Long-term outcomes in patients with locally advanced rectal cancer treated with preoperative chemoradiation followed by curative surgical resection.
OBJECTIVE
To determine the oncologic outcomes and clinical factors affecting survival in patients with locally advanced rectal cancer who underwent preoperative chemoradiotherapy (CRT) followed by curative surgical resection.


METHODS
We retrospectively analyzed outcomes in 581 patients who underwent preoperative CRT for advanced rectal cancer (T3/4 or node positive) followed by curative resection. All patients received preoperative radiation to the entire pelvis, at a total dose of 45-50.4 Gy in 20-25 fractions for 4-5 weeks, and 569 (97.9%) patients received concurrent chemotherapy with a 5-FU based agent. All patients underwent a curative proctectomy, including total mesorectal excision, a median 6 weeks later, and 432 (74.4%) patients underwent sphincter-saving surgery. Oncologic outcomes, including survival and recurrence, were evaluated according to pathologic parameters, and factors affecting survival were investigated.


RESULTS
The 5-year disease-free and overall survival rates were 72.4% and 77.8%, respectively. Eighty-nine patients (15.3%) had a pathologic complete response. Multivariate analysis showed that ypN category independently affected 5-year overall survival rates (ypN0 88.0%; ypN1 55.1%; ypN2 47.1%; P < 0.001). Factors independently affecting 5-year disease-free survival (DFS) rates included ypN category (ypN0 84.5%; ypN1 44.2%; ypN2 34.9%; P < 0.001), tumor regression grade (TRG1 52.9%; TRG2 72.0%; TRG3 86.7%; TRG4 86.8%; P = 0.004) and surgical method (sphincter-saving 76.3%; sphincter sacrificing 61.7%; P = 0.005).


CONCLUSIONS
Less advanced pathologic N-stage is a significantly favorable prognostic factor for disease-free and overall survival, with good response and sphincter saving surgery benefiting DFS.
Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea.
Seok-Byung
SB
Lim
Chang Sik
CS
Yu
Yong Sang
YS
Hong
Tae Won
TW
Kim
Jong Hoon
JH
Kim
Jin Cheon
JC
Kim
D000293:Adolescent; D000328:Adult; D000368:Aged; D059248:Chemoradiotherapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D015996:Survival Rate; D016896:Treatment Outcome