Wen-Shih Huang1, Feng-Che Kuan2,3, Meng-Hung Lin4, Miao-Fen Chen5,6,7, Wen-Cheng Chen8,9. 1. Department of Colon and Rectal Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan. 2. Department of Hematology and Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan. 3. Graduate Institute of Clinical Medical Sciences, Chang-Gung University, Tao-Yuan, Taiwan. 4. Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi, Taiwan. 5. Graduate Institute of Clinical Medical Sciences, Chang-Gung University, Tao-Yuan, Taiwan. miaofen@adm.cgmh.org.tw. 6. Department of Radiation Oncology, Chang Gung Memorial Hospital, Chia-Yi, Hsien, Taiwan. miaofen@adm.cgmh.org.tw. 7. School of Medicine, Chang Gung University, Taoyuan, Taiwan. miaofen@adm.cgmh.org.tw. 8. Department of Radiation Oncology, Chang Gung Memorial Hospital, Chia-Yi, Hsien, Taiwan. danielchen@adm.cgmh.org.tw. 9. School of Medicine, Chang Gung University, Taoyuan, Taiwan. danielchen@adm.cgmh.org.tw.
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-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.
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 cancerpatients 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-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.
Authors: E Kapiteijn; C A Marijnen; I D Nagtegaal; H Putter; W H Steup; T Wiggers; H J Rutten; L Pahlman; B Glimelius; J H van Krieken; J W Leer; C J van de Velde Journal: N Engl J Med Date: 2001-08-30 Impact factor: 91.245
Authors: Rolf Sauer; Heinz Becker; Werner Hohenberger; Claus Rödel; Christian Wittekind; Rainer Fietkau; Peter Martus; Jörg Tschmelitsch; Eva Hager; Clemens F Hess; Johann-H Karstens; Torsten Liersch; Heinz Schmidberger; Rudolf Raab Journal: N Engl J Med Date: 2004-10-21 Impact factor: 91.245
Authors: Willem van Gijn; Corrie A M Marijnen; Iris D Nagtegaal; Elma Meershoek-Klein Kranenbarg; Hein Putter; Theo Wiggers; Harm J T Rutten; Lars Påhlman; Bengt Glimelius; Cornelis J H van de Velde Journal: Lancet Oncol Date: 2011-05-17 Impact factor: 41.316
Authors: Monique Maas; Patty J Nelemans; Vincenzo Valentini; Prajnan Das; Claus Rödel; Li-Jen Kuo; Felipe A Calvo; Julio García-Aguilar; Rob Glynne-Jones; Karin Haustermans; Mohammed Mohiuddin; Salvatore Pucciarelli; William Small; Javier Suárez; George Theodoropoulos; Sebastiano Biondo; Regina G H Beets-Tan; Geerard L Beets Journal: Lancet Oncol Date: 2010-08-06 Impact factor: 41.316
Authors: Mark S Roh; Linda H Colangelo; Michael J O'Connell; Greg Yothers; Melvin Deutsch; Carmen J Allegra; Morton S Kahlenberg; Luis Baez-Diaz; Carol S Ursiny; Nicholas J Petrelli; Norman Wolmark Journal: J Clin Oncol Date: 2009-09-21 Impact factor: 44.544
Authors: David Sebag-Montefiore; Richard J Stephens; Robert Steele; John Monson; Robert Grieve; Subhash Khanna; Phil Quirke; Jean Couture; Catherine de Metz; Arthur Sun Myint; Eric Bessell; Gareth Griffiths; Lindsay C Thompson; Mahesh Parmar Journal: Lancet Date: 2009-03-07 Impact factor: 79.321