Down-staging depth score to predict outcome
Objective:Prognosis of patients with locally advanced rectal cancer(LARC)but achieving yp T1–2N0 stage after neoadjuvant concurrent chemo-radiotherapy(CRT)has been shown to be study aims to determine whether the long-term outcome of yp T1–2N0 cases can be comparable to that of p T1–2N0 cohort that received definitive surgery for early :From January 2008 to December 2013,449 consecutive patients with rectal cancer were treated and their outcome maintained in a with LARC underwent total mesorectal excision(TME)surgery at4–8 weeks after completion of CRT,and those achieving stage yp I were identified as a group.As a comparison,stage p I group pertains to patients whose initially limited disease was not upstaged after TME surgery propensity score matching(PSM),comparisons of local regional control(LC),distant metastasis-free survival(DMFS),disease-free survival(DFS)and overall survival(OS)were performed using Kaplan-Meier analysis and log-rank test between yp I and p I depth score(DDS),a novel method of evaluating CRT response,was used for subset :Of the 449 patients,168 matched cases were generated for LC,DMFS,DFS and OS for stage p I vs.yp I groups were 96.7%vs.96.4%(P=0.796),92.7%vs.73.6%(P=0.025),91.2%vs.73.6%(P=0.080)and 93.1%vs.72.3%(P=0.040), the DDS-favorable subset of the yp I group,LC,DMFS,DFS and OS resulted in no significant differences in comparison with the p I group(P=0.384,0.368,0.277 and0.458,respectively).Conclusions:LC was comparable in both groups;however,distant metastasis developed more frequently in down-staged LARC than de novo early stage cases,reflecting the need to improve the efficacy of systemic treatment despite excellent pathologic can be an indicator to identify a subset of the yp I group whose longterm oncologic outcomes are as good as those of stage p I cohort.
