title: Prognostic significance of clinical and pathological stages on locally advanced rectal carcinoma after neoadjuvant chemoradiotherapy.
abstract: OBJECTIVE
  To 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.
  
  
  METHODS
  210 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.
  
  
  RESULTS
  The 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.
  
  
  CONCLUSIONS
  Pathological 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.
authors.affiliation: Department of Radiation Oncology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China. wenbix@mail.sysu.edu.cn.
authors.forename: Bixiu
authors.initials: B
authors.lastname: Wen
authors.affiliation: Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China. zhangln@sysc.org.cn.
authors.forename: Luning
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Radiation Oncology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China. wangcht5@mail.sysu.edu.cn.
authors.forename: Chengtao
authors.initials: C
authors.lastname: Wang
authors.affiliation: Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China. huangrong@sysucc.org.cn.
authors.forename: Rong
authors.initials: R
authors.lastname: Huang
authors.affiliation: Department of Radiation Oncology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China. phhnihao@126.com.
authors.forename: Haihua
authors.initials: H
authors.lastname: Peng
authors.affiliation: Department of Radiation Oncology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China. zhangtian62@gmail.com.
authors.forename: Tian
authors.initials: T
authors.lastname: Zhang
authors.affiliation: Department of Radiation Oncology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China. dongjun2201@163.com.
authors.forename: Jun
authors.initials: J
authors.lastname: Dong
authors.affiliation: Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China. xiaoww@sysucc.org.cn.
authors.forename: Weiwei
authors.initials: W
authors.lastname: Xiao
authors.affiliation: Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China. zengzf@sysucc.org.cn.
authors.forename: Zhifan
authors.initials: Z
authors.lastname: Zeng
authors.affiliation: Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China. liumz@sysucc.org.cn.
authors.forename: Mengzhong
authors.initials: M
authors.lastname: Liu
authors.affiliation: Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China. gaoyh@mail.sysu.edu.cn.
authors.forename: Yuanhong
authors.initials: Y
authors.lastname: Gao
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000556:secondary / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D000069287:Capecitabine / Q000627:therapeutic use; D059248:Chemoradiotherapy; D003131:Combined Modality Therapy; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000031:analogs & derivatives; D006801:Humans; D053208:Kaplan-Meier Estimate; D002955:Leucovorin / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D010071:Oxaloacetates; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D016016:Proportional Hazards Models; D020266:Radiotherapy, Conformal; D011882:Radiotherapy, High-Energy; D012004:Rectal Neoplasms / Q000473:pathology* / Q000628:therapy; D055815:Young Adult
chemical_list: D000964:Antimetabolites, Antineoplastic; D009944:Organoplatinum Compounds; D010071:Oxaloacetates; D003841:Deoxycytidine; D000069287:Capecitabine; D002955:Leucovorin; D005472:Fluorouracil