Jin Ho Song1, Sung Hwan Kim2, Jong Hoon Lee3, Hyeon Min Cho4, Dae Yong Kim5, Tae Hyun Kim5, Sun Young Kim5, Ji Yeon Baek5, Jae Hwan Oh5, Taek Keun Nam6, Mee Sun Yoon6, Jae Uk Jeong6, Kyubo Kim7, Eui Kyu Chie7, Hong Seok Jang8, Jae Sung Kim9, Jin Hee Kim10, Ki Mun Kang11. 1. Department of Radiation Oncology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea; Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea. 2. Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea. 3. Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea. Electronic address: koppul@catholic.ac.kr. 4. Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea. 5. Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea. 6. Department of Radiation Oncology, Chonnam National University Hospital, Hwasun, Republic of Korea. 7. Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea. 8. Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. 9. Department of Radiation Oncology, Seoul National University Bundang Hospital, College of Medicine, Bundang, Republic of Korea. 10. Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea. 11. Department of Radiation Oncology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea.
Abstract
BACKGROUND AND PURPOSE: To evaluate the pre-treatment clinical factors affecting recurrence and survival in rectal cancer patients who receive preoperative chemoradiotherapy (CRT) and curative surgery. METHODS AND MATERIALS: The clinical data of 1782 patients from 8 institutions in Korea were analyzed. The potential prognostic factors that could be acquired before radical surgery were patient age, gender, clinical T and N stages, tumor size and location, tumor grade, carcinoembryonic antigen (CEA) level, and the concurrent chemotherapy regimen. The relapse-free survival (RFS), overall survival (OS), and cumulative incidence of locoregional and distant recurrence were analyzed according to the clinical factors. RESULTS: Among the pre-treatment clinical factors, tumor grade, pre-CRT CEA level, tumor location, and clinical N stage were significant prognostic factors affecting the RFS. The high-grade tumor was the hazardous factor for RFS on the multivariate analysis [Hazard ratio (HR), 1.83; 95% confidence interval (CI), 1.29-2.58; p=0.001]. The 5-year RFS rate for high-grade tumors was significantly lower than that for low-grade tumors (63.8% vs. 78.8%, p<0.001). The tumor grade was a significant prognostic factor for distant recurrence (HR, 1.83, 95% CI, 1.29-2.58; p<0.001), but not for locoregional recurrence (HR, 1.49, 95% CI, 0.68-3.26; p=0.320) on the multivariate analysis. The 5-year OS rate for high-grade tumors was significantly lower than that for low-grade tumors (70.6% vs. 85.5%, p<0.001). CONCLUSION: The tumor grade is the significant pre-treatment clinical factor for recurrence and survival in rectal cancer patients who receive preoperative CRT and curative surgery.
BACKGROUND AND PURPOSE: To evaluate the pre-treatment clinical factors affecting recurrence and survival in rectal cancerpatients who receive preoperative chemoradiotherapy (CRT) and curative surgery. METHODS AND MATERIALS: The clinical data of 1782 patients from 8 institutions in Korea were analyzed. The potential prognostic factors that could be acquired before radical surgery were patient age, gender, clinical T and N stages, tumor size and location, tumor grade, carcinoembryonic antigen (CEA) level, and the concurrent chemotherapy regimen. The relapse-free survival (RFS), overall survival (OS), and cumulative incidence of locoregional and distant recurrence were analyzed according to the clinical factors. RESULTS: Among the pre-treatment clinical factors, tumor grade, pre-CRT CEA level, tumor location, and clinical N stage were significant prognostic factors affecting the RFS. The high-grade tumor was the hazardous factor for RFS on the multivariate analysis [Hazard ratio (HR), 1.83; 95% confidence interval (CI), 1.29-2.58; p=0.001]. The 5-year RFS rate for high-grade tumors was significantly lower than that for low-grade tumors (63.8% vs. 78.8%, p<0.001). The tumor grade was a significant prognostic factor for distant recurrence (HR, 1.83, 95% CI, 1.29-2.58; p<0.001), but not for locoregional recurrence (HR, 1.49, 95% CI, 0.68-3.26; p=0.320) on the multivariate analysis. The 5-year OS rate for high-grade tumors was significantly lower than that for low-grade tumors (70.6% vs. 85.5%, p<0.001). CONCLUSION: The tumor grade is the significant pre-treatment clinical factor for recurrence and survival in rectal cancerpatients who receive preoperative CRT and curative surgery.