Skip Navigation LinksHome > December 2010 - Volume 252 - Issue 6 > Pathologic Complete Response of Primary Tumor Following Preo...
Annals of Surgery:
doi: 10.1097/SLA.0b013e3181f3f1b1
Original Articles: ORIGINAL STUDY

Pathologic Complete Response of Primary Tumor Following Preoperative Chemoradiotherapy for Locally Advanced Rectal Cancer: Long-term Outcomes and Prognostic Significance of Pathologic Nodal Status (KROG 09-01)

Yeo, Seung-Gu MD*,†; Kim, Dae Yong MD*; Kim, Tae Hyun MD*; Chang, Hee Jin MD*; Oh, Jae Hwan MD*; Park, Won MD; Choi, Doo Ho MD; Nam, Heerim MD; Kim, Jun-Sang MD§; Cho, Moon-June MD§; Kim, Jong Hoon MD; Park, Jin-hong MD; Kang, Min Kyu MD; Koom, Woong Sub MD#; Kim, Jae-Sung MD**; Nam, Taek-Keun MD††; Chie, Eui Kyu MD‡‡; Kim, Jung Soo MD§§; Lee, Kyung-Ja MD••

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Abstract

Objective: To investigate long-term outcomes of locally advanced rectal cancer (LARC) patients with postchemoradiotherapy (post-CRT) pathologic complete response of primary tumor (ypT0) and determine prognostic significance of post-CRT pathologic nodal (ypN) status.

Background: LARC patients with post-CRT pathologic complete response were suggested to have favorable long-term outcomes, but prognostic significance of ypN status has never been specifically defined in ypT0 patients.

Methods: The Korean Radiation Oncology Group collected clinical data for 333 LARC patients with ypT0 following preoperative CRT and curative radical resections between 1993 and 2007. Sphincter preservation surgery and abdominoperineal resection were performed in 283 (85.0%) and 50 (15.0%) patients, respectively. Postoperative chemotherapy was given to 285 (85.6%) patients. Survival was estimated by the Kaplan-Meier method, and the Cox proportional hazard model was used in multivariate analyses.

Results: After median follow-up of 43 (range = 14–172) months, 5-year disease-free survival (DFS) was 84.6% and overall survival (OS) was 92.8%. The ypN status was ypT0N0 in 304 (91.3%), ypT0N1 in 22 (6.6%), and ypT0N2 in 7 (2.1%) patients. The ypN status was the most relevant independent prognostic factor for both DFS and OS in ypT0 patients. The 5-year DFS and OS was 88.5% and 94.8% in ypT0N0 patients, and 45.2% and 72.8% in ypT0N+ patients (both, P < 0.001).

Conclusions: LARC patients achieving ypT0N0 after preoperative CRT had favorable long-term outcomes, whereas positive ypN status had a poor prognosis even after total regression of primary tumor.

© 2010 Lippincott Williams & Wilkins, Inc.

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