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Neoadjuvant chemoradiotherapy for rectal cancer: how important is tumour regression?
Author(s) -
McCoy Melanie J.,
Hemmings Chris,
Hillery Simon,
Penter Cheryl,
Bulsara Max K.,
Zeps Nik,
Platell Cameron F.
Publication year - 2017
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.13394
Subject(s) - medicine , colorectal cancer , hazard ratio , oncology , neoadjuvant therapy , chemoradiotherapy , stage (stratigraphy) , univariate analysis , multivariate analysis , proportional hazards model , t stage , pathological , cancer , confidence interval , breast cancer , paleontology , biology
Background Pathological complete response following neoadjuvant chemoradiotherapy ( CRT ) for locally advanced rectal cancer is associated with reduced local recurrence and improved long‐term outcome. However, the prognostic value of a partial response, or of tumour regression in patients with metastatic disease, is less clear. Methods We present a single‐centre cohort study of 205 patients with stage II–IV rectal cancer treated with surgery and neoadjuvant CRT between 2006 and 2013. Tumour regression was assessed using the D worak system. Results The probability of 3‐year recurrence‐free survival ( RFS ) was 95% for D worak grade 4, 82% for grade 3, 64% for grade 2 and 53% for grade 1 ( P = 0.0005). In univariate regression analysis, D worak grade was associated with RFS (hazard ratio (HR) 0.51, P < 0.0001; trend analysis) and cancer‐specific survival ( HR 0.52, P = 0.002). In multivariate analysis, D worak grade remained an independent predictor of RFS ( HR 0.62, P = 0.012), along with clinical metastases stage, resection margin status, the presence or absence of extramural venous invasion and type of surgical procedure. Conclusions Tumour regression grade after neoadjuvant CRT was an independent prognostic factor for RFS , highlighting the importance of the degree of local response to CRT .