Model predicting the ypN0 status after good response to chemoradiotherapy in rectal cancer

Am J Surg. 2018 Sep;216(3):438-443. doi: 10.1016/j.amjsurg.2018.03.025. Epub 2018 Mar 31.

Abstract

Background: The purpose of this study was to identify the predictive factors for ypN0 status in tumors with good pathologic response to chemoradiotherapy (CRT).

Methods: A retrospective chart review was conducted on patients at two tertiary cancer center who underwent rectal resection after good response to CRT between 2000 and 2013.

Results: No preoperative treatment (oxaliplatin use, radiotherapy boost of 5,4 Gy, delay CRT-surgery) impacted on the ypN status. In the multivariate analysis, only a ypT<3 (HR 7.5 [2,9-19.5]) was significant and no lymphovascular invasion (HR 8,9 [1.6-49.8]) was limited to significance.The best model predicting the ypN0 status used only the ypT status<3. The major part (92.2%) of patients with ypT0-2 tumors had no LN invasion.

Conclusion: The risk of lymph node involvement metastases was only 7.8% for the patients with an ypT0-2 status. A fullthickness transanal resection coud be the futur treatment of these patients.

Keywords: Chemoradiotherapy; Chemoradiotherapy T status; Good response; Lymph node; Nodal staging; Rectal cancer.

Publication types

  • Multicenter Study

MeSH terms

  • Adenocarcinoma / diagnosis
  • Adenocarcinoma / secondary*
  • Adenocarcinoma / therapy
  • Aged
  • Chemoradiotherapy, Adjuvant
  • Colectomy / methods
  • Female
  • Humans
  • Laparoscopy
  • Lymph Nodes / pathology*
  • Lymphatic Metastasis
  • Male
  • Middle Aged
  • Neoplasm Staging / methods*
  • Prognosis
  • Rectal Neoplasms / diagnosis*
  • Rectal Neoplasms / therapy
  • Retrospective Studies