Risk Stratification Using Neoadjuvant Rectal Score in the Era of Neoadjuvant Chemoradiotherapy: Validation With Long-term Outcome Data
- 주제(키워드) Adjuvant chemotherapy , Neoadjuvant rectal score , Predictive value , Prognostic factors , Rectal neoplasm
- 주제(기타) Gastroenterology & Hepatology
- 주제(기타) Surgery
- 설명문(일반) [Lim, Yu Jin] Kyung Hee Univ, Med Ctr, Dept Radiat Oncol, Coll Med, Seoul, South Korea; [Song, Changhoon] Seoul Natl Univ, Bundang Hosp, Dept Radiat Oncol, Coll Med, Seongnam, South Korea; [Jeon, Seung Hyuck; Chie, Eui Kyu] Seoul Natl Univ, Dept Radiat Oncol, Coll Med, 101 Daehak Ro, Seoul 03080, South Korea; [Kim, Kyubo] Ewha Womans Univ, Dept Radiat Oncol, Coll Med, Seoul, South Korea; [Chie, Eui Kyu] Seoul Natl Univ, Inst Radiat Med, Med Res Ctr, Seoul, South Korea
- 등재 SCIE, SCOPUS
- 발행기관 LIPPINCOTT WILLIAMS & WILKINS
- 발행년도 2021
- 총서유형 Journal
- URI http://www.dcollection.net/handler/ewha/000000190868
- 본문언어 영어
- Published As https://doi.org/10.1097/DCR.0000000000001777
- PubMed https://pubmed.ncbi.nlm.nih.gov/33306532
초록/요약
BACKGROUND: Despite the widespread use of neoadjuvant chemoradiotherapy, there is no prognostic surrogate marker established in locally advanced rectal cancer. OBJECTIVE: This study evaluated the role of neoadjuvant rectal score as a prognostic factor to stratify individual-level risks of survival and tumor recurrence. DESIGN: This is a retrospective study. SETTINGS: This study was conducted at the Seoul National University Hospital. PATIENTS: A total of 397 patients who underwent chemoradiotherapy plus total mesorectal excision were analyzed. INTERVENTIONS: There was no intervention. MAIN OUTCOME MEASURES: Harrell C statistic and receiver operating characteristic analysis, as well as Cox regression analysis, were used to assess the prognostic strength. RESULTS: The low (<8), intermediate (8-16), and high (>16) neoadjuvant rectal score groups included 91 (23%), 208 (52%), and 98 patients (25%). A high neoadjuvant rectal score was independently associated with inferior overall survival and disease-free survival (p = 0.011 and 0.008). Regarding the prognostic models adjusted for neoadjuvant rectal score (I) and ypT/N stage (II), the c-index was higher in model I (0.799 and 0.787, p = 0.009 for overall survival; 0.752 and 0.743, p = 0.093 for disease-free survival). The predictive ability of the neoadjuvant rectal score was superior to tumor regression grade, ypT, and ypN in the receiver operating characteristic analyses (p < 0.05 for all). Adjuvant chemotherapy was associated with better overall and disease-free survival (p = 0.003 and 0.052) in the high neoadjuvant rectal score group. LIMITATIONS: Potential selection bias attributed to the retrospective study design was a limitation. CONCLUSIONS: We verified the applicability of the neoadjuvant rectal score to stratify the relapse risk at the individual level for patients with stage II/III rectal cancer undergoing neoadjuvant chemoradiotherapy. Additional studies are needed to validate the usability of neoadjuvant rectal score levels as a determinant of adjuvant strategy.
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