Partial pathologic response and nodal status as most significant prognostic factors for advanced rectal cancer treated with preoperative chemoradiotherapy

Marianne Huebner, Bruce G. Wolff, Thomas Christopher Smyrk, Jeremiah Aakre, David Larson

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

Background: This study evaluated the impact of tumor regression grading (TRG) and other pathologic variates in a cohort of rectal carcinoma patients treated with neoadjuvant chemoradiotherapy (CRT). The value of a grading less than pCR for predicting survival is unknown. Tumor budding has not been systematically studied in rectal cancer after neoadjuvant therapy. Methods: Pathologic risk factors for survival were evaluated on surgical specimens of 237 patients with stages I, II, and III rectal cancer treated between 1996 and 2006. All patients underwent preoperative CRT followed by surgical resection 6-8 weeks later. TRG, tumor grade, budding, venous invasion, radial margin, and nodal status were evaluated. The prognostic value of TRG categories was calculated with Cox regression models and validated with resampling methods. Results: TRG of <25% occurred in 61 (25.7%) and a complete response in 39 (16.4%) of the resected specimens. TRG of <25% was shown to be a statistically significant predictor for cancer-specific survival (CSS) and recurrence-free survival (RFS) compared to TRG ≥25% (P = 0.013). Tumor budding was present in 24 (10.1%) of the patients and was negatively associated with CSS (P = 0.013). Lymph node involvement was observed in 83 (35.0%) patients. TRG and nodal status (P < 0.001) were the most significant predictors associated with outcome. Conclusion: Partial pathologic response ≥25% was a superior predictor compared to pCR for improved survival after preoperative CRT. CSS and RFS were adversely affected by the presence of lymph node metastases.

Original languageEnglish (US)
Pages (from-to)675-683
Number of pages9
JournalWorld Journal of Surgery
Volume36
Issue number3
DOIs
StatePublished - Mar 2012

Fingerprint

Chemoradiotherapy
Rectal Neoplasms
Neoplasm Grading
Survival
Neoplasms
Lymph Nodes
Recurrence
Neoadjuvant Therapy
Proportional Hazards Models
Neoplasm Metastasis
Carcinoma

ASJC Scopus subject areas

  • Surgery

Cite this

Partial pathologic response and nodal status as most significant prognostic factors for advanced rectal cancer treated with preoperative chemoradiotherapy. / Huebner, Marianne; Wolff, Bruce G.; Smyrk, Thomas Christopher; Aakre, Jeremiah; Larson, David.

In: World Journal of Surgery, Vol. 36, No. 3, 03.2012, p. 675-683.

Research output: Contribution to journalArticle

@article{15768360c14a4366a269db01f3cf3264,
title = "Partial pathologic response and nodal status as most significant prognostic factors for advanced rectal cancer treated with preoperative chemoradiotherapy",
abstract = "Background: This study evaluated the impact of tumor regression grading (TRG) and other pathologic variates in a cohort of rectal carcinoma patients treated with neoadjuvant chemoradiotherapy (CRT). The value of a grading less than pCR for predicting survival is unknown. Tumor budding has not been systematically studied in rectal cancer after neoadjuvant therapy. Methods: Pathologic risk factors for survival were evaluated on surgical specimens of 237 patients with stages I, II, and III rectal cancer treated between 1996 and 2006. All patients underwent preoperative CRT followed by surgical resection 6-8 weeks later. TRG, tumor grade, budding, venous invasion, radial margin, and nodal status were evaluated. The prognostic value of TRG categories was calculated with Cox regression models and validated with resampling methods. Results: TRG of <25{\%} occurred in 61 (25.7{\%}) and a complete response in 39 (16.4{\%}) of the resected specimens. TRG of <25{\%} was shown to be a statistically significant predictor for cancer-specific survival (CSS) and recurrence-free survival (RFS) compared to TRG ≥25{\%} (P = 0.013). Tumor budding was present in 24 (10.1{\%}) of the patients and was negatively associated with CSS (P = 0.013). Lymph node involvement was observed in 83 (35.0{\%}) patients. TRG and nodal status (P < 0.001) were the most significant predictors associated with outcome. Conclusion: Partial pathologic response ≥25{\%} was a superior predictor compared to pCR for improved survival after preoperative CRT. CSS and RFS were adversely affected by the presence of lymph node metastases.",
author = "Marianne Huebner and Wolff, {Bruce G.} and Smyrk, {Thomas Christopher} and Jeremiah Aakre and David Larson",
year = "2012",
month = "3",
doi = "10.1007/s00268-011-1409-8",
language = "English (US)",
volume = "36",
pages = "675--683",
journal = "Presentations from the 9th Annual Electric Utilities Environmental Conference",
issn = "0364-2313",
publisher = "Springer New York",
number = "3",

}

TY - JOUR

T1 - Partial pathologic response and nodal status as most significant prognostic factors for advanced rectal cancer treated with preoperative chemoradiotherapy

AU - Huebner, Marianne

AU - Wolff, Bruce G.

AU - Smyrk, Thomas Christopher

AU - Aakre, Jeremiah

AU - Larson, David

PY - 2012/3

Y1 - 2012/3

N2 - Background: This study evaluated the impact of tumor regression grading (TRG) and other pathologic variates in a cohort of rectal carcinoma patients treated with neoadjuvant chemoradiotherapy (CRT). The value of a grading less than pCR for predicting survival is unknown. Tumor budding has not been systematically studied in rectal cancer after neoadjuvant therapy. Methods: Pathologic risk factors for survival were evaluated on surgical specimens of 237 patients with stages I, II, and III rectal cancer treated between 1996 and 2006. All patients underwent preoperative CRT followed by surgical resection 6-8 weeks later. TRG, tumor grade, budding, venous invasion, radial margin, and nodal status were evaluated. The prognostic value of TRG categories was calculated with Cox regression models and validated with resampling methods. Results: TRG of <25% occurred in 61 (25.7%) and a complete response in 39 (16.4%) of the resected specimens. TRG of <25% was shown to be a statistically significant predictor for cancer-specific survival (CSS) and recurrence-free survival (RFS) compared to TRG ≥25% (P = 0.013). Tumor budding was present in 24 (10.1%) of the patients and was negatively associated with CSS (P = 0.013). Lymph node involvement was observed in 83 (35.0%) patients. TRG and nodal status (P < 0.001) were the most significant predictors associated with outcome. Conclusion: Partial pathologic response ≥25% was a superior predictor compared to pCR for improved survival after preoperative CRT. CSS and RFS were adversely affected by the presence of lymph node metastases.

AB - Background: This study evaluated the impact of tumor regression grading (TRG) and other pathologic variates in a cohort of rectal carcinoma patients treated with neoadjuvant chemoradiotherapy (CRT). The value of a grading less than pCR for predicting survival is unknown. Tumor budding has not been systematically studied in rectal cancer after neoadjuvant therapy. Methods: Pathologic risk factors for survival were evaluated on surgical specimens of 237 patients with stages I, II, and III rectal cancer treated between 1996 and 2006. All patients underwent preoperative CRT followed by surgical resection 6-8 weeks later. TRG, tumor grade, budding, venous invasion, radial margin, and nodal status were evaluated. The prognostic value of TRG categories was calculated with Cox regression models and validated with resampling methods. Results: TRG of <25% occurred in 61 (25.7%) and a complete response in 39 (16.4%) of the resected specimens. TRG of <25% was shown to be a statistically significant predictor for cancer-specific survival (CSS) and recurrence-free survival (RFS) compared to TRG ≥25% (P = 0.013). Tumor budding was present in 24 (10.1%) of the patients and was negatively associated with CSS (P = 0.013). Lymph node involvement was observed in 83 (35.0%) patients. TRG and nodal status (P < 0.001) were the most significant predictors associated with outcome. Conclusion: Partial pathologic response ≥25% was a superior predictor compared to pCR for improved survival after preoperative CRT. CSS and RFS were adversely affected by the presence of lymph node metastases.

UR - http://www.scopus.com/inward/record.url?scp=84857572341&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84857572341&partnerID=8YFLogxK

U2 - 10.1007/s00268-011-1409-8

DO - 10.1007/s00268-011-1409-8

M3 - Article

C2 - 22270980

AN - SCOPUS:84857572341

VL - 36

SP - 675

EP - 683

JO - Presentations from the 9th Annual Electric Utilities Environmental Conference

JF - Presentations from the 9th Annual Electric Utilities Environmental Conference

SN - 0364-2313

IS - 3

ER -