Skip to main content
SpringerLink
Log in

Partial Pathologic Response and Nodal Status as Most Significant Prognostic Factors for Advanced Rectal Cancer Treated With Preoperative Chemoradiotherapy

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

This study evaluated the impact of tumor regression grading (TRG) and other pathologic variates in a cohort of rectal carcinoma patients treated with neoadjuvant chemoradiotherapy (CRT). The value of a grading less than pCR for predicting survival is unknown. Tumor budding has not been systematically studied in rectal cancer after neoadjuvant therapy.

Methods

Pathologic risk factors for survival were evaluated on surgical specimens of 237 patients with stages I, II, and III rectal cancer treated between 1996 and 2006. All patients underwent preoperative CRT followed by surgical resection 6–8 weeks later. TRG, tumor grade, budding, venous invasion, radial margin, and nodal status were evaluated. The prognostic value of TRG categories was calculated with Cox regression models and validated with resampling methods.

Results

TRG of <25% occurred in 61 (25.7%) and a complete response in 39 (16.4%) of the resected specimens. TRG of <25% was shown to be a statistically significant predictor for cancer-specific survival (CSS) and recurrence-free survival (RFS) compared to TRG ≥25% (P = 0.013). Tumor budding was present in 24 (10.1%) of the patients and was negatively associated with CSS (P = 0.013). Lymph node involvement was observed in 83 (35.0%) patients. TRG and nodal status (P < 0.001) were the most significant predictors associated with outcome.

Conclusion

Partial pathologic response ≥25% was a superior predictor compared to pCR for improved survival after preoperative CRT. CSS and RFS were adversely affected by the presence of lymph node metastases.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Anonymous (2010) AJCC cancer staging manual. In: Edge SB, Byrd DR, Compton CC et al (eds) Colon and Rectum. Springer, New York

    Google Scholar 

  2. Kim TH, Chang HJ, Kim DY et al (2010) Pathologic nodal classification is the most discriminating prognostic factor for disease-free survival in rectal cancer patients treated with preoperative chemoradiotherapy and curative resection. Int J Radiat Oncol Biol Phys 77:1158–1165

    Article  PubMed  Google Scholar 

  3. Roh MS, Colangelo LH, O’Connell MJ et al (2009) Preoperative multimodality therapy improves disease-free survival in patients with carcinoma of the rectum: NSABP R-03. J Clin Oncol 27:5124–5130

    Article  PubMed  Google Scholar 

  4. Sauer R, Becker H, Hohenberger W et al (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740

    Article  PubMed  CAS  Google Scholar 

  5. Capirci C, Valentini V, Cionini L et al (2008) Prognostic value of pathologic complete response after neoadjuvant therapy in locally advanced rectal cancer: long-term analysis of 566 ypCR patients. Int J Radiat Oncol Biol Phys 72:99–107

    Article  PubMed  Google Scholar 

  6. Kalady MF, de Campos-Lobato LF, Stocchi L et al (2009) Predictive factors of pathologic complete response after neoadjuvant chemoradiation for rectal cancer. Ann Surg 250:582–589

    PubMed  Google Scholar 

  7. Smith KD, Tan D, Das P et al (2010) Clinical significance of acellular mucin in rectal adenocarcinoma patients with a pathologic complete response to preoperative chemoradiation. Ann Surg 251:261–264

    Article  PubMed  Google Scholar 

  8. Rodel C, Martus P, Papadoupolos T et al (2005) Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer. J Clin Oncol 23:8688–8696

    Article  PubMed  Google Scholar 

  9. Okuyama T, Oya M, Ishikawa H (2003) Budding as a useful prognostic marker in pT3 well- or moderately-differentiated rectal adenocarcinoma. J Surg Oncol 83:42–47

    Article  PubMed  Google Scholar 

  10. Ueno H, Price AB, Wilkinson KH et al (2004) A new prognostic staging system for rectal cancer. Ann Surg 240:832–839

    Article  PubMed  Google Scholar 

  11. Bouzourene H, Bosman FT, Seelentag W et al (2002) Importance of tumor regression assessment in predicting the outcome in patients with locally advanced rectal carcinoma who are treated with preoperative radiotherapy. Cancer 94:1121–1130

    Article  PubMed  Google Scholar 

  12. Suarez J, Vera R, Balen E et al (2008) Pathologic response assessed by Mandard grade is a better prognostic factor than down staging for disease-free survival after preoperative radiochemotherapy for advanced rectal cancer. Colorectal Dis 10:563–568

    Article  PubMed  CAS  Google Scholar 

  13. Losi L, Luppi G, Gavioli M et al (2006) Prognostic value of Dworak grade of regression (GR) in patients with rectal carcinoma treated with preoperative radiochemotherapy. Int J Colorectal Dis 21:645–651

    Article  PubMed  Google Scholar 

  14. Vecchio FM, Valentini V, Minsky BD et al (2005) The relationship of pathologic tumor regression grade (TRG) and outcomes after preoperative therapy in rectal cancer. Int J Radiat Oncol Biol Phys 62:752–760

    Article  PubMed  Google Scholar 

  15. Zaheer S, Pemberton JH, Farouk R et al (1998) Surgical treatment of adenocarcinoma of the rectum. Ann Surg 227:800–811

    Article  PubMed  CAS  Google Scholar 

  16. Ueno H, Murphy J, Jass JR et al (2002) Tumour ‘budding’ as an index to estimate the potential of aggressiveness in rectal cancer. Histopathology 40:127–132

    Article  PubMed  CAS  Google Scholar 

  17. Dworak O, Keilholz L, Hoffmann A (1997) Pathological features of rectal cancer after preoperative radiochemotherapy. Int J Colorectal Dis 12:19–23

    Article  PubMed  CAS  Google Scholar 

  18. Harrell F, Lee KL, Califf RM et al (2006) Regression modelling strategies for improved prognostic prediction. Stat Med 3:143–152

    Article  Google Scholar 

  19. R Development Core Team (2009) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna

    Google Scholar 

  20. Nagtegaal I, Marijnen C (2008) The future of TNM staging in rectal cancer: the era of neoadjuvant therapy. Curr Colorectal Cancer Rep 4:147–154

    Article  Google Scholar 

  21. Beddy D, Hyland JM, Winter DC et al (2008) A simplified tumor regression grade correlates with survival in locally advanced rectal carcinoma treated with neoadjuvant chemoradiotherapy. Ann Surg Oncol 15:3471–3477

    Article  PubMed  CAS  Google Scholar 

  22. Bujko K, Kolodziejczyk M, Nasierowska-Guttmejer A et al (2010) Tumour regression grading in patients with residual rectal cancer after preoperative chemoradiation. Radiother Oncol 95:298–302

    Article  PubMed  Google Scholar 

  23. Hase K, Shatney C, Johnson D et al (1993) Prognostic value of tumor “budding” in patients with colorectal cancer. Dis Colon Rectum 36:627–635

    Article  PubMed  CAS  Google Scholar 

  24. Jass JR, O’Brien J, Riddell RH et al (2008) Recommendations for the reporting of surgically resected specimens of colorectal carcinoma: Association of Directors of Anatomic and Surgical Pathology. Am J Clin Pathol 129:13–23

    Article  PubMed  Google Scholar 

  25. Masaki T, Matsuoka H, Sugiyama M et al (2006) Actual number of tumor budding as a new tool for the individualization of treatment of T1 colorectal carcinomas. J Gastroenterol Hepatol 21:1115–1121

    Article  PubMed  Google Scholar 

  26. Wang LM, Kevans D, Mulcahy H et al (2009) Tumor budding is a strong and reproducible prognostic marker in T3N0 colorectal cancer. Am J Surg Pathol 33:134–141

    Article  PubMed  CAS  Google Scholar 

  27. Prall F (2007) Tumour budding in colorectal carcinoma. Histopathology 50:151–162

    Article  PubMed  CAS  Google Scholar 

Download references

Conflicts of interest

The authors do not have actual or potential conflicts of interest.

Author information

Authors and Affiliations

  1. Division of Health Sciences Research, Mayo Clinic, Rochester, MN, USA

    Marianne Huebner & Jeremiah Aakre

  2. Department of Statistics and Probability, Michigan State University, East Lansing, MI, USA

    Marianne Huebner

  3. Division of Colorectal Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA

    Bruce G. Wolff & David W. Larson

  4. Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA

    Thomas C. Smyrk

Authors
  1. Marianne Huebner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bruce G. Wolff
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thomas C. Smyrk
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jeremiah Aakre
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. David W. Larson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marianne Huebner.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Huebner, M., Wolff, B.G., Smyrk, T.C. et al. Partial Pathologic Response and Nodal Status as Most Significant Prognostic Factors for Advanced Rectal Cancer Treated With Preoperative Chemoradiotherapy. World J Surg 36, 675–683 (2012). https://doi.org/10.1007/s00268-011-1409-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-011-1409-8

Keywords

Search

Navigation