Neoadjuvant rectal score in prognostic prediction of clinical stage Ⅲ middle-low rectal cancer
Li Shuai, Jin Jing, Ye feng, Tang yuan, Li Ning, Yu Jing, Ren Hua, Wang Xin, LiuWen Yang, Wang Shulian, Song Yongwen, Wang Weihu, Liu Yueping, Fang Hui, Lu Ning Ning, Tang Yu, Chen Bo, Li Yexiong
Department of Radiation Oncology,National Cancer Center/Cancer Hospital,Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing 100021,China
Abstract：Objective To investigate the effects of downstaging and neoadjuvant rectal (NAR) score on the prognosis of patients with clinical stage Ⅲ middle-low rectal cancer undergoing preoperative concurrent chemoradiotherapy. Methods From 2006 to 2014, 195 patients who were admitted to our hospital and diagnosed with clinical stage Ⅲ middle-low rectal cancer by pelvic magnetic resonance imaging or computed tomography were enrolled. All patients received preoperative radiotherapy with doses of 42-50.4 Gy (median:50 Gy, 93.8% of patients received doses of ≥50 Gy) and concurrent chemotherapy with capecitabine ± oxaliplatin. Total mesorectal (R0) excision surgery was performed at 4-15 weeks (median:7 weeks) after concurrent chemoradiotherapy. The effects of downstaging (stage yp0—Ⅱ) and NAR score (calculated based on cT staging and ypT/N staging) on the prognosis were evaluated. The 3-year disease-free survival (DFS) rate was calculated using the Kaplan-Meier method and analyzed by log-rank test. Results In all the patients, the median follow-up time was 44 months (6.7-125.5 months);the 3-year DFS rate was 76.8%. Downstaging after preoperative chemoradiotherapy was a significant prognostic factor for the 3-year DFS (92.2% vs. 56.8%, P=0.000). The median NAR score was 15.0(0-65.0) in all the patients. Patients with NAR scores of ≤15.0 had significantly improved 3-year DFS than those with NAR scores of>15.0(90.1% vs. 57.0%, P=0.001). In patients with downstaging, those with NAR scores of ≤8.4 had significantly improved prognosis compared with those with NAR scores of>8.4(95.1% vs. 87.5%, P=0.022). Conclusions Patients with downstaging after preoperative concurrent chemoradiotherapy for stage cⅢ middle-low rectal cancer have satisfactory prognosis. The NAR score is an effective prognostic predictor.
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2018, Vol. 27 
