Factors Predicting Pathological Response to Neoadjuvant Chemoradiotherapy in Rectal Cancer: The Experience of a Single Institution with 269 Patients (STONE-01).

Michele Fiore,Sara Ramella,Alessandro Coppola,Marco Caricato,Gian M Petrianni,Luca E Trodella,Edy Ippolito,Gabriele D’Ercole,Damiano Caputo,Pasquale Trecca,Roberto Coppola,Rolando M D’Angelillo

doi:10.3390/cancers13236074

Michele Fiore, Sara Ramella + Show 10 more

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https://doi.org/10.3390/cancers13236074

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Abstract

Simple SummaryNeoadjuvant chemoradiotherapy (CRT) followed by total mesorectal excision is currently the standard of care for locally advanced rectal cancer (LARC). This retrospective cohort study evaluated the pathological response after CRT in relation to treatment factors and patient and disease factors in order to find useful indicators to further improve the efficacy of CRT and create tailored therapeutic approaches. To date, the optimal timing for surgery after CRT has not been established. In literature, there are controversial results regarding the risk of higher surgical morbidity and perioperative complications due to delayed surgery. In our study carried out on 269 consecutive LARC patients, among the items analyzed, an interval time from CRT to surgery of >8 weeks was the only independent significant factor for pCR and downstaging.Aims: The aim of this study was to define a potential benefit of pathological complete response rate (pCR) and downstaging rate after neoadjuvant chemoradiotherapy (CRT) in relation to treatment and patient factors in locally advanced rectal cancer. Methods: We performed a retrospective cohort study. Patients were divided according to chemotherapy regimens concurrent to radiotherapy (1-drug vs. 2-drug) and according to the time interval between the end of CRT and surgery (≤8 weeks vs. >8 weeks), as well as in relation to specific relevant clinical factors. Logistic regression was used to estimate the independent factors for pCR and downstaging. Results: 269 patients were eligible for this study. Overall, pCR and downstaging rates were 26% and 75.4%, respectively. Univariate analysis showed that female gender (p = 0.01) and time to surgery >8 weeks (p = 0.04) were associated with pCR; age > 70 years (p = 0.05) and time to surgery >8 weeks (p = 0.002) were correlated to downstaging. At multivariate analysis, interval time to surgery of >8 weeks was the only independent factor for both pCR and downstaging (p = 0.02; OR: 0.5, CI: 0.27–0.93 and p = 0.003; OR: 0.42, CI: 0.24–0.75, respectively). Conclusions: This study indicates that, in our population, an interval time to surgery of >8 weeks is an independent significant factor for pCR and downstaging. Further prospective studies are needed to define the best interval time.

Highlights

Colorectal cancer is currently the fourth most common malignancy and the second cause of cancer mortality worldwide [1]
From July 2007 to July 2018, 564 patients diagnosed with rectal cancer were treated with radiation therapy at Campus Bio-Medico University of Rome
Seventy-three patients were excluded from the final analysis for lack of data related to pathological specimens and clinical follow-up

Summary

Introduction

Colorectal cancer is currently the fourth most common malignancy and the second cause of cancer mortality worldwide [1]. A pooled analysis of 3105 patients demonstrated a 5-year DFS of 83.3 percent for patients with pCR and of 65.6 percent for those without pCR (HR 0.44, 95% CI 0.34–0.57; p < 0.0001) with a median follow-up of 48 months [9]. These findings suggest a more favorable prognosis for patients with pCR than those with residual disease after CRT, indicating pCR as a goal in the neoadjuvant treatment of rectal cancer [5,10]

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