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The ypT may better predict the efficacy of neoadjuvant chemoradiotherapy than tumor regression grade in locally advanced rectal cancer patients diagnosed ypT1-4N0

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Abstract

Purpose

This study aimed to assess the impact of ypT stage and tumor regression grade (TRG) on the long-term prognosis of patients with locally advanced rectal cancer (LARC) stage ypT1-4N0 after neoadjuvant chemoradiotherapy (NCRT).

Methods

We retrospectively analyzed 585 patients with histologically diagnosed middle-low LARC (cT3-4 or cN + by pelvic MRI) from 2014 to 2019. All patients underwent NCRT, followed by total mesorectal excision. Disease-free survival (DFS) rates were compared among patients with different ypT stages and TRGs by Kaplan–Meier survival analysis. The chi-square test was used to analyze the relationship between clinicopathological or therapeutic factors and ypT stage.

Results

The median follow‐up was 35.8 months (range 2.8–71.8 months). The 3-year DFS was 79.5%. A better 3-year DFS was achieved in patients with a pathologic complete response (94.0% vs. 74.3%, p < 0.001) and those in the ypT0-2 (86.5% vs. 66.6%, p < 0.001), ypN0 (85.0% vs. 60.2%, p < 0.001), and TRG0 + 1 (83.1% vs. 73.0%, p = 0.004) subgroups. A total of 309 patients (52.8%) achieved stage ypT1-4N0 after surgery. Among these patients, the ypT1-2N0 subgroup achieved a significantly higher 3-year DFS than the ypT3-4N0 subgroup (85.4% vs. 72.8%, p = 0.018); in contrast, the 3-year DFS did not significantly differ between the TRG1 and TRG2 + 3 subgroups (79.9% vs. 81.1%, p = 0.833). In the ypT1-2N0 or ypT3-4N0 subgroup, different TRG had no significant effect on failure patterns.

Conclusions

For LARC patients with a ypT1-4N0 status after NCRT, ypT stage may be a more effective predictor of long-term prognosis than TRG.

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Data availability

The datasets used for analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

Funding was provided by Beijing Municipal Science &Technology Commission (No. Z181100001718192). Capital’s Funds for Health Improvement and Research (No. 2020–2-1027). National Natural Science Foundation (No. 82073333). Beijing Hospitals Authority’s Ascent Plan (No. DFL20220902). Peking University Medicine Sailing Program for Young Scholars’ Scientific & Technological Innovation (No. BMU2023YFJHPY022). Beijing Hospitals Authority Clinical medicine Development of special funding support (No. ZLRK202327).

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Author notes

  1. Yujun Cui, Xinzhi Liu and Shuai Li contributed equally in this article.

Authors and Affiliations

  1. Department of Radiation Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, 100142, China

    Yujun Cui, Shuai Li, Hongzhi Wang, Yirong Xiang, Yangzi Zhang, Maxiaowei Song, Jianhao Geng, Zhiyan Liu, Huajing Teng, Xianggao Zhu, Yong Cai, Yongheng Li & Weihu Wang

  2. Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, 100142, China

    Xinzhi Liu

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Contributions

All authors contributed substantially to the work. WHW and YHL made substantial contributions to the conception and design. YJC, SL and XZL were mainly responsible for data collection. YJC, SL, XZL, HZW, HJT, MXWS and YRX were co-responsible for data curation, interpretation and statistical analyses. YZZ, JHG, ZYL, YC, XGZ and YHL were mainly responsible for patients’ management. All authors were substantially involved in manuscript writing. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Yongheng Li or Weihu Wang.

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Conflict of interest

The authors have no potential conflicts of interest to disclose.

Ethical approval

This study was approved by Ethics Committee of Peking University Cancer Hospital and Institute. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

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All patients were informed about the risks and benefits of NCRT and provided informed consent to treatment.

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Cui, Y., Liu, X., Li, S. et al. The ypT may better predict the efficacy of neoadjuvant chemoradiotherapy than tumor regression grade in locally advanced rectal cancer patients diagnosed ypT1-4N0. Clin Transl Oncol 26, 1012–1021 (2024). https://doi.org/10.1007/s12094-023-03343-x

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