title: A single institution's long-term follow-up of patients with pathological complete response in locally advanced rectal adenocarcinoma following neoadjuvant chemoradiotherapy.
abstract: OBJECTIVE
  This paper aimed to study the long term follow-up of patients with primary rectal adenocarcinoma receiving neoadjuvant chemoradiotherapy who obtained a pathological complete response (pCR) and identify factors predicting complete response.
  
  
  METHODS
  Retrospective review of notes, histology, pre-operative full blood count and imaging of patients with primary rectal adenocarcinoma diagnosed in our institute from 2000 to 2012 from a prospectively maintained database were used. SPSS version 22.0 was used for statistical analysis.
  
  
  RESULTS
  Three hundred eighty patients diagnosed with primary rectal adenocarcinoma were identified, 277 received neoadjuvant chemoradiotherapy followed by curative resection. Forty-six patients obtained a pCR (ypT0N0) with no local recurrence and two metastatic recurrences on follow-up. Patients with a pCR have a significantly improved overall survival and disease-free survival compared to a non-pCR (150.0 and 136.1 vs 77.5 and 84.7 months, p = 0.001). On univariate analysis, increased tumour height above anal verge, low lymph node yield, high pre-operative haemoglobin and a low neutrophil-lymphocyte ratio are significant factors identifying a pCR. Multivariable analysis of the above factors confirmed tumour height above anal verge as significant in obtaining a pCR.
  
  
  CONCLUSIONS
  Patients with rectal adenocarcinoma who develop a pCR following neoadjuvant chemoradiotherapy have improved overall and disease-free survival. We have identified distance from anal verge, low lymph node yield, high pre-operative haemoglobin and low neutrophil-lymphocyte ratio as significant predictors of developing a pCR.
authors.affiliation: Department of Colorectal Surgery, University Hospitals of Leicester, Infirmary Square, Leicester, LE1 5WW, UK. Franscois_gerald@yahoo.com.
authors.forename: Franscois
authors.identifier: http://orcid.org/0000-0001-6778-459X
authors.initials: F
authors.lastname: Runau
authors.affiliation: Department of Colorectal Surgery, University Hospitals of Leicester, Infirmary Square, Leicester, LE1 5WW, UK.
authors.forename: Anna
authors.initials: A
authors.lastname: Collins
authors.affiliation: Department of Colorectal Surgery, University Hospitals of Leicester, Infirmary Square, Leicester, LE1 5WW, UK.
authors.forename: Glenn Ace
authors.initials: GA
authors.lastname: Fenech
authors.affiliation: Department of Colorectal Surgery, University Hospitals of Leicester, Infirmary Square, Leicester, LE1 5WW, UK.
authors.forename: Eleanor
authors.initials: E
authors.lastname: Ford
authors.affiliation: Department of Colorectal Surgery, University Hospitals of Leicester, Infirmary Square, Leicester, LE1 5WW, UK.
authors.forename: Nikoletta
authors.initials: N
authors.lastname: Dimitriou
authors.affiliation: Department of Colorectal Surgery, University Hospitals of Leicester, Infirmary Square, Leicester, LE1 5WW, UK.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Chaudhri
authors.affiliation: Department of Colorectal Surgery, University Hospitals of Leicester, Infirmary Square, Leicester, LE1 5WW, UK.
authors.forename: Justin M C
authors.initials: JM
authors.lastname: Yeung
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000628:therapy*; D000368:Aged; D059248:Chemoradiotherapy; D003710:Demography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D018655:Lymphocyte Count; D008297:Male; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D012372:ROC Curve; D012004:Rectal Neoplasms / Q000473:pathology* / Q000628:therapy*; D016896:Treatment Outcome
keywords: Neoadjuvant chemoradiotherapy; Neutrophil-lymphocyte ratio; Pathological complete response; Rectal adenocarcinoma