Is final TNM staging a predictor for survival in locally advanced rectal cancer after preoperative chemoradiation therapy?

Li Jen Kuo, Mei Ching Liu, James Jer Min Jian, Cheng Fang Horng, Tsun I. Cheng, Chung Ming Chen, Wei Tse Fang, Yih Lin Chung

Research output: Contribution to journalArticle

117 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)2766-2772
Number of pages7
JournalAnnals of Surgical Oncology
Volume14
Issue number10
DOIs
Publication statusPublished - Oct 2007
Externally publishedYes

Fingerprint

Rectal Neoplasms
Disease-Free Survival
Neoplasm Metastasis
Recurrence
Neoadjuvant Therapy
Survival
Neoplasms
Therapeutics
Survival Rate
Residual Neoplasm
Fluorouracil
Retrospective Studies
Magnetic Resonance Imaging
Radiation
Carcinoma
Biopsy
Drug Therapy

Keywords

  • Chemoradiation
  • Complete response
  • Neoadjuvant therapy
  • Rectal cancer
  • Survival
  • TNM stage

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Is final TNM staging a predictor for survival in locally advanced rectal cancer after preoperative chemoradiation therapy? / Kuo, Li Jen; Liu, Mei Ching; Jian, James Jer Min; Horng, Cheng Fang; Cheng, Tsun I.; Chen, Chung Ming; Fang, Wei Tse; Chung, Yih Lin.

In: Annals of Surgical Oncology, Vol. 14, No. 10, 10.2007, p. 2766-2772.

Research output: Contribution to journalArticle

Kuo, Li Jen ; Liu, Mei Ching ; Jian, James Jer Min ; Horng, Cheng Fang ; Cheng, Tsun I. ; Chen, Chung Ming ; Fang, Wei Tse ; Chung, Yih Lin. / Is final TNM staging a predictor for survival in locally advanced rectal cancer after preoperative chemoradiation therapy?. In: Annals of Surgical Oncology. 2007 ; Vol. 14, No. 10. pp. 2766-2772.
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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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T1 - Is final TNM staging a predictor for survival in locally advanced rectal cancer after preoperative chemoradiation therapy?

AU - Kuo, Li Jen

AU - Liu, Mei Ching

AU - Jian, James Jer Min

AU - Horng, Cheng Fang

AU - Cheng, Tsun I.

AU - Chen, Chung Ming

AU - Fang, Wei Tse

AU - Chung, Yih Lin

PY - 2007/10

Y1 - 2007/10

N2 - 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.

AB - 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.

KW - Chemoradiation

KW - Complete response

KW - Neoadjuvant therapy

KW - Rectal cancer

KW - Survival

KW - TNM stage

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