Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision", Lancet, 2, pp.996~999 (1986)
- Birbeck KF, "Rates of circumferential resection margin involvement vary between surgeons and predict outcomes in rectal cancer surgery", Ann Surg, 235, pp.449~457 (2002)
- Wibe A, "Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer", Br J Surg, 89, pp.327~334 (2002)
- Baik SH, "Prognostic significance of circumferential resection margin following total mesorectal excision and adjuvant chemoradiotherapy in patients with rectal cancer", Ann Surg Oncol, 14, pp.462~469 (2007)
- de Haas-Kock DF, "Prognostic significance of radial margins of clearance in rectal cancer", Br J Surg, 83, pp.781~785 (1996)
- Bouzourene H, "Predictive factors in locally advanced rectal cancer treated with preoperative hyperfractionated and accelerated radiotherapy", Hum Pathol, 34, pp.541~548 (2003)
- Luna-Pérez P, "Prognostic significance of circumferential margin involvement in rectal adenocarcinoma treated with preoperative chemoradiotherapy and low anterior resection", J Surg Oncol, 90, pp.20~25 (2005)
- Rullier A, "Predictive factors of positive circumferential resection margin after radiochemotherapy for rectal cancer: the French randomised trial ACCORD12", 0405 PRODIGE 2, 2013, pp.49, 82~89