| Objective: Neoadjuvant chemoradiotherapy(CRT)was recommended for patients with local advanced rectal cancer(LARC)by National Comprehensive Cancer Network(NCCN)guidelines.It was benefit to decrease the risk of local recurrence and increase the rate of sphincter-preserving.Tumor regression grade(TRG)was proposed to evaluate the reaction of neoadjuvant CRT.However,lymph node statues acting as an important part of TNM stages were never involved.Therefore,the primary aim of the study was to discuss the risk factors relating to lymph node metastasis in rectal cancer after neoadjuvant CRT and the clinical significance.Furthermore,lymph node regression grade(LRG)taking lymph node statues into consideration was compared with TRG to find out a more accurate prognostic indicator in patients with LARC after neoadjuvant CRT followed radical surgery.Methods: 1.From Jan 2005 to Dec 2013,the clinical data of 178 patients with advanced rectal cancer underwent radical excision after neoadjuvant chemoradiotherapy in our department were reviewed retrospectively.A total of eleven clinical factors including gender,age,post-CRT CEA,post-CRT CA19-9,distance,proportion of intestinal circumference,operation,ypT stage,lymph nodes,pathologic type and TRG were studied with univariate and multivariate analyses.2.The project was a retrospective cohort study from Jan 2005 to Dec 2013.A total of 155 patients with local advanced rectal cancer who received CRT followed radical resection were included.TRG and LRG scores were based on the percentage of fibrosis and the presence of residual tumor amount according to the standard of Mandard.Then the scores of TRG and LRG in each specimen were recorded respectively.The impacts of TRG and LRG on survival and recurrence were analyzed.Multivariate analysis was performed using Cox proportional hazard models for mortality and recurrence.Results: 1.A total of 178 patients with rectal cancer after neoadjuvant CRT including in the study.There were 74 cases had lymph node metastasis,while 104 cases with no lymph node metastasis.Univariate analysis showed that age(P=0.001)?post-CRT CEA level(P=0.0112)?ypT stage(P<0.0001)?pathologic type(P=0.004)?TRG(P=0.0338)were significantly associated with lymph node metastasis.Multivariate analysis showed that age(OR=2.428,95%CI 1.407,4.191,P=0.0014)?post-CRT CEA level(OR=2.366,95%CI 1.047,5.347,P=0.0385)and ypT stage(OR=2.951,95%CI 1.424,6.114,P=0.0036)were independent risk factors of yp N stage.In addition,15.8% patients who achieved pathological complete response(pCR)still developed lymph node metastasis,indicating that TRG was not an independent risk factor associated with lymph node metastasis in rectal cancer after neoadjuvant CRT.2.A total of 155 patients completed long-course preoperative CRT followed radical resection and formed the basis of the study.There were 63 patients having lymph metastasis while 92 patients were not.Overall,51(32.9%)patients suffered recurrence(local or distant),and 34(21.9%)patients died during follow up.The 5-year overall survival(OS)was 66.1% and 5-year disease free survival(DFS)was 59.5%.Both TRG and LRG could be the predictor of prognosis in patients with LARC after neoadjuvant CRT.Influenced by ypN stages,TRG scores of all patients had no significance in OS and DFS.Of the 92 patients with ypN0,TRG had significant difference in DFS(P=0.01),however,with no significance in OS(P=0.07).LRG excepting LRG0 had significant difference in OS(P=0.001)and DFS(P=0.04).Furthermore,LRG was found to be an independent risk factor for mortality(Hazard Ratio 1.533,95%CI 1.223-1.922;P=0.0002)and recurrence(Hazard Ratio 1.278,95%CI 1.061-1.539;P=0.01).Conclusions: 1.Treatments without radical resection should be particularly choosy for patients with rectal cancer who achieved clinical complete response after neoadjuvant CRT.2.TRG was found to be a potential predictor for outcomes in patients without lymph node metastasis.However,LRG could provide more accurate prediction to prognosis in patients with LARC after neoadjuvant CRT. |
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