L Lorenzon1, D Parini2, D Rega3, A Mellano4, V Vigorita5, A Biondi6, R Jaminez-Rosellon7, M Scheiterle8, I Giannini9, G Gallo10, G Marino11, L Turati12, P Marsanic4, L De Franco8, L Marano13, R De Luca14. 1. Surgical and Medical Department of Translational Medicine, Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy. Electronic address: laura.lorenzon@uniroma1.it. 2. General Surgery Unit, Santa Maria della Misericordia Hospital, Rovigo, Italy. 3. Colorectal Surgical Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori Fondazione Giovanni Pascale IRCCS, Naples, Italy. 4. Surgical Oncology Unit, Candiolo Cancer Institute - IRCCS - Candiolo Cancer Institute - IRCCS, Turin, Italy. 5. Unit of Coloproctology, Department of General and Digestive Surgery, University Hospital Complex of Vigo Alvaro Conquieiro Hospital, Vigo, Spain. 6. General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University, Rome, Italy. 7. Digestive Surgery Unit, University Hospital La Fe, Valencia, Spain. 8. Department of Medicine, Surgery and Neurosciences - Unit of General Surgery and Surgical Oncology, University of Siena, Italy. 9. General Surgery Unit, Policlinico Bari, Italy. 10. Coloproctology Unit, Santa Rita Clinic, Vercelli, Italy; Department of Medical and Surgical Sciences, University of Catanzaro, Italy. 11. Surgery Unit, IRCCS CROB Regional Oncologic Center, Rionero in Vulture, Potenza, Italy. 12. Surgical Oncology Unit, Treviglio Hospital, ASST Bergamo Ovest, Italy. 13. Multidisciplinary Robotic Surgery Unit, "San Matteo degli Infermi Hospital" - ASL Umbria 2, Spoleto, Perugia, Italy. 14. Department of Surgical Oncology, National Cancer Research Centre, Istituto Tumori Giovanni Paolo II, Bari, Italy.
Abstract
AIM: To investigate the outcome and pattern of survivals of rectal cancer patients presenting a complete or nearly complete tumor response after neo-adjuvant treatment. METHODS: Young surgeons <40 years old affiliated to the Italian Society of Surgical Oncology (YSICO) from 13 referral centers for colorectal cancer treatment, were invited to participate a retrospective study. Records from patients treated from 2005 to 2015 with a pathological diagnosis of ypT0/ypTis were retrieved and pooled in a common data-base for statistical purposes. All clinical and pathological variables were reviewed. Univariate and multivariate analyses were conducted with the end-point of survivals. RESULTS: Two hundreds and sixty-one patients were analyzed including 237 ypT0 and 24 ypTis. Nodal positive patients were 8.7%. More than sixty-six percent of the patients did not perform adjuvant chemotherapy, with a statistical difference comparing N0 versus N+ patients (66.8% vs 40.9%, p 0.02). Mean follow-up was of 47.6 months. Twenty-two relapses were observed, 91.6% at a distant site. The mean time to recurrence was of 35.3 months. On univariate analysis, the use of adjuvant chemotherapy correlated with better OS exclusively in ypT0N + patients and not in ypT0N0. Univariate and multivariate analyses documented nodal positivity as the only prognostic factor correlated with a worse OS. CONCLUSION: Recurrences were mostly diagnosed at a distant site and within the third year of follow-up. Nodal positivity was the only variable independently correlated with a worse OS. Univariate analysis documented a benefit for the use of adjuvant chemotherapy treatment exclusively in ypT0N + rectal cancers.
AIM: To investigate the outcome and pattern of survivals of rectal cancerpatients presenting a complete or nearly complete tumor response after neo-adjuvant treatment. METHODS: Young surgeons <40 years old affiliated to the Italian Society of Surgical Oncology (YSICO) from 13 referral centers for colorectal cancer treatment, were invited to participate a retrospective study. Records from patients treated from 2005 to 2015 with a pathological diagnosis of ypT0/ypTis were retrieved and pooled in a common data-base for statistical purposes. All clinical and pathological variables were reviewed. Univariate and multivariate analyses were conducted with the end-point of survivals. RESULTS: Two hundreds and sixty-one patients were analyzed including 237 ypT0 and 24 ypTis. Nodal positive patients were 8.7%. More than sixty-six percent of the patients did not perform adjuvant chemotherapy, with a statistical difference comparing N0 versus N+ patients (66.8% vs 40.9%, p 0.02). Mean follow-up was of 47.6 months. Twenty-two relapses were observed, 91.6% at a distant site. The mean time to recurrence was of 35.3 months. On univariate analysis, the use of adjuvant chemotherapy correlated with better OS exclusively in ypT0N + patients and not in ypT0N0. Univariate and multivariate analyses documented nodal positivity as the only prognostic factor correlated with a worse OS. CONCLUSION: Recurrences were mostly diagnosed at a distant site and within the third year of follow-up. Nodal positivity was the only variable independently correlated with a worse OS. Univariate analysis documented a benefit for the use of adjuvant chemotherapy treatment exclusively in ypT0N + rectal cancers.
Authors: Anita Nguyen; David R James; Eric J Dozois; Scott R Kelley; Kellie L Mathis Journal: J Gastrointest Surg Date: 2019-02-06 Impact factor: 3.452