The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Evaluation of treatment response and tissue necrosis as prognostic indicators following neoadjuvant chemoradiotherapy in rectal cancer patients

  • Jung, Ji-Han (Department of Hospital Pathology, College of Medicine, The Catholic University of Korea) ;
  • An, Ho Jung (Department of Internal Medicine, College of Medicine, The Catholic University of Korea) ;
  • Kim, Hyung-Jin (Department of General Surgery, College of Medicine, The Catholic University of Korea) ;
  • Lee, Jonghoon (Department of Radiation Oncology, College of Medicine, The Catholic University of Korea) ;
  • Lee, Kang-Moon (Department of Internal Medicine, College of Medicine, The Catholic University of Korea) ;
  • Kim, Sung Hwan (Department of Radiation Oncology, College of Medicine, The Catholic University of Korea) ;
  • Cho, Hyeon-Min (Department of General Surgery, College of Medicine, The Catholic University of Korea) ;
  • Shim, Byoung Yong (Department of Internal Medicine, College of Medicine, The Catholic University of Korea)
  • Received : 2014.09.03
  • Accepted : 2014.12.05
  • Published : 2016.01.01
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Abstract

Background/Aims: The objective of this study was to assess the prognostic roles of treatment response and tissue necrosis after chemoradiotherapy (CRT) in locally advanced rectal cancer. Methods: A total of 243 patients with locally advanced rectal cancer who underwent neoadjuvant CRT were included. Three treatment response groups were classified by their pathological stage results: complete treatment response (CTR), intermediate treatment response (ITR), and poor treatment response (PTR). Three tissue necrosis groups were classified based on tissue pathological results: complete necrosis response (CNR), intermediate necrosis response (INR), and poor necrosis response (PNR). Results: Overall survival (OS) and recurrence-free survival (RFS) rate at three years were 74.5% and 61.3%, respectively. The 3-year OS rates of the CTR, ITR, and PTR groups were 83.7%, 75.9%, and 69.7%, respectively (p < 0.001); the 3-year RFS rates were 76.7%, 69.0%, and 52.1%, respectively (p < 0.001). The 3-year OS rates of the CNR, INR, and PNR groups were 83.7%, 80.6%, and 61.8%, respectively (p < 0.001); the 3-year RFS rates were 76.7%, 68.9%, and 44.3%, respectively (p < 0.001). When compared to CTR/CNR, PTR/PNR was strongly related to an increased risk of recurrence (hazard ratio [HR], 5.53; 95% confidence interval [CI], 2.01 to 15.23 vs. HR, 6.37; 95% CI, 2.29 to 17.74, respectively) in univariate Cox regression. Both PTR and PNR were strongly associated with shorter RFS and OS when compared with CTR and CNR in the multivariate Cox regression. Conclusions: Tissue necrosis is an equally important prognostic marker as treatment response for oncologic outcomes in locally advanced rectal cancer.

Keywords

References

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