Predicting survival in locally advanced rectal cancer with effective chemoradiotherapy response

Seijong Kim; Jung Wook Huh; Woo Yong Lee; Seong Hyeon Yun; Hee Cheol Kim; Yong Beom Cho; Yoonah Park; Jung Kyong Shin

doi:10.1016/j.ejso.2024.108361

Predicting survival in locally advanced rectal cancer with effective chemoradiotherapy response

Eur J Surg Oncol. 2024 Apr 20;50(6):108361. doi: 10.1016/j.ejso.2024.108361. Online ahead of print.

Authors

Seijong Kim¹, Jung Wook Huh², Woo Yong Lee¹, Seong Hyeon Yun¹, Hee Cheol Kim¹, Yong Beom Cho¹, Yoonah Park¹, Jung Kyong Shin¹

Affiliations

¹ Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
² Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: jungwook.huh@gmail.com.

PMID: 38657375
DOI: 10.1016/j.ejso.2024.108361

Abstract

Background: Locally advanced rectal cancer patients often display favorable responses and favorable oncologic outcomes. Due to the low recurrence rate, there is scarcity of studies investigating the prognostic factors influencing their survival. Therefore, our study sought to assess the prognostic factors associated with survival in rectal cancer patients who achieved either a pathologic complete response or a pathologic stage I after neoadjuvant chemoradiotherapy combined with radical resection.

Methods: In this retrospective study, we analyzed data from cohort of 1394 patients diagnosed with locally advanced rectal cancer who underwent neoadjuvant chemoradiotherapy combined with total mesorectal excision from January 2008 to April 2017. Finally, we selected 474 (34.2 %) who exhibited either a pathologic complete response or attained pathologic stage I following the treatment. Subsequently, we analyzed the prognostic factors influencing disease-free and overall survival.

Results: A total of 161 (34 %) achieved a pathologic complete response. Our analysis revealed that circumferential resection margin and the administration of adjuvant chemotherapy were prognostic factors for disease-free survival (p = 0.011, p = 0.022). Furthermore, factors influencing overall survival included the clinical N stage and administration of adjuvant chemotherapy (p = 0.035, p = 0.015).

Conclusion: In conclusion, the circumferential resection margin, clinical N stage, and administration of adjuvant chemotherapy were prognostic factors for survival in patients showing good response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer. For patients with a positive circumferential resection margin and clinical N (+) stage, intensive follow-up might be needed to achieve favorable oncologic outcomes. Also, we recommend considering adjuvant chemotherapy as a beneficial treatment approach for these patients.

Keywords: Neoadjuvant chemoradiotherapy; Rectal cancer; Risk factor; Survival.