Role of the complete pathological response in rectal cancer: Value as a prognostic factor

Gil Rodríguez Caravaca

doi:10.31487/j.jso.2018.01.005

Abstract

Objective To study the effect of the pathologic complete response (pCR) on the survival of patients treated with surgery and neoadjuvant chemo-radiotherapy in locally advanced non-metastatic rectal carcinoma (LARC). Materials and methodology We underwent an observational retrospective analysis of cohorts. The recruitment was carried out by means of non-probabilistic consecutive inclusion of patients with rectal cancer treated between January 2009 and December 2016 with surgery and neoadjuvant chemo-radiotherapy. The patients recruited had been diagnosed with locally advanced non-metastatic rectal cancer. cT3-4 o N+. based on the American Joint Committee on Cancer (AJCC) 2010. with histological confirmation of adenocarcinoma and no treatment with induction chemotherapy. The pathologic response was calibrated in accordance with the Ryan system. Survival was calculated with multivariate Cox regression analysis Results Pathologic complete response was reached by 19.2% Patients. The disease free survival was significantly lower in the no pathologic complete response (HR 0.099. p value 0.025). The progression in the group of patients with pathological complete response occurred in only one patient and have local and distal component compared to 39 patients in no pCR 21.2% distant metastases and 3.8% locally relapse. Perineural invasion and adjuvant chemotherapy were also significatly associated with disease free survival Conclusions The pathological complete response is a good prognosis factor in patients treated with surgery and nCRT in LARC with distal and local relapse. Perineural invasion and adjuvant chemotherapy were also good prognostic factors.

Highlights

Colorectal cancer is a significant health problem at global level, with an estimated 1.8 million newly diagnosed cases in 2018 and 881.000 deaths, it being third in terms of incidence and second in terms of mortality
Surgery is the only curative treatment for locally advanced nonmetastatic rectal carcinoma, being total mesorectal excision (TME) the gold standard treatment for this disease, taking into account that the rate of local recurrences is between 4% and 27% while that of lymph node involvement can reach 15% [3].The most appropriate surgical technique is selected based on how far the tumour is from the anal margin as well as the clinico-radiological status
In the univariate analysis the pre-operative carcinoembryonic antigen (CEA) level, adjuvant chemotherapy, pathologic complete response (pCR), pathological stage, lymphovascular invasion, perineural invasion and the surgical margins were independently associated with disease free survival

Summary

Introduction

Colorectal cancer is a significant health problem at global level, with an estimated 1.8 million newly diagnosed cases in 2018 and 881.000 deaths, it being third in terms of incidence and second in terms of mortality. The Community of Madrid has its own record, the data published in 2017 showing that gastro-intestinal tumours were recorded as the most frequent, comprising 23.2% of the total, with 997 cases of rectal cancer diagnosed throughout that year [2]. Surgery is the only curative treatment for locally advanced nonmetastatic rectal carcinoma, being total mesorectal excision (TME) the gold standard treatment for this disease, taking into account that the rate of local recurrences is between 4% and 27% while that of lymph node involvement can reach 15% [3].The most appropriate surgical technique is selected based on how far the tumour is from the anal margin as well as the clinico-radiological status. The carcinomas which are located in the upper or middle third of the rectum tend to require intervention by means of low anterior resection while only those tumours which do not have a 2 cm margin of healthy tissue distal to the tumour, will be treated by means of abdomino-perineal resection

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Discussion

Conclusion