Long-term efficacy of preoperative chemoradiotherapy combined with total mesorectal excision for locally advanced rectal cancer:an analysis of 241 patients
Li Shuai, Jin Jing, Tang Yuan, Li Ning, Yu Jing, Ren Hua, Wang Xin, Liu Wenyang, Wang Shulian, Song Yongwen, Wang Weihu, Liu Yueping, Fang Hui, Lu Ningning, Tang Yu, Chen Bo, Li Yexiong
Department of Radiation Oncology,National Cancer Center/Cancer Hospital,Chinese Academy of Medical Scicences and Peking Union Medical College,Beijing 100021,China (Li S,Jin J,Tang Y,Li N,Yu J,Ren H,Wang X,Liu WY,Wang SL,Song YW,Liu YP,Fang H,Lu NN,Tang Y,Chen B,Li YX) Department of Radiation Oncology,Cancer Hospital of Peking University,Beijing 100042,China (Wang WH)
Abstract：Objective To retrospectively analyze the long-term efficacy of and prognostic factors after preoperative chemoradiotherapy combined with total mesorectal excision (TME) in the treatment of 241 patients with locally advanced rectal cancer. Methods A total of 241 patients who were consecutively admitted to our hospital and diagnosed with locally advanced mid-low rectal adenocarcinoma by pelvic magnetic resonance imaging or computed tomography from January 2006 to November 2014 were enrolled as subjects. All patients received preoperative radiotherapy with doses ranging between 42.0 and 50.4 Gy (median dose=50 Gy) and concurrent chemotherapy with capecitabine±oxaliplatin. Patients received TME (R0 excision) at 4-15 weeks (median time=7 weeks) after chemoradiotherapy. Adjuvant postoperative chemotherapy was given depending on the recovery and preference of each patient. Disease-free survival (DFS), locoregional recurrence (LRR), overall survival (OS), and distant metastasis (DM) rates were calculated by the Kaplan-Meier method and analyzed by the log-rank test. The Cox model was used for multivariate analysis. Results In all the patients, the median follow-up time was 42 months;the 3-year LRR, DFS, OS, and DM rates were 3.8%, 76.2%, 85.9%, and 20.6%, respectively. The subgroup analysis showed that ypT0-2, ypN-, pCR, and TRG4 were associated with improved DFS (ypT0-2 vs. ypT3-4:86.0% vs. 69.3%, P=0.002;ypN-vs ypN+:88.1% vs. 56.9%, P=0.000;pCR vs. non-pCR:100% vs. 72.4%, P=0.001;TRG4 vs. TRG2-3 vs. TRG0-1:94.9% vs. 73.6% vs. 66.3%, P=0.011). The multivariate analysis revealed that the postoperative ypN status was an independent prognostic factor for DFS (P=0.000). Conclusions For patients with locally advanced mid-low rectal adenocarcinoma, preoperative chemoradiotherapy combined with radical surgery achieves satisfactory outcomes in local control. The major reason for treatment failure lies in distant metastasis. The ypN status after chemoradiotherapy is an independent prognostic factor for DFS.
Li Shuai,Jin Jing,Tang Yuan et al. Long-term efficacy of preoperative chemoradiotherapy combined with total mesorectal excision for locally advanced rectal cancer:an analysis of 241 patients[J]. Chinese Journal of Radiation Oncology, 2018, 27(2): 170-176.
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