title: Distance to the anal verge is associated with pathologic complete response to neoadjuvant therapy in locally advanced rectal cancer.
abstract: OBJECTIVE
  Achieving a pathologic complete response (pCR) after neoadjuvant therapy has been associated with better prognosis in rectal cancer patients. The objective of this study was to investigate the relationship between distance to the anal verge (DTAV) and pCR.
  
  
  METHODS
  Review of a prospectively maintained database of patients with locally advanced rectal cancer who received neoadjuvant treatment was completed. Uni- and multivariate analysis assessed the association between DTAV and pCR after neoadjuvant therapy.
  
  
  RESULTS
  Of 827 included patients, 20% had a pCR. We found that pCR rates were 11% for tumors <4 cm, 24% for tumors 4-6 cm, 30% for tumors at 6-8 cm, 17% for tumors 8-10 cm, and 14% for tumors >10 cm from the anal verge (P = 0.002). Multivariate analysis also showed a strong association between DTAV and pCR (P = 0.008). The bimodal distribution of pCR resulted in a lower odds ratio of pCR for tumors <4 and >8 cm from the anal verge.
  
  
  CONCLUSIONS
  Patients with low tumors (<4 cm) and higher tumors (>8 cm), were less likely to have a pCR. Further investigation is warranted to determine if these observations are related to tumor biology or possibly differences in radiation technique. J. Surg. Oncol. 2016;114:637-641. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York. patels2@kgh.kari.ca.|Department of Surgery, Kingston General Hospital, Queens University, Kingston, Canada. patels2@kgh.kari.ca.
authors.forename: Sunil V
authors.initials: SV
authors.lastname: Patel
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Campbell S
authors.initials: CS
authors.lastname: Roxburgh
authors.affiliation: Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Efsevia
authors.initials: E
authors.lastname: Vakiani
authors.affiliation: Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Jinru
authors.initials: J
authors.lastname: Shia
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: J Joshua
authors.initials: JJ
authors.lastname: Smith
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Larissa K
authors.initials: LK
authors.lastname: Temple
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Philip
authors.initials: P
authors.lastname: Paty
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Julio
authors.initials: J
authors.lastname: Garcia-Aguilar
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Garrett
authors.initials: G
authors.lastname: Nash
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Jose
authors.initials: J
authors.lastname: Guillem
authors.affiliation: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Abraham
authors.initials: A
authors.lastname: Wu
authors.affiliation: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Marsha
authors.initials: M
authors.lastname: Reyngold
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Martin R
authors.initials: MR
authors.lastname: Weiser
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal; D059186:Chemoradiotherapy, Adjuvant; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D012004:Rectal Neoplasms / Q000473:pathology* / Q000628:therapy*; D016896:Treatment Outcome
keywords: distance to anal verge; neoadjuvant therapy; pathologic complete response; rectal cancer