Pathologic Complete Response of Primary Tumor Following Preoperative Chemoradiotherapy for Locally Advanced Rectal Cancer Long-term Outcomes and Prognostic Significance of Pathologic Nodal Status (KROG 09-01)

Title
Pathologic Complete Response of Primary Tumor Following Preoperative Chemoradiotherapy for Locally Advanced Rectal Cancer Long-term Outcomes and Prognostic Significance of Pathologic Nodal Status (KROG 09-01)
Author(s)
강민규여승구[여승구]김대용[김대용]김태현[김태현]장희진[장희진]오재환[오재환]박원[박원]최두호[최두호]남희림[남희림]김준상[김준상]
Keywords
COMBINED-MODALITY THERAPY; NEOADJUVANT CHEMORADIATION; NONOPERATIVE TREATMENT; MESORECTAL EXCISION; GENE-EXPRESSION; CHEMOTHERAPY; RADIOTHERAPY; RECURRENCE; SURVIVAL; MANAGEMENT
Issue Date
201012
Publisher
LIPPINCOTT WILLIAMS & WILKINS
Citation
ANNALS OF SURGERY, v.252, no.6, pp.998 - 1004
Abstract
Objective: To investigate long-term outcomes of locally advanced rectal cancer (LARC) patients with postchemoradiotherapy (post-CRT) pathologic complete response of primary tumor (ypT0) and determine prognostic significance of post-CRT pathologic nodal (ypN) status. Background: LARC patients with post-CRT pathologic complete response were suggested to have favorable long-term outcomes, but prognostic significance of ypN status has never been specifically defined in ypT0 patients. Methods: The Korean Radiation Oncology Group collected clinical data for 333 LARC patients with ypT0 following preoperative CRT and curative radical resections between 1993 and 2007. Sphincter preservation surgery and abdominoperineal resection were performed in 283 (85.0%) and 50 (15.0%) patients, respectively. Postoperative chemotherapy was given to 285 (85.6%) patients. Survival was estimated by the Kaplan-Meier method, and the Cox proportional hazard model was used in multivariate analyses. Results: After median follow-up of 43 (range = 14-172) months, 5-year disease-free survival (DFS) was 84.6% and overall survival (OS) was 92.8%. The ypN status was ypT0N0 in 304 (91.3%), ypT0N1 in 22 (6.6%), and ypT0N2 in 7 (2.1%) patients. The ypN status was the most relevant independent prognostic factor for both DFS and OS in ypT0 patients. The 5-year DFS and OS was 88.5% and 94.8% in ypT0N0 patients, and 45.2% and 72.8% in ypT0N+ patients (both, P < 0.001). Conclusions: LARC patients achieving ypT0N0 after preoperative CRT had favorable long-term outcomes, whereas positive ypN status had a poor prognosis even after total regression of primary tumor.
URI
http://hdl.handle.net/YU.REPOSITORY/23263http://dx.doi.org/10.1097/SLA.0b013e3181f3f1b1
ISSN
0003-4932
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의과대학 > 방사선종양학교실 > Articles
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