Pathologic stage is most prognostic of disease-free survival in locally advanced rectal cancer patients after preoperative chemoradiation Journal Article


Authors: Quah, H. M.; Chou, J. F.; Gonen, M.; Shia, J.; Schrag, D.; Saltz, L. B.; Goodman, K. A.; Minsky, B. D.; Wong, W. D.; Weiser, M. R.
Article Title: Pathologic stage is most prognostic of disease-free survival in locally advanced rectal cancer patients after preoperative chemoradiation
Abstract: BACKGROUND. Preoperative chemoradiation is the standard treatment for locally advanced rectal cancer. However, it is uncertain whether pretreatment clinical stage, degree of response to neoadjuvant treatment, or pathologic stage is the most reliable predictor of outcome. This study compared various staging elements and treatment-related variables to identify which factors or combination of factors reliably prognosticates disease-free survival in rectal cancer patients receiving neoadjuvant combined modality therapy. METHODS. From a prospectively maintained single institution database, 342 consecutive patients with locally advanced rectal cancer staged by endorectal ultrasound were identified. Patients underwent rectal resection 4 to 8 weeks after a 5.5-week course of pelvic radiotherapy/concurrent chemotherapy. The degree of tumor regression was histologically graded on each resected specimen using a previously reported response scale of 0% to 100%. Predictive models of disease-free survival were created utilizing available pretherapy and postoperative staging elements in addition to the degree of tumor regression noted histologically. Model accuracy was measured and compared by concordance index, with 95% confidence interval (CI). RESULTS. Stratifying patients by degree of tumor regression predicted outcome with a concordance index of 0.65 (95% CI, 0.59-0.71), which was significantly better than models using preoperative stage elements (concordance index of 0.54; 95% CI, 0.50-0.58). However, the model found to be most predictive of disease-free survival stratified patients by final pathologic T classification and N classification elements, with a concordance index of 0.75 (95% CI, 0.70-0.80). CONCLUSIONS. Tumor response to preoperative therapy is a strong predictor of disease-free survival. However, outcome is most accurately estimated by final pathologic stage, which is influenced by both preoperative stage and response to therapy. © 2008 American Cancer Society.
Keywords: survival; adult; cancer survival; controlled study; human tissue; treatment outcome; aged; aged, 80 and over; disease-free survival; middle aged; major clinical study; postoperative period; fluorouracil; capecitabine; chemotherapy, adjuvant; combined modality therapy; neoadjuvant therapy; radiotherapy, adjuvant; cancer staging; neoplasm staging; recurrence; tumor regression; data base; histology; ultrasound; irinotecan; confidence interval; preoperative period; surgery; oxaliplatin; rectal neoplasms; rectum cancer; chemoradiation; response to therapy; outcome prediction; rectal carcinoma
Journal Title: Cancer
Volume: 113
Issue: 1
ISSN: 0008-543X
Publisher: Wiley Blackwell  
Date Published: 2008-07-01
Start Page: 57
End Page: 64
Language: English
DOI: 10.1002/cncr.23516
PUBMED: 18442099
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 33" - "Export Date: 17 November 2011" - "CODEN: CANCA" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Joanne Fu-Lou Chou
    153 Chou
  2. Leonard B Saltz
    580 Saltz
  3. Karyn A Goodman
    244 Goodman
  4. Mithat Gonen
    701 Gonen
  5. Hak Mien Quah
    5 Quah
  6. Deborah Schrag
    137 Schrag
  7. Jinru Shia
    450 Shia
  8. Martin R Weiser
    338 Weiser
  9. Douglas W Wong
    173 Wong