Abstract 4032
Background
We decided to evaluate preoperative clinical factors associated with progression free survival, overall survival and tumor regression in patients with locally-advanced rectal cancer after chemo-radiotherapy.
Methods
we analyzed prospective database of patients with locally-advancded rectal cancer (cT3-4N0-2M0) who received preoperative chemo-radiotherapy followed by surgery in our center from 2004 to 2013. Multivariate regression analyses was performed to evaluate odds of absent morphological response (Dworak tumo regression rate system 0-2) and hazards of progression and deaths. Statistical analyses was performed with SPSS v.20.
Results
Chemo-radiotherapy followed by surgery was performed in 457 patients with locally-advanced rectal cancer. The median f.-up was 46 months (2-141), 3-year progression free survival and overall survival were 79% and 91%, respectively. Multivariate regression analyses revealed factors associated with tumor regression rate 0-2 as high level (above normal range) CEA (carcinoembryonic antigen) before chemo-radiotherapy (OR 1.49 95%CI 1.11-2.02, p = 0.008), neutrophils count ≥ 7,000/µl (OR 2.29, 95%CI 1.0-5.2, p=0.05) and cT4 (OR 3.73, 95%CI 2.03-6.86, p < 0.001). Independent negative prognostic factors for progression free survival were perineural invasion (HR 3.1, 95% CI 1.43-6.89, p<0,001), neutrophil/lymphocyte ratio before surgery ≥ 3 (HR 1.8, 95%CI 1.37-2.42, p=0.01) and ypT3-4 or/and N + (HR 1.82, 95%CI 0.45-0.92, p<0.01). For overall survival: ypT3-4 or/and N + (HR 1.9, 95%CI 1.3-2.65, p<0.01), lymphatic vessel invasion (HR 2.4, 95%CI 1.27-4.59, p<0.01) and leucocytes count before surgery ≥11,000/µl (HR 3.1, 95%CI 1.33-7.33, p<0.01).
Conclusions
ypTNM after preoperative chemo-radiotherapy more effective than cTNM predicts progression free and overall survival in patients with localy-advanced rectal cancer.
Clinical trial identification
Legal entity responsible for the study
Mikhail Fedyanin.
Funding
Has not received any funding.
Editorial Acknowledgement
Disclosure
All authors have declared no conflicts of interest.