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Is Final TNM Staging A Predictor for Survival in Locally Advanced Rectal Cancer after Preoperative Chemoradiation Therapy?

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Neoadjuvant chemoradiation therapy has improved the local control rate and overall survival in locally advanced rectal cancers. The purpose of this retrospective study is to evaluate the correlation between the final pathologic stage and survival in these patients.

Methods

Patients with biopsy-proven rectal carcinoma, pretreatment staging by magnetic resonance imaging such as T3 or T4 tumors, or node-positive disease were treated with preoperative concomitant 5-fluorouracil-based chemotherapy and radiation, followed by radical surgical resection. Clinical outcome with survival, disease-free survival, recurrence rate, and local recurrence rate were compared with each T and N findings using the American Joint Committee on Cancer Tumor-Node-Metastasis (TNM) staging system.

Results

A total of 248 patients were enrolled in this study. Overall survival and disease-free survival at 1, 3, and 5 years were 97.1, 92, and 89.9% and 87.5, 71.1, and 69.5%, respectively. Thirty-six patients (14.5%) had a pathologic complete response after neoadjuvant therapy. The recurrence rate was significantly different between the pathologic complete response group and residual group (5.6 vs 31.1%; P = .002). Five-year disease-free survival was significantly better in the complete response group than the residual tumor group (93 vs 66%; P = .0045). There was no statistical difference in survival or locoregional recurrence rate between these two groups.

Conclusions

Posttreatment pathologic TNM stage is correlated to disease-free survival and tumor recurrence rate in locally advanced rectal cancer after preoperative chemoradiation. Also, pathologic complete response to neoadjuvant treatment has its oncologic benefit in both overall recurrence and disease-free survival.

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References

  1. Jessup JM, Stewart AK, Menck HR. The National Cancer Database report on patterns of care for adenocarcinoma of the rectum, 1985–1995. Cancer 1998;83:2408–18

    Article  PubMed  CAS  Google Scholar 

  2. Hyams DM, Mamounas EP, Petrelli N, et al. A clinical trial to evaluate the worth of preoperative multimodality therapy in patients with operable carcinoma of the rectum: a progress report of National Surgical Breast and Bowel Project Protocol R-03. Dis Colon Rectum 1997; 40:131–9

    Article  PubMed  CAS  Google Scholar 

  3. Vauthey JN, Marsh RW, Zlotecki RA, et al. Recent advances in the treatment and outcome of locally advanced rectal cancer. Ann Surg 1999; 229:745–54

    Article  PubMed  CAS  Google Scholar 

  4. Onaitis MW, Noone RB, Hartwig M, et al. Neoadjuvant chemoradiation for rectal cancer analysis of clinical outcomes from a 13-year institutional experience. Ann Surg 2001; 233:778–85

    Article  PubMed  CAS  Google Scholar 

  5. Janjan NA, Crane C, Feig BW, et al. Improved overall survival among responders to preoperative chemoradiation for locally advanced rectal cancer. Am J Clin Oncol 2001; 24:107–12

    Article  PubMed  CAS  Google Scholar 

  6. Luna-Perez P, Rodriguez-Ramirez S, Gutierrez de la Barrera M, Labastida S. Prognostic significance of retrieved lymph nodes per specimen in resected rectal adenocarcinoma after preoperative chemoradiation therapy. Arch Med Res 2003; 34:281–6

    Article  PubMed  Google Scholar 

  7. Fisher B, Wolmark N, Rockette H, et al. Postoperative adjuvant chemotherapy or radiation therapy for rectal cancer: results from NSABP protocol R-01. J Natl Cancer Inst 1988; 80:21–9

    Article  PubMed  CAS  Google Scholar 

  8. Rullier E, Goffre B, Bonnel C, Zerbib F, Caudry M, Saric J. Preoperative radiochemotherapy and sphincter-saving resection for T3 carcinomas of the low third of the rectum. Ann Surg 2001; 234:633–40

    Article  PubMed  CAS  Google Scholar 

  9. Crane CH, Skibber JM, Birnbaum EH, et al. The addition of continuous infusion 5-FU to preoperative radiation therapy increases tumor response, leading to increased sphincter preservation on locally advanced rectal cancer. Int J Radiat Oncol Biol Phys 2003; 57:84–9

    Article  PubMed  CAS  Google Scholar 

  10. Improved survival with preoperative radiotherapy in resectable rectal cancer. Swedish Rectal Cancer Trial. N Engl J Med 1997; 336:980–7

    Article  Google Scholar 

  11. Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 2004; 351:1731–40

    Article  PubMed  CAS  Google Scholar 

  12. Mendenhall WM, Vauthey JN, Zlotchki RA, Marsh RD, Copeland EM 3rd. Preoperative chemoradiation for locally advanced rectal carcinoma—the University of Florida experience. Semin Surg Oncol 2003; 21:261–4

    Article  PubMed  Google Scholar 

  13. Charis RS, Tyler DS, Anscher MS, et al. Preoperative radiation and chemotherapy in the treatment of adenocarcinoma of the rectum. Ann Surg 1995; 221:778–87

    Article  Google Scholar 

  14. Garcia-Aguilar J, Hernandez de Anda E, Sirivongs P, Lee SH, Madoff RD, Rothenberger DA. A pathologic complete response to preoperative chemoradiation is associated with lower local recurrence and improved survival in rectal cancer patients treated by mesorectal excision. Dis Colon Rectum 2003; 46:298–304

    Article  PubMed  Google Scholar 

  15. Heald RJ, Moran BJ, Ryall RD, Sexton R, MacFarlane JK. Rectal cancer. The Basingstoke experience of total mesorectal excision 1978–1997. Arch Surg 1998; 133:894–9

    Article  PubMed  CAS  Google Scholar 

  16. Killingback M, Barron P, Dent OF. Local recurrence after curative resection of cancer of the rectum without total mesorectal excision. Dis Colon Rectum 2001; 44:473–86

    Article  PubMed  CAS  Google Scholar 

  17. Eu KW, Seow-Choen F, Ho JM, Ho YH, Leong AF. Local recurrence following rectal resection for cancer. J R Coll Surg Edinb 1998; 43:393–6

    PubMed  CAS  Google Scholar 

  18. Hall NR, Finan PJ, al-Jaberi T, et al. Circumferential margin involvement after mesorectal excision of rectal cancer with curative intent. Predictor of survival but not local recurrence? Dis Colon Rectum 1998; 41:979–83

    Article  PubMed  CAS  Google Scholar 

  19. Bulow S, Christensen IJ, Harling H, Kronborg O, Fenger C, Nielsen HJ. Recurrence and survival after emsorectal excision for rectal cancer. Br J Surg 2003; 90:974–80

    Article  PubMed  CAS  Google Scholar 

  20. Arbman G, Nilsson E, Hallbook O, Sjodahl R. Local recurrence following total mesorectal excision for rectal cancer. Br J Surg 2002; 83:375–9

    Article  Google Scholar 

  21. Martling AL, Holm T, Rutqvist LE, Moran BJ, Heald RJ, Cedermark B. Effect of a surgical training programme on outcome of rectal cancer in the County of Stockholm. Stockholm Colorectal Cancer Study Group. Basingstoke Bowel Cancer Research Project. Lancet 2000; 356:93–6

    Article  PubMed  CAS  Google Scholar 

  22. Chan AK, Wong A, Jenken D, Heine J, Buie D, Johnson D. Posttreatment TNM staging is a prognostic indicator of survival and recurrence in tethered or fixed rectal carcinoma after preoperative chemotherapy and radiotherapy. Int J Radiat Oncol Biol Phys 2005; 61:665–77

    Article  PubMed  Google Scholar 

  23. Grann A, Minsky BD, Cohen AM, et al. Preliminary results of preoperative 5-fluorouracial, low-dose leucovorin, and concurrent radiation therapy for clinical resectable T3 rectal cancer. Dis Colon Rectum 1997; 40:515–22

    Article  PubMed  CAS  Google Scholar 

  24. Minsky BD, Cohen AM, Enker WE, et al. Preoperative 5-FU, low-dose leucovorin, and radiation therapy for locally advanced and unresectable rectal cancer. Int J Radiat Oncol Biol Phys 1997; 37:289–95

    Article  PubMed  CAS  Google Scholar 

  25. Mohiuddin M, Regine WF, John WJ, et al. Preoperative chemoradiation in fixed distal rectal cancer: dose time factors for pathological complete response. Int J Radiat Oncol Biol Phys 2000; 46:883–8

    Article  PubMed  CAS  Google Scholar 

  26. Onaitis MW, Noone RB, Fields R, et al. Complete response to neoadjuvant chemoradiation for rectal cancer dose not influence survival. Ann Surg Oncol 2001; 8:801–6

    Article  PubMed  CAS  Google Scholar 

  27. Theodoropoulos G, Wise WE, Padmanabhan A, Kerner BA, Taylor CW, Aguilar PS, Khanduja KS . T-level downstaging and complete pathologic response after preoperative chemoradiation for advanced rectal cancer result in decreased recurrence and improved disease-free survival. Dis Colon Rectum 2002; 45:895–903

    Article  PubMed  Google Scholar 

  28. Janjan NA, Abbruzzese J, Pazdur R, et al. Prognostic implications of response to preoperative infusional chemoradiation in locally advanced rectal cancer. Radiother Oncol 1999; 51:153–60

    Article  PubMed  CAS  Google Scholar 

  29. Brown CL, Ternent CA, Thorson AG, et al. Response to preoperative chemoradiation in stage II and III rectal cancer. Dis Colon Rectum 2003; 46:1189–93

    Article  PubMed  Google Scholar 

  30. Moore HG, Gittleman AE, Minsky BD, et al. Rate of pathologic complete response with increased interval between preoperative combined modality therapy and rectal cancer resection. Dis Colon Rectum 2004; 47:279–86

    Article  PubMed  Google Scholar 

  31. Komuro Y, Watanabe T, Hosoi Y, et al. Prediction of tumor radiosensitivity in rectal carcinoma based on p53 and Ku70 expression. J Exp Clin Cancer Res 2003; 22:223–8

    PubMed  CAS  Google Scholar 

  32. Kim NK, Park JK, Lee KY, et al. p53, BCL-2, and Ki-67 expression according to tumor response after concurrent chemoradiotherapy for advanced rectal cancer. Ann Surg Oncol 2001; 8:418–24

    Article  PubMed  CAS  Google Scholar 

  33. Giralt J, Eraso A, Armengol M, et al. Epidermal growth factors receptor is a predictor of tumor response in locally advanced rectal cancer patients treated with preoperative radiotherapy. Int J Radiat Oncol Biol Phys 2002; 54:1460–5

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Li-Jen Kuo MD.

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Kuo, LJ., Liu, MC., Jian, J.JM. et al. Is Final TNM Staging A Predictor for Survival in Locally Advanced Rectal Cancer after Preoperative Chemoradiation Therapy?. Ann Surg Oncol 14, 2766–2772 (2007). https://doi.org/10.1245/s10434-007-9471-z

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  • DOI: https://doi.org/10.1245/s10434-007-9471-z

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