Pathologic response following treatment for locally advanced rectal cancer: Does location matter?
| Autor: | William H. Ward, Andrew C. Esposito, Brian Wernick, Eric C. Sorenson, Jeffrey M. Farma, Elin R. Sigurdson, Karen Ruth, Samuel M. Manstein |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Colorectal cancer medicine.medical_treatment Rectum Article 03 medical and health sciences 0302 clinical medicine Outcome Assessment Health Care medicine Rectal Adenocarcinoma Humans Prospective Studies Stage (cooking) Neoadjuvant therapy Aged Neoplasm Staging Aged 80 and over Rectal Neoplasms business.industry Cancer Middle Aged medicine.disease Combined Modality Therapy Total mesorectal excision Logistic Models medicine.anatomical_structure 030220 oncology & carcinogenesis Anal verge Female 030211 gastroenterology & hepatology Surgery Radiology business |
| Zdroj: | J Surg Res |
| ISSN: | 0022-4804 |
| DOI: | 10.1016/j.jss.2017.11.072 |
| Popis: | Background Despite advances in the treatment of rectal adenocarcinoma, the management of locally advanced disease remains a challenge. The standard of care for patients with stages II and III rectal cancer includes neoadjuvant chemoradiation followed by total mesorectal excision and postoperative chemotherapy. Much effort has been dedicated to the identification of predictive factors associated with pathologic complete response (pCR). The aim of our study was to examine our institutional experience and determine whether any association exists between anatomic tumor location and the rate of pCR. We hypothesized that lesions more than 6 cm from the anal verge are more likely to achieve a pCR. Methods Using data from our prospectively maintained tumor registry, a query was completed to identify all patients with locally advanced rectal adenocarcinoma who underwent treatment at Fox Chase Cancer Center from 2002 to 2015. Demographics, pretreatment, posttreatment, and final pathologic TNM staging data were collected as well as treatment intervals in days, recurrence status, overall survival, and disease-free survival. Patients with incomplete endoscopic data, staging information, survival, or recurrence status were excluded. The primary outcome measured was the degree of pathologic response. Logistic regression was used to adjust for covariates. Results Of the 135 patients eligible in the study cohort, 39% were female and 61% were male. Regarding initial clinical stage, 43% were stage II and 57% were stage III. A total of 29% had a pCR, 43% had partial pathologic response, and 28% had no response to neoadjuvant treatment. Tumor location ranged from 0 to 13 cm from the anal verge. Longitudinal tumor length was recorded in 111 patients, facilitating the calculation of mean tumor distance from the anal verge. This ranged from 0 to 15.5 cm. Univariate and multivariable analyses were completed using pCR as a primary outcome. No statistically significant difference was noted based on tumor location, regardless of measurement approach. Conclusions Anatomic location of cancer of the rectum does not affect pCR after neoadjuvant therapy and subsequent surgical resection. |
| Databáze: | OpenAIRE |
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