Clinical Outcomes of Patients With Locally Advanced Rectal Cancer With Persistent Circumferential Resection Margin Invasion After Preoperative Chemoradiotherapy
Purpose Treatment after failure of circumferential resection margin (CRM) conversion after preoperative chemoradiotherapy (pCRT) for locally advanced rectal cancer (LARC) has not been evaluated well. We conducted a single‐center, retrospective analysis to fill this information gap. Methods From 2008...
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Korean Society of Coloproctology
2019-04-01
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| Series: | Annals of Coloproctology |
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| Online Access: | http://coloproctol.org/upload/pdf/ac-2019-04-22.pdf |
| _version_ | 1818331628094619648 |
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| author | Chang Hyun Kim Seung-Seop Yeom Hand-Duk Kwak Soo Young Lee Jae Kyun Ju Young Jin Kim Hyeong Rok Kim |
| author_facet | Chang Hyun Kim Seung-Seop Yeom Hand-Duk Kwak Soo Young Lee Jae Kyun Ju Young Jin Kim Hyeong Rok Kim |
| author_sort | Chang Hyun Kim |
| collection | DOAJ |
| description | Purpose Treatment after failure of circumferential resection margin (CRM) conversion after preoperative chemoradiotherapy (pCRT) for locally advanced rectal cancer (LARC) has not been evaluated well. We conducted a single‐center, retrospective analysis to fill this information gap. Methods From 2008 to 2016, we included 112 patients who had predictive CRM involvement on baseline magnetic resonance imaging (MRI) and who underwent surgery following pCRT for LARC. Baseline and posttreatment radiologic and clinical factors were analyzed. Results Of 493 patients with LARC, 112 had CRM involvement by baseline MRI (mrCRM). In 40 patients (35.7%), mrCRM involvement was converted as negative posttreatment CRM (ymrCRM−). Multivariate analysis showed the risk factors for persistent CRM involvement (ymrCRM+) after pCRT were extramural venous invasion (mrEMVI+) (P = 0.030) and lower tumor location (P = 0.007). In addition, persistent CRM involvement after pCRT was an independent risk factor for predicting pathologic CRM involvement. The Cox proportional hazard model showed baseline positive mrEMVI remained significant for disease-free survival (DFS) (P < 0.001). On posttreatment MRI, abdominoperineal resection (P = 0.031), intersphincteric resection (P = 0.006), and persistent CRM involvement (P = 0.001) remained significant for local recurrence-free survival. With regard to DFS, persistent CRM involvement (P = 0.048) and positive EMVI on posttreatment MRI (ymrEMVI) (P = 0.014) were significant. In the patient subgroup with persistent CRM involvement, 5-year DFS in patients with mrEMVI and ymrEMVI was 29.8% and 21.2%, respectively. Conclusion Patients who fail to convert to negative CRM have extremely poor oncologic outcomes. Lower tumor height and negative mrEMVI status were good responders to ymrCRM conversion. Our results suggest that these patients require a more intensive treatment modality. |
| first_indexed | 2024-12-13T13:22:52Z |
| format | Article |
| id | doaj.art-780e71ec47134949879233748d85409b |
| institution | Directory Open Access Journal |
| issn | 2287-9714 2287-9722 |
| language | English |
| last_indexed | 2024-12-13T13:22:52Z |
| publishDate | 2019-04-01 |
| publisher | Korean Society of Coloproctology |
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| series | Annals of Coloproctology |
| spelling | doaj.art-780e71ec47134949879233748d85409b2022-12-21T23:44:22ZengKorean Society of ColoproctologyAnnals of Coloproctology2287-97142287-97222019-04-01352728210.3393/ac.2019.04.221618Clinical Outcomes of Patients With Locally Advanced Rectal Cancer With Persistent Circumferential Resection Margin Invasion After Preoperative ChemoradiotherapyChang Hyun Kim0Seung-Seop Yeom1Hand-Duk Kwak2Soo Young Lee3Jae Kyun Ju4Young Jin Kim5Hyeong Rok Kim6 Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Gwangju, Korea Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Gwangju, Korea Department of Surgery, Chonnam National University Medical School, Gwangju, Korea Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Gwangju, Korea Department of Surgery, Chonnam National University Medical School, Gwangju, Korea Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Gwangju, Korea Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Gwangju, KoreaPurpose Treatment after failure of circumferential resection margin (CRM) conversion after preoperative chemoradiotherapy (pCRT) for locally advanced rectal cancer (LARC) has not been evaluated well. We conducted a single‐center, retrospective analysis to fill this information gap. Methods From 2008 to 2016, we included 112 patients who had predictive CRM involvement on baseline magnetic resonance imaging (MRI) and who underwent surgery following pCRT for LARC. Baseline and posttreatment radiologic and clinical factors were analyzed. Results Of 493 patients with LARC, 112 had CRM involvement by baseline MRI (mrCRM). In 40 patients (35.7%), mrCRM involvement was converted as negative posttreatment CRM (ymrCRM−). Multivariate analysis showed the risk factors for persistent CRM involvement (ymrCRM+) after pCRT were extramural venous invasion (mrEMVI+) (P = 0.030) and lower tumor location (P = 0.007). In addition, persistent CRM involvement after pCRT was an independent risk factor for predicting pathologic CRM involvement. The Cox proportional hazard model showed baseline positive mrEMVI remained significant for disease-free survival (DFS) (P < 0.001). On posttreatment MRI, abdominoperineal resection (P = 0.031), intersphincteric resection (P = 0.006), and persistent CRM involvement (P = 0.001) remained significant for local recurrence-free survival. With regard to DFS, persistent CRM involvement (P = 0.048) and positive EMVI on posttreatment MRI (ymrEMVI) (P = 0.014) were significant. In the patient subgroup with persistent CRM involvement, 5-year DFS in patients with mrEMVI and ymrEMVI was 29.8% and 21.2%, respectively. Conclusion Patients who fail to convert to negative CRM have extremely poor oncologic outcomes. Lower tumor height and negative mrEMVI status were good responders to ymrCRM conversion. Our results suggest that these patients require a more intensive treatment modality.http://coloproctol.org/upload/pdf/ac-2019-04-22.pdfrectal neoplasmschemoradiotherapyresection marginchemoradiotherapyprognostic factor |
| spellingShingle | Chang Hyun Kim Seung-Seop Yeom Hand-Duk Kwak Soo Young Lee Jae Kyun Ju Young Jin Kim Hyeong Rok Kim Clinical Outcomes of Patients With Locally Advanced Rectal Cancer With Persistent Circumferential Resection Margin Invasion After Preoperative Chemoradiotherapy Annals of Coloproctology rectal neoplasms chemoradiotherapy resection margin chemoradiotherapy prognostic factor |
| title | Clinical Outcomes of Patients With Locally Advanced Rectal Cancer With Persistent Circumferential Resection Margin Invasion After Preoperative Chemoradiotherapy |
| title_full | Clinical Outcomes of Patients With Locally Advanced Rectal Cancer With Persistent Circumferential Resection Margin Invasion After Preoperative Chemoradiotherapy |
| title_fullStr | Clinical Outcomes of Patients With Locally Advanced Rectal Cancer With Persistent Circumferential Resection Margin Invasion After Preoperative Chemoradiotherapy |
| title_full_unstemmed | Clinical Outcomes of Patients With Locally Advanced Rectal Cancer With Persistent Circumferential Resection Margin Invasion After Preoperative Chemoradiotherapy |
| title_short | Clinical Outcomes of Patients With Locally Advanced Rectal Cancer With Persistent Circumferential Resection Margin Invasion After Preoperative Chemoradiotherapy |
| title_sort | clinical outcomes of patients with locally advanced rectal cancer with persistent circumferential resection margin invasion after preoperative chemoradiotherapy |
| topic | rectal neoplasms chemoradiotherapy resection margin chemoradiotherapy prognostic factor |
| url | http://coloproctol.org/upload/pdf/ac-2019-04-22.pdf |
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