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Dis Colon Rectum. 2013 Jun;56(6):698-703. doi: 10.1097/DCR.0b013e3182837e5b.

Clinical prediction of pathological complete response after preoperative chemoradiotherapy for rectal cancer.

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  • 1Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Abstract

BACKGROUND:

The clinical pretreatment factors that accurately predict response to chemoradiation in rectal cancer are not currently known.

OBJECTIVE:

The aim of this study is to evaluate the clinical factors associated with a pathological complete response after preoperative chemoradiotherapy for rectal cancer.

DESIGN:

This study is a retrospective review of prospectively collected data.

SETTING:

This study was conducted at a tertiary care hospital/referral center in South Korea.

PATIENTS:

From December 2000 to September 2011, a total of 391 consecutive patients with rectal cancer who underwent neoadjuvant chemoradiotherapy followed by radical surgery were identified. The treatment consisted of concurrent chemoradiation, which included preoperative 5-fluorouracil-based chemotherapy and pelvic radiation (median, 5040 cGy); this was followed 8 weeks later (median, 57 days) by surgery with curative intent.

MAIN OUTCOME MEASURES:

The primary outcome measured was the clinicopathological comparison between pathological complete response (n = 57, 14.6%) and non-pathological complete response (n = 334, 85.4%) groups.

RESULTS:

The pathological complete response groups had a higher percentage of noncircumferential tumors, nonmacroscopic ulceration, well differentiation, small tumor diameter, early clinical T stage, early clinical N stage, or low levels of pretreatment CEA than the non-pathological complete response group. In multivariate regression analysis, independent predictors of a higher pathological complete response rate were noncircumferentiality (p = 0.007; OR, 3.214), nonmacroscopic ulceration (p = 0.002; OR, 6.702), and low pretreatment CEA level (p = 0.004; OR, 2.656). Significant differences in the pathological complete response rate existed among the 4 risk stratification groups (p < 0.001). For the prediction of pathological complete response by the clinical risk score model, the sensitivity was 64.1% and the specificity was 73.7% (area under the curve, 0.706; p < 0.001).

LIMITATIONS:

This study was limited because it was a single-institution study with a small sample size.

CONCLUSIONS:

Pretreatment clinical variables, including tumor circumferentiality, macroscopic ulceration, and CEA level, may be important determinants in achieving a pathological complete response.

PMID:
23652742
[PubMed - indexed for MEDLINE]
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