Endoscopic Criteria for Evaluating Tumor Stage after Preoperative Chemoradiation Therapy in Locally Advanced Rectal Cancer.
OBJECTIVE
Local excision may be an another option for selected patients with markedly down-staged rectal cancer after preoperative chemoradiation therapy (CRT), and proper evaluation of post-CRT tumor stage (ypT) is essential prior to local excision of these tumors. This study was designed to determine the correlations between endoscopic findings and ypT of rectal cancer.


METHODS
In this study, 481 patients with locally advanced rectal cancer who underwent preoperative CRT followed by surgical resection between 2004 and 2013 at a single institution were evaluated retrospectively. Pathological good response (p-GR) was defined as ypT ≤ 1, and pathological minimal or no response (p-MR) as ypT ≥ 2. The patients were randomly classified according to two groups, a testing (n=193) and a validation (n=288) group. Endoscopic criteria were determined from endoscopic findings and ypT in the testing group and used in classifying patients in the validation group as achieving or not achieving p-GR.


RESULTS
Based on findings in the testing group, the endoscopic criteria for p-GR included scarring, telangiectasia, and erythema, whereas criteria for p-MR included nodules, ulcers, strictures, and remnant tumors. In the validation group, the kappa statistic was 0.965 (p < 0.001), and the sensitivity, specificity, positive predictive value, and negative predictive value were 0.362, 0.963, 0.654, and 0.885, respectively.


CONCLUSIONS
The endoscopic criteria presented are easily applicable for evaluation of ypT after preoperative CRT for rectal cancer. These criteria may be used for selection of patients for local excision of down-staged rectal tumors, because patients with p-MR could be easily ruled out.
Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
Kyung Su
KS
Han
Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
Dae Kyung
DK
Sohn
Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
Dae Yong
DY
Kim
Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
Byung Chang
BC
Kim
Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
Chang Won
CW
Hong
Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
Hee Jin
HJ
Chang
Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
Sun Young
SY
Kim
Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
Ji Yeon
JY
Baek
Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
Sung Chan
SC
Park
Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
Min Ju
MJ
Kim
Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
Jae Hwan
JH
Oh
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059248:Chemoradiotherapy; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011300:Preoperative Care; D012004:Rectal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
Chemoradiotherapy; Endoscopy; Neoadjuvant therapy; Rectal neoplasms; Response Evaluation Criteria in Solid Tumors