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©The Author(s) 2016.
World J Gastrointest Oncol. Sep 15, 2016; 8(9): 695-706
Published online Sep 15, 2016. doi: 10.4251/wjgo.v8.i9.695
Published online Sep 15, 2016. doi: 10.4251/wjgo.v8.i9.695
Table 1 Demographic and clinical characteristics of patients
Group I (n = 45) | Group II (n = 42) | P value | |
Age (mean ± SD) | 53.7 ± 13.4 | 58 ± 13.2 | 0.82 |
Sex (male/female) | 32/13 | 31/11 | 0.62 |
Localization of tumor from the anal verge (cm) (mean ± SD) | 5.6 ± 3 | 6.1 ± 2.8 | 0.39 |
T stage (2-4) | 8/28/9 | 6/32/4 | 0.56 |
Stage (II/III) | 4/41 | 5/37 | 0.53 |
Preoperative radiation dose (Gy) (mean) | 49.5 ± 1.99 | 49.5 ± 2 | 0.78 |
Follow-up time (mo) (mean ± SD) | 37.2 ± 19.6 | 31.1 ± 20.7 | 0.51 |
Table 2 Effect of interval time on the perioperative variables n (%)
Group I | Group II | P value | |
(n = 45) | (n = 42) | ||
Procedure type | |||
LAR | 28 (62.2) | 31 (73.8) | 0.06 |
ULAR | 11 (24.4) | 7 (16.7) | 0.09 |
APR | 6 (13.3) | 4 (9.5) | 0.50 |
Diverting ileostomy | 42 (93.3) | 39 (92.9) | 0.90 |
Operative time (min) (mean ± SD) | 134.2 ± 19.9 | 133.4 ± 23.5 | 0.62 |
Intraoperative complications | 8 (8.9) | 3 (7.1) | 0.48 |
Postoperative complications | 13 (28.9) | 11 (26.1) | 0.42 |
Early postoperative mortality | 1 (2.3) | 2 (4.7) | 0.37 |
Hospital stay (d) (mean ± SD) | 11 ± 10.5 | 10 ± 9.3 | 0.32 |
Table 3 Comparison of pre- and post-treatment stages in both groups n (%)
Group I (n = 45) | Group II (n = 42) | Comparison of groups I and II | |||
Pre-treatment | Post-treatment | Pre-treatment | Post-treatment | P value | |
T stage | 0.17 | ||||
T0 | - | 9 (18.9) | - | 8 (19) | |
T1 | - | 2 (4.4) | - | 2 (4.8) | |
T2 | 8 (17.8) | 14 (31.7) | 6 (14.3) | 14 (33.4) | |
T3 | 28 (62.2) | 19 (42.8) | 32 (76.2) | 16 (38.1) | |
T4 | 9 (20) | 1 (2.2) | 4 (9.5) | 2 (4.8) | |
Stage | 0.002 | ||||
Stage 0 | - | 4 (8.9) | - | 8 (19) | |
Stage 1 | - | 11 (24.4) | - | 15 (35.7) | |
Stage 2 | 4 (8.9) | 8 (17.8) | 2 (11.9) | 11 (26.2) | |
Stage 3 | 41 (91.1) | 22 (48.9) | 37 (88.1) | 8 (19) | |
Postop LN without metastasis | 21 (46.7) | 34 (81) | 0.001 |
Table 4 Analysis of the effect of factors on pathological tumor regression grade
TRG | Relationship between demographics and TRG (p) and OR with 95%CI | Distribution and comparison of TRG rates in both groups | ||||||
Age | Sex | Tumor localization | Preop T stage | Preop stage | Group I (n = 45) | Group II (n = 42) | P value | |
% | % | |||||||
Complete response | (0.46) | (0.84) | (0.17) | (0.24) | (0.48) | (n = 4) | (n = 8) | 0.36 |
2.19, 95%CI: 0.55-8.72 | 0.54, 95%CI: 0.12-2.29 | 0.66, 95%CI: 0.15-2.92 | 1.00, 95%CI: 0.90-1.50 | 1.21, 95%CI: 0.12-11.8 | 8.9 | 19 | ||
Near complete response | (0.91) | (0.79) | (0.38) | (0.75) | (0.80) | (n = 9) | (n = 14) | 0.35 |
1.02, 95%CI: 0.37-2.79 | 1.11, 95%CI: 0.36-3.38 | 1.93, 95%CI: 0.64-5.8 | 0.50, 95%CI: 0.12-2.57 | 0.36, 95%CI: 0.10-1.51 | 20 | 33.3 | ||
Minimal response | (0.79) | (0.59) | (0.12) | (0.66) | (0.38) | (n = 12) | (n = 16) | 0.15 |
0.67, 95%CI: 0.25-1.76 | 1.25, 95%CI: 0.43-3.63 | 0.45, 95%CI: 0.16-1.20 | 2.25, 95%CI: 0.36-13.8 | 2.02, 95%CI: 0.37-10.9 | 26.7 | 38.1 | ||
Poor response | (0.48) | (0.95) | (0.11) | (0.19) | (0.70) | (n = 20) | (n = 4) | 0.002 |
0.98, 95%CI: 0.35-2.76 | 0.94, 95%CI: 0.31-2.82 | 1.65, 95%CI: 0.56-4.84 | 3.22, 95%CI: 0.92-11.2 | 1.34, 95%CI: 0.23-7.62 | 44.4 | 9.5 |
Table 5 Effect of factors on overall survival and disease-free survival
OS | DFS | |||
P value | HR with 95%CI | P value | HR with 95%CI | |
Sex | 0.61 | 0.97, 95%CI: 0.19-4.99 | 0.69 | 0.50, 95%CI: 0.46-4.46 |
Age | 0.57 | 1.01, 95%CI: 0.95-1.08 | 0.60 | 1.00, 95%CI: 0.94-1.06 |
Tumor localization | 0.53 | 0.97, 95%CI: 0.72-1.30 | 0.88 | 1.17, 95%CI: 0.80-1.70 |
Pre-treatment stage | 0.94 | 0.77, 95%CI: 0.80-7.50 | 0.45 | 0.90, 95%CI: 0.80-1.50 |
Pre-treatment T stage | 0.59 | 1.08, 95%CI: 0.21-5.48 | 0.39 | 0.39, 95%CI: 0.15-3.02 |
Post-treatment stage | 0.01 | 18.07, 95%CI: 0.60-53.9 | 0.007 | 0.82, 95%CI: 0.10-6.23 |
Post-treatment T stage | 0.13 | 0.62, 95%CI: 0.34-11.3 | 0.07 | 0.25, 95%CI: 0.19-8.54 |
Postoperative metastatic lymph node (+) | 0.001 | 0.91, 95%CI: 0.69-1.20 | 0.001 | 1.25, 95%CI: 0.93-1.67 |
Pathologic TRG | 0.11 | 0.90, 95%CI: 1.28-6.35 | 0.04 | 1.19, 95%CI: 0.17-8.41 |
Table 6 Studies comparing the effects of the interval periods between neoadjuvant therapy and surgery on oncological outcome in locally advanced rectal cancer
Ref. | Total no. of patients | Design | Interval time (wk) | pCR | Local recurrence | OS |
Francois et al[6] | 201 | Prospective, randomized | 2/6-8 | 7%/14%2 | 13%/10%2 | 69%/66%2 |
Wolthuis et al[20] | 356 | Retrospective | ≤ 7/> 7 | 16%/28%2 | 6%/3%2 | NA |
Kalady et al[21] | 306 | Prospective | < 8/≥ 8 | 16.3%/28%2 | NA | NA |
Garcia-Aguilar et al[22] | 136 | Prospective, nonrandomized | 6/11 | 18%/25%2 | NA | NA |
de Campos-Lobato et al[23] | 177 | Retrospective | < 8/≥ 8 | 16.5%/30.8%2 | 1.2%/10.5%2 | NA |
Tulchinsky et al[24] | 132 | Retrospective | ≤ 7/> 7 | 17%/35%2 | 6%/4%1 | 81%/93%2 |
Sloothaak et al[25] | 1593 | Prospective | < 13/13-14/15-16 | 10%/13%/18%1 | NA | NA |
Saglam et al[31] | 153 | Prospective, randomized | 4/8 | 19.7%/14.3%2 | 11.8%/10.3%2 | 76.5%/74.2%2 |
Rödel et al[36] | 385 | Prospective | > 6 | 10.4% | 3% | 85% |
Kerr et al[42] | 189 | Retrospective | Median 76 d | 15.9% | 21% | NA |
(6-215 d) |
- Citation: Mihmanlı M, Kabul Gürbulak E, Akgün İE, Celayir MF, Yazıcı P, Tunçel D, Bek TT, Öz A, Ömeroğlu S. Delaying surgery after neoadjuvant chemoradiotherapy improves prognosis of rectal cancer. World J Gastrointest Oncol 2016; 8(9): 695-706
- URL: https://www.wjgnet.com/1948-5204/full/v8/i9/695.htm
- DOI: https://dx.doi.org/10.4251/wjgo.v8.i9.695