Long-term outcomes in patients with locally advanced rectal cancer treated with preoperative chemoradiation followed by curative surgical resection

Objective To determine the oncologic outcomes and clinical factors affecting survival in patients with locally advanced rectal cancer who underwent preoperative chemoradiotherapy (CRT) followed by curative surgical resection. Methods : We retrospectively analyzed outcomes in 581 patients who underwent preoperative CRT for advanced rectal cancer (T3/4 or node positive) followed by curative resection. All patients received preoperative radiation to the entire pelvis, at a total dose of 4550.4?Gy in 2025 fractions for 45 weeks, and 569 (97.9%) patients received concurrent chemotherapy with a 5-FU based agent. All patients underwent a curative proctectomy, including total mesorectal excision, a median 6 weeks later, and 432 (74.4%) patients underwent sphincter-saving surgery. Oncologic outcomes, including survival and recurrence, were evaluated according to pathologic parameters, and factors affecting survival were investigated. Results The 5-year disease-free and overall survival rates were 72.4% and 77.8%, respectively. Eighty-nine patients (15.3%) had a pathologic complete response. Multivariate analysis showed that ypN category independently affected 5-year overall survival rates (ypN0 88.0%; ypN1 55.1%; ypN2 47.1%; P?<?0.001). Factors independently affecting 5-year disease-free survival (DFS) rates included ypN category (ypN0 84.5%; ypN1 44.2%; ypN2 34.9%; P?<?0.001), tumor regression grade (TRG1 52.9%; TRG2 72.0%; TRG3 86.7%; TRG4 86.8%; P?=?0.004) and surgical method (sphincter-saving 76.3%; sphincter sacrificing 61.7%; P?=?0.005). Conclusion Less advanced pathologic N-stage is a significantly favorable prognostic factor for disease-free and overall survival, with good response and sphincter saving surgery benefiting DFS. J. Surg. Oncol. 2012; 106:659666. (c) 2012 Wiley Periodicals, Inc.