title: Is Pathologic Near-Total Regression an Appropriate Indicator of a Good Response to Preoperative Chemoradiotherapy Based on Oncologic Outcome of Disease?
abstract: We evaluated the oncologic outcomes of patients with rectal cancer who demonstrated pathologic near-total regression (NTR) after preoperative chemoradiotherapy (PCRT) and compared with total regression (TR). Pathologic NTR in rectal cancer by tumor regression grade (TRG) is usually considered to indicate a good response, when evaluating tumor response to PCRT. We retrospectively analyzed the outcomes in 263 patients who received PCRT for advanced T3/4 or N+ rectal cancer followed by radical resection. Patients were diagnosed with TR (n = 132) or NTR (n = 131) according to the TRG. Recurrence-free survival (RFS) was evaluated and compared between groups. For evaluating the consistency between the result and previously published data, meta-analysis for summing up survival curve was performed using generalized linear mixed model. ypT status was heterogeneous in the NTR group as follows; 3 Tis (2.3%), 21 T1 (16%), 72 T2 (55%), and 35 T3 (26.7%). Metastatic lymph nodes were more frequently found in the NTR group (6.8% in TR vs 24.4% in NTR patients; P = 0.003). The cumulative recurrence rate was higher in the NTR group (19.8% vs 6.1%; P = 0.003). The 5-year RFS was lower in the NTR group (94% vs 77.8%; P = 0.001). Significant differences in the RFS rate were found in comparison with the published literature. Based on differences in the oncologic outcomes between the TR and NTR groups, it might not be suitable to use NTR as an indicator of good response to PCRT together with TR.
authors.affiliation: From the Department of Colon and Rectal Surgery (JYK, IJP, JLL, YSY, CWK, S-BL, CSY, JCK), Department of Pathology (SMH), and Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea (JBL).
authors.forename: Jee Yeon
authors.initials: JY
authors.lastname: Kim
authors.forename: In Ja
authors.initials: IJ
authors.lastname: Park
authors.forename: Seung Mo
authors.initials: SM
authors.lastname: Hong
authors.forename: Jong Lyul
authors.initials: JL
authors.lastname: Lee
authors.forename: Yong Sik
authors.initials: YS
authors.lastname: Yoon
authors.forename: Chan Wook
authors.initials: CW
authors.lastname: Kim
authors.forename: Seok-Byung
authors.initials: SB
authors.lastname: Lim
authors.forename: Jung Bok
authors.initials: JB
authors.lastname: Lee
authors.forename: Chang Sik
authors.initials: CS
authors.lastname: Yu
authors.forename: Jin Cheon
authors.initials: JC
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D059248:Chemoradiotherapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents