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Does total regression of primary rectal cancer after preoperative chemoradiotherapy represent “no tumor” status?

Annals of Surgical Treatment and Research 2019년 96권 2호 p.78 ~ 85
 ( Jeong Seong-A ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery

 ( Park In-Ja ) - University of Ulsan College of Medicine Asan Medical Center Department of Colon and Rectal Surgery
 ( Hong Seung-Mo ) - University of Ulsan College of Medicine Asan Medical Center Department of Pathology
 ( Bong Jun-Woo ) - University of Ulsan College of Medicine Asan Medical Center Department of Colon and Rectal Surgery
 ( Choi Hye-Yoon ) - University of Ulsan College of Medicine Asan Medical Center Department of Colon and Rectal Surgery
 ( Seo Ji-Hyun ) - University of Ulsan College of Medicine Asan Medical Center Department of Colon and Rectal Surgery
 ( Kim Hyong-Eun ) - University of Ulsan College of Medicine Asan Medical Center Department of Colon and Rectal Surgery
 ( Lim Seok-Byung ) - University of Ulsan College of Medicine Asan Medical Center Department of Colon and Rectal Surgery
 ( Yu Chang-Sik ) - University of Ulsan College of Medicine Asan Medical Center Department of Colon and Rectal Surgery
 ( Kim Jin-Cheon ) - University of Ulsan College of Medicine Asan Medical Center Department of Colon and Rectal Surgery

Abstract

Purpose: Insistence that total regression of primary tumor would not represent long-term oncologic outcomes has been raised. Therefore, this study aimed to evaluate the outcomes of these patients after preoperative chemoradiotherapy (PCRT) and radical surgery and to evaluate the associated risk factors.

Methods: We included 189 patients with rectal cancer who showed total regression of the primary tumor after PCRT, followed by radical resection, between 2001 and 2012. Recurrence-free survival (RFS) was calculated using the Kaplan-Meier method, and the results were compared with 77 patients with Tis rectal cancer who received only radical resection. Factors associated with RFS were evaluated using Cox regression analysis.

Results: Sphincter-saving resection was performed for 146 patients (77.2%). Adjuvant chemotherapy was administered to 168 patients (88.9%). During the follow-up period, recurrence occurred in 17 patients (9%). The 5-year RFS was 91.3%, which was significantly lower than that of patients with Tis rectal cancer without PCRT (P = 0.005). In univariate analysis, preoperative CEA and histologic differentiation were associated with RFS. However, no factors were found to be associated with RFS.

Conclusion: RFS was lower in patients with total regression of primary rectal cancer after PCRT than in those with Tis rectal cancer without PCRT, and it would not be considered as the same entity with early rectal cancer or “disappeared tumor” status.

키워드

Rectal neoplasm; Chemoradiotherapy; Total regression; Recurrence
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