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1	Clinical criteria underestimate complete pathological response in rectal cancer treated with neoadjuvant chemoradiotherapy. Dis Colon Rectum 2014;57:311-5. [PMID: 24509452 DOI: 10.1097/dcr.0b013e3182a84eba] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Abstract BACKGROUND Published criteria define specific mucosal features of clinical complete response for rectal cancer after neoadjuvant chemoradiotherapy. OBJECTIVE The aim of this study was to determine the performance of these criteria to identify a pathological complete response. DESIGN Histopathology reports were retrieved for consecutive rectal cancers treated with neoadjuvant therapy followed by proctectomy. The mucosal appearance of residual disease was compared with the final pathological stage. SETTING This study was conducted at a single-institution, tertiary referral center. PATIENTS The study included 238 patients. INTERVENTIONS All patients underwent neoadjuvant chemoradiation followed by proctectomy between 1997 and 2007. MAIN OUTCOME MEASURES Gross mucosal appearance was compared with the final pathological stage. RESULTS Following neoadjuvant chemoradiation, 61 of 238 (25%) patients were downstaged to ypT0. Forty-five of these 61 patients (74%) had a residual mucosal abnormality that precluded assignment of a complete response. Of these, 40 had residual ulcers (up to 10 mm in depth) and 5 had exophytic lesions. The remaining 16 patients with pathological complete response fulfilled criteria for clinical complete response and had either no visible abnormality or a scar. Although mucosal complete clinical response was statistically associated with ypT0 status (p < 0.0001), 6 of 22 (27%) patients with mucosal complete clinical response still had residual disease. Smaller size of residual mucosal abnormality was also associated with ypT0 status (p = 0.002). LIMITATIONS This is a retrospective study and preoperative clinical assessment of response is not recorded for comparison to resected specimens. CONCLUSIONS The majority of patients attaining ypT0 status do not display mucosal features of complete response. When present, a mucosal complete response is statistically associated with ypT0 status, but is poorly sensitive. If rectal conservation after chemoradiation is to be pursued, alternative means of restaging are required to maximize the number who might benefit from this approach. Collapse Key Words Collapse MESH Headings Collapse Grants Collapse Affiliation(s) Collapse

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Cited by Other Article(s)

Clinical criteria underestimate complete pathological response in rectal cancer treated with neoadjuvant chemoradiotherapy. Dis Colon Rectum 2014;57:311-5. [PMID: 24509452 DOI: 10.1097/dcr.0b013e3182a84eba] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]

Abstract

BACKGROUND

Published criteria define specific mucosal features of clinical complete response for rectal cancer after neoadjuvant chemoradiotherapy.

OBJECTIVE

The aim of this study was to determine the performance of these criteria to identify a pathological complete response.

DESIGN

Histopathology reports were retrieved for consecutive rectal cancers treated with neoadjuvant therapy followed by proctectomy. The mucosal appearance of residual disease was compared with the final pathological stage.

SETTING

This study was conducted at a single-institution, tertiary referral center.

PATIENTS

The study included 238 patients.

INTERVENTIONS

All patients underwent neoadjuvant chemoradiation followed by proctectomy between 1997 and 2007.

MAIN OUTCOME MEASURES

Gross mucosal appearance was compared with the final pathological stage.

RESULTS

Following neoadjuvant chemoradiation, 61 of 238 (25%) patients were downstaged to ypT0. Forty-five of these 61 patients (74%) had a residual mucosal abnormality that precluded assignment of a complete response. Of these, 40 had residual ulcers (up to 10 mm in depth) and 5 had exophytic lesions. The remaining 16 patients with pathological complete response fulfilled criteria for clinical complete response and had either no visible abnormality or a scar. Although mucosal complete clinical response was statistically associated with ypT0 status (p < 0.0001), 6 of 22 (27%) patients with mucosal complete clinical response still had residual disease. Smaller size of residual mucosal abnormality was also associated with ypT0 status (p = 0.002).

LIMITATIONS

This is a retrospective study and preoperative clinical assessment of response is not recorded for comparison to resected specimens.

CONCLUSIONS

The majority of patients attaining ypT0 status do not display mucosal features of complete response. When present, a mucosal complete response is statistically associated with ypT0 status, but is poorly sensitive. If rectal conservation after chemoradiation is to be pursued, alternative means of restaging are required to maximize the number who might benefit from this approach.

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