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Poster display - Cocktail

619 - Impact of tumor regression grade as a major prognostic factor in pathological stage II and III rectal cancer after neoadjuvant chemoradiotherapy

Date

24 Nov 2018

Session

Poster display - Cocktail

Topics

Radiation Oncology

Tumour Site

Colon and Rectal Cancer

Presenters

Jae-Sung Kim

Citation

Annals of Oncology (2018) 29 (suppl_9): ix28-ix45. 10.1093/annonc/mdy431

Authors

J. Kim1, C. Song1, S. Kang2, H.S. Lee3, K. Lee4

Author affiliations

  • 1 Radiation Oncology, Seoul National University Bundang Hospital, 13620 - Seongnam/KR
  • 2 Surgical Oncology, Seoul National University Bundang Hospital, 13620 - Seongnam/KR
  • 3 Pathology, Seoul National University Bundang Hospital, 13620 - Seongnam/KR
  • 4 Medical Oncology, Seoul National University Bundang Hospital, 13620 - Seongnam/KR
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Resources

Abstract 619

Background

There is ongoing debate regarding the significance of complete or near-complete response after neoadjuvant chemoradiotherapy (CRT) for rectal cancer. This study assessed the prognostic value of the Dworak tumor regression grade (TRG) following neoadjuvant CRT and surgery in patients with pathological stage (ypStage) II and III rectal cancer.

Methods

The records of 331 patients who underwent neoadjuvant CRT followed by total mesorectal excision between 2004 and 2015 were retrospectively reviewed. Patients were categorized as having a good response (GR = TRG 3 + 4, n = 122) or a poor response (PR = TRG 1 + 2, n = 209).

Results

At a median follow-up of 65 months, 5-year disease-free survival (DFS) was higher in the GR group than in the PR group (91.3% vs. 66.6%, p < 0.001). DFS was 90.7% in ypStages 0–I, 75.9% in ypStage II, and 56.6% in ypStage III (p < 0.001). Patients with a GR and ypStage II disease had a DFS that was indistinguishable from that of patients with ypStage 0–I disease (p = 0.885) and somewhat, although not significantly, better than that of patients with a PR and ypStage II disease (92.3% vs. 72.8%, p = 0.110). Likewise, patients with a GR and ypStage III disease had a 5-year DFS similar to those with ypStage II disease (p = 0.789) and significantly better than that of patients with a PR and ypStage III disease (76.0% vs. 51.3%, p = 0.040). The same pattern was observed for overall survival (OS). Multivariate analysis revealed that TRG 3 + 4 (hazard ratio: 0.35, 95% confidence interval: 0.19–0.66), ypN classification, and perineural invasion were independently associated with DFS.

Conclusions

A GR to neoadjuvant CRT is an independent predictor of good DFS and OS and further stratifies patients so as to estimate the risk of recurrence and survival among patients with ypStage II and III rectal cancer.

Editorial acknowledgement

Clinical trial identification

Legal entity responsible for the study

Jae-Sung Kim MD.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.

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