Annals of Coloproctology

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Difference in Tumor Area as a Predictor of a Pathological Complete Response for Patients With Locally Advanced Rectal Cancer: Ji Hyeong Song, Yo-Han Park, Sang Hyuk Seo, Anbok Lee, Kwang Hee Kim, Min Sung An, Ki Beom Bae, Kwan Hee Hong, Jin Won Hwang, Ji Hyun Kim, Hyun Seok Jung, Ki Jung Ahn; Ann Coloproctol. 2017;33(6):219-226. Published online December 31, 2017; DOI: https://doi.org/10.3393/ac.2017.33.6.219

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Purpose

This study was conducted to discover the clinical factors that can predict pathologically complete remission (pCR) after neoadjuvant chemoradiotherapy (CRT), so that those factors may help in deciding on a treatment program for patients with locally advanced rectal cancer.

Methods

A total of 137 patients with locally advanced rectal cancer were retrospectively enrolled in this study, and data were collected retrospectively. The patients had undergone a total mesorectal excision after neoadjuvant CRT. Histologic response was categorized as pCR vs. non-pCR. The tumor area was defined as (tumor length) × (maximum tumor depth). The difference in tumor area was defined as pre-CRT tumor area – post-CRT tumor area. Univariate and multivariate logistic regression analyses were conducted to find the factors affecting pCR. A P-value < 0.05 was considered significant.

Results

Twenty-three patients (16.8%) achieved pCR. On the univariate analysis, endoscopic tumor circumferential rate <50%, low pre-CRT T & N stage, low post-CRT T & N stage, small pretreatment tumor area, and large difference in tumor area before and after neoadjuvant CRT were predictive factors of pCR. A multivariate analysis found that only the difference in tumor area before and after neoadjuvant CRT was an independent predictor of pCR (P < 0.001).

Conclusion

The difference in tumor area, as determined using radiologic tools, before and after neoadjuvant CRT may be important predictor of pCR. This clinical factor may help surgeons to determine which patients who received neoadjuvant CRT for locally advanced rectal cancer should undergo surgery.

Citations

Citations to this article as recorded by

Particular aspects of treating rectal cancer: The watch and wait approach
Diana Andreea Draghici, Alexandru Rares Stoian, Vlad Andrei Porojan, Oana Ilona David, Ştefan Bedereag, Anda Natalia Ciuhu, Andrei Haidar, Dragoş Crețoiu, Carmen Elena Condrat, Valentin Titus Grigorean
Journal of Cancer Research and Therapeutics.2023; 19(2): 461. CrossRef
Predicting stage ypT0–1N0 for nonradical management in patients with middle or low rectal cancer who undergo neoadjuvant chemoradiotherapy: a retrospective cohort study
Jeehye Lee, In Jun Yang, Jung Wook Suh, Hong-min Ahn, Heung-Kwon Oh, Duck-Woo Kim, Young-Hoon Kim, Kyoung Ho Lee, Sung-Bum Kang
Annals of Surgical Treatment and Research.2022; 103(1): 32. CrossRef
Radiotherapy after local excision of rectal cancer may offer reduced local recurrence rates
H. J. S. Jones, S. Goodbrand, R. Hompes, N. Mortensen, C. Cunningham
Colorectal Disease.2019; 21(4): 451. CrossRef
‘Watch and wait’ in rectal cancer: summary of the current evidence
Jason On, Emad H Aly
International Journal of Colorectal Disease.2018; 33(9): 1159. CrossRef

Clinical Significance of Lymph Node Ratio in Stage III Colorectal Cancer: Yo Han Park, Jae Im Lee, Jong Kyung Park, Hang Ju Jo, Won Kyung Kang, Chang Hyeok An; J Korean Soc Coloproctol. 2011;27(5):260-265. Published online October 31, 2011; DOI: https://doi.org/10.3393/jksc.2011.27.5.260

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8 Citations

Abstract PDF

Purpose

Recent literature has shown that lymph node ratio is superior to the absolute number of metastatic lymph nodes in predicting the prognosis in several malignances other than colorectal cancer. The aim of this study was to evaluate the prognostic significance of the lymph node ratio (LNR) in patients with stage III colorectal cancer.

Methods

We included 186 stage III colorectal cancer patients who underwent a curative resection over a 10-year period in one hospital. The cutoff point of LNR was chosen as 0.07 because there was significant survival difference at that LNR. The Kaplan-Meier and the Cox proportional hazard models were used to evaluate the prognostic effect according to LNR.

Results

There was statistically significant longer overall survival in the group of LNR > 0.07 than in the group of LNR ≤ 7 (P = 0.008). Especially, there was a survival difference for the N1 patients group (LN < 4) according to LNR (5-year survival of N1 patients was lower in the group of LNR > 0.07, P = 0.025), but there was no survival difference for the N2 group (4 ≥ LN) according to LNR. The multivariate analysis showed that the LNR is an independent prognostic factor.

Conclusions

LNR can be considered as a more accurate and potent modality for prognostic stratifications in patients with stage III colorectal cancer.

Citations

Citations to this article as recorded by

The prognostic performance of the log odds of positive lymph nodes in patients with esophageal squamous cell carcinoma: A population study of the US SEER database and a Chinese single‐institution cohort
Hongdian Zhang, Wanyi Xiao, Peng Ren, Kai Zhu, Ran Jia, Yueyang Yang, Lei Gong, Zhentao Yu, Peng Tang
Cancer Medicine.2021; 10(17): 6149. CrossRef
Lymph Node Ratio and Liver Metachronous Metastases in Colorectal Cancer
Giovanni Li Destri, Giuseppe Privitera, Gaetano La Greca, Roberto Scilletta, Antonio Pesce, Teresa Rosanna Portale, Erminia Conti, Stefano Puleo
International Surgery.2021; 105(1-3): 122. CrossRef
Rectal cancers with microscopic circumferential resection margin involvement (R1 resections): Survivals, patterns of recurrence, and prognostic factors
Gianpiero Gravante, David Hemingway, James Andrew Stephenson, David Sharpe, Ahmed Osman, Melissa Haines, Vafa Pirjamali, Roberto Sorge, Justin Ming Yeung, Michael Norwood, Andrew Miller, Kirsten Boyle
Journal of Surgical Oncology.2016; 114(5): 642. CrossRef
Prognostic Impact of the Metastatic Lymph Node Ratio on Survival in Rectal Cancer
Wafi Attaallah, Omer Gunal, Manuk Manukyan, Gulden Ozden, Cumhur Yegen
Annals of Coloproctology.2013; 29(3): 100. CrossRef
Prognostic Value of Total Lymph Node Identified and Ratio of Lymph Nodes in Resected Colorectal Cancer
Leila Ghahramani, Leila Moaddabshoar, Samira Razzaghi, Sayed Hasan Hamedi, Saeedeh Pourahmad, Mohammad Mohammadianpanah
Annals of Colorectal Research.2013; 1(3): 81. CrossRef
Prognostic Value of Lymph Node Ratios in Node Positive Rectal Cancer Treated with Preoperative Chemoradiation
Jamal Jafari Nadoshan, Ramesh Omranipour, Omid Beiki, Kazem Zendedel, Abbas Alibakhshi, Habibollah Mahmoodzadeh
Asian Pacific Journal of Cancer Prevention.2013; 14(6): 3769. CrossRef
Proposal of a New Classification for Stage III Colorectal Cancer Based on the Number and Ratio of Metastatic Lymph Nodes
Li‐Ping Wang, Hong‐Yan Wang, Rui Cao, Cong Zhu, Xiong‐Zhi Wu
World Journal of Surgery.2013; 37(5): 1094. CrossRef
An appraisal of lymph node ratio in colon and rectal cancer: not one size fits all
M. Medani, Niall Kelly, George Samaha, G. Duff, Vourneen Healy, Elizabeth Mulcahy, Eoghan Condon, David Waldron, Jean Saunders, J. Calvin Coffey
International Journal of Colorectal Disease.2013; 28(10): 1377. CrossRef

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