title: [Downstaging correlates the prognosis of rectal cancer after intensified neoadjuvant chemoradiotherapy].
abstract: OBJECTIVE
  To evaluate the impact of downstaging factors on oncologic outcomes in a cohort of patients with rectal cancer after intensified neoadjuvant chemoradiotherapy.
  
  
  METHODS
  Clinical and follow-up data of 135 patients with mid-low rectal cancer receiving intensified neoadjuvant chemoradiotherapy in our hospital from 2005 to 2012 were analyzed retrospectively. Tumor stages before chemoradiotherapy (uTNM) and after surgery (ypTNM) were compared. The therapeutic regimen consisted of 25 fractions of totaled 50 Gy radiation and 2-3 cycles of combination chemotherapy with 5-Fu/capecitabine plus oxaliplatin. Association of 3-year disease-free survival (DFS) with T-stage, N-stage and TNM-stage was examined through the comparison of uTNM and ypTNM.
  
  
  RESULTS
  The mean follow-up of 135 patients was 37.1 (12 to 87) months. The 3-year DFS was 85.2%. The 3-year DFS of patients with downstaging of T-stage (n=76) was 90.8%, which was significantly better compared to those without downstaging (n=48, 75.0%, P=0.040). The 3-year DFS of patients with downstaging of N-stage (n=54) was 98.1%, which was n=53, better compared to those without downstaging (significantly 77.4%) and those with progressive disease (n=16, 75.0%) (P=0.009). Multivariate analysis showed downstaging in N-stage was a prognostic factor for DFS (HR=0.793, 95%CI:0.626-1.004, P=0.054).
  
  
  CONCLUSIONS
  Patients with pathologic downstaging in T-stage, N-stage and TNM classification after intensified neoadjuvant chemoradiotherapy may improve patient survival. Downstaging in N-stage may be an independent predictor of survival.
authors: Department of General Surgery, Peking Union Medical College Hospital, Beijing 100730, China. xiaoy@pumch.cn.
authors: Yi
authors: Y
authors: Xiao
authors: Junyang
authors: J
authors: Lu
authors: Guangxi
authors: G
authors: Zhong
authors: Guangbing
authors: G
authors: Xiong
authors: Bin
authors: B
authors: Wu
authors: Guole
authors: G
authors: Lin
authors: Huadan
authors: H
authors: Xue
authors: Huizhong
authors: H
authors: Qiu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059248:Chemoradiotherapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011379:Prognosis; D012004:Rectal Neoplasms / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult