Prognostic Significance of Neoadjuvant Rectal Scores in Preoperative Short-Course Radiotherapy and Long-Course Concurren
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ORIGINAL ARTICLE – COLORECTAL CANCER
Prognostic Significance of Neoadjuvant Rectal Scores in Preoperative Short-Course Radiotherapy and Long-Course Concurrent Chemoradiotherapy for Patients with Locally Advanced Rectal Cancer Wen-Shih Huang, MD1, Feng-Che Kuan, MD2,3, Meng-Hung Lin, PhD4, Miao-Fen Chen, MD, PhD3,5,6, and Wen-Cheng Chen, MD5,6 Department of Colon and Rectal Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan; 2Department of Hematology and Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan; 3Graduate Institute of Clinical Medical Sciences, ChangGung University, Tao-Yuan, Taiwan; 4Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi, Taiwan; 5Department of Radiation Oncology, Chang Gung Memorial Hospital, Chia-Yi, Hsien, Taiwan; 6School of Medicine, Chang Gung University, Taoyuan, Taiwan
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ABSTRACT Background. This study aimed to investigate the prognostic factors and the utility of the neoadjuvant rectal (NAR) score for patients who have locally advanced rectal cancer (LARC) treated with preoperative short-course radiotherapy (SRT) or long-course concurrent chemoradiotherapy (CRT). Methods. Of 314 consecutive stage 2 or 3 rectal cancer patients enrolled from January 2006 to December 2017, 205 underwent preoperative SRT (2500 cGy/5 fractions), and 109 underwent preoperative CRT (4200–5080 cGy/ 21–28 fractions) after total mesorectal excision (TME). The study calculated NAR scores using the following equation: [5 pN - 3(cT - pT) ? 12]2/9.61. Results. The multivariate analysis showed that age above 65 years, pT4, pN2, NAR scores higher than 16, and distance from anal verges (\ 8 cm) were significant prognostic factors for overall survival (OS), whereas, pN2, NAR scores lower than 16, and distance from anal verges (\ 8 cm) were significant prognostic factors for disease-
Ó Society of Surgical Oncology 2020 First Received: 31 May 2020 Accepted: 28 July 2020 M.-F. Chen, MD, PhD e-mail: [email protected] W.-C. Chen, MD e-mail: [email protected]
free survival (DFS) and distant metastasis (DM). The patients with an NAR score higher than 16, had a 5-year OS rate of 67.6%, a DFS rate of 56.9%, a locoregional recurrence (LRR) rate of 7.7%, and a DM rate of 35% compared with corresponding rates of 87.6%, 76.7%, 5.4%, and 7.2% for the patients with an NAR score of 16 or lower (p \ 0.001 for OS, \ 0.001 for DFS, 0.25 for LRR, and \ 0.001 for DM). Conclusions. For patients who undergo SRT or CRT for LARC, a higher NAR score is associated with worse OS and DFS and higher DM rates at 5 years. The NAR score could be used as a short-term surrogate end point after neoadjuvant therapy for LARC.
For locally advanced rectal adenocarcinoma (T3-4 or N?), neoadjuvant short-course radiotherapy (SRT)1–5 or long-course chemoradiotherapy (CRT)6–8 before surgery have been shown to improve the treatment outcomes (locoregional control or survival) by several large randomized trials. The benefits still are holding as truth even in this era of total mesorectal excision (TME). I
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