Published online Jan 14, 2015. doi: 10.3748/wjg.v21.i2.563
Peer-review started: May 7, 2014
First decision: June 10, 2014
Revised: June 30, 2014
Accepted: August 28, 2014
Article in press: August 28, 2014
Published online: January 14, 2015
AIM: To ascertain pathologic stage as a prognostic indicator for rectal cancer patients receiving preoperative chemoradiotherapy (PCRT).
METHODS: Patients with mid- and low rectal carcinoma (magnetic resonance imaging - based clinical stage II or III) between 2000 and 2009 and treated with curative radical resection were identified. Patients were divided into two groups: PCRT and No-PCRT. Recurrence-free survival (RFS) was examined according to pathologic stage and addition of adjuvant treatment.
RESULTS: Overall, 894 patients were identified. Of these, 500 patients received PCRT. Adjuvant chemotherapy was delivered to 81.5% of the No-PCRT and 94.8% of the PCRT patients. Adjuvant radiotherapy was given to 29.4% of the patients in the No PCRT group. The 5-year RFS for the No-PCRT group was 92.6% for Stage I, 83.3% for Stage II, and 72.9% for Stage III. The 5-year RFS for the PCRT group was 95.2% for yp Stage 0, 91.7% for yp Stage I, 73.9% for yp Stage II, and 50.7% for yp Stage III.
CONCLUSION: Pathologic stage can predict prognosis in PCRT patients. 5-year RFS is significantly lower among PCRT patients than No-PCRT patients in pathologic stage II and III. These results should be taken into account when considering adjuvant treatment for patients treated with PCRT.
Core tip: Strictly speaking, there is no common objective guideline to predict prognosis and give adjuvant treatment according to risk stratification. Patients who show good response were thought to have good prognosis. However, expected value of recurrence-free survival or recurrence rate was not suggested especially in patients who did not show good response to patients receiving preoperative chemoradiotherapy (PCRT). In addition, how to measure the response level was variable. The present study suggests impression of prognosis based on pathologic stage, which is objective, after PCRT and radical resection and show stage-by-stage comparison with those without PCRT to give impression of prognosis by using familiar stage-based prognosis.