+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Recurrence Rates and Prognostic Factors in ypN Rectal Cancer After Neoadjuvant Chemoradiation and Total Mesorectal Excision



Recurrence Rates and Prognostic Factors in ypN Rectal Cancer After Neoadjuvant Chemoradiation and Total Mesorectal Excision







Neoadjuvant chemoradiation followed by surgery and adjuvant chemotherapy is typically recommended for patients with locally advanced rectal cancer. Patients with pathologically node-negative tumors have an improved prognosis, but recurrence patterns and independent prognostic factors in these patients have been incompletely characterized. Using a retrospective cohort study design, we included all rectal cancer patients treated with neoadjuvant chemoradiation and curative surgery from 1993 through 23, who had ypN tumors. We characterized recurrence rates and patterns in patients not treated with adjuvant chemotherapy. Secondarily, we compared them to patients who did receive adjuvant treatment and assessed for independent prognostic factors, using univariate and multivariable survival analyses. Overall, 324 ypN patients (ypT: n = 73; ypT1 2: n = 13; ypT3 4: n = 12) were followed for a median of 5.8 years. The risk of recurrence was associated with pathologic stage 2.7% ypT, 12.3% ypT1 2, 24.2%ypT3 4. Five-year recurrence-free survival in patients who did not receive adjuvant treatment was 1% (ypT), 84.4% (ypT1 2) and 75% (ypT3 4). There was no significant difference in 5-year recurrence-free survival between patients who did and did not receive adjuvant treatment. In multivariable analysis, pathologic stage was the factor most strongly associated with recurrence (hazard ratio 3.6 for ypT3 4 vs. ypT 2, 95% confidence interval 1.9 6.7, P < .1). The recurrence rates for selected patients with ypT 2N rectal cancer after neoadjuvant chemoradiation and total mesorectal excision are low. Although standard practice remains completion of planned postoperative adjuvant chemotherapy for all patients undergoing chemoradiation, these data suggest prospective trials may be warranted to measure the benefit of adjuvant chemotherapy in favorable subgroups, such as ypT 2N.

Please choose payment method:






(PDF emailed within 1 workday: $29.90)

Accession: 036099498

Download citation: RISBibTeXText


Related references

Recurrence rates and prognostic factors in ypN0 rectal cancer after neoadjuvant chemoradiation and total mesorectal excision. Annals of Surgical Oncology 18(13): 3666-3672, 2011

Factors associated with local recurrence after neoadjuvant chemoradiation with total mesorectal excision for rectal cancer. World Journal of Surgery 33(8): 1741-1749, 2009

Neoadjuvant chemotherapy evaluation by MRI volumetry in rectal cancer followed by chemoradiation and total mesorectal excision: Initial experience. Journal of Magnetic Resonance Imaging 38(3): 726-732, 2013

Effect of Neoadjuvant Systemic Chemotherapy With or Without Chemoradiation on Bowel Function in Rectal Cancer Patients Treated With Total Mesorectal Excision. Journal of Gastrointestinal Surgery 23(4): 800-807, 2019

Long-term oncological outcomes of robotic versus laparoscopic total mesorectal excision of mid-low rectal cancer following neoadjuvant chemoradiation therapy. Surgical Endoscopy 31(4): 1728-1737, 2017

Comparative Outcomes of Neoadjuvant Treatment Prior to Total Mesorectal Excision and Total Mesorectal Excision Alone in Selected Stage II/III Low and Mid Rectal Cancer. Annals of Surgical Oncology 23(1): 106-113, 2016

Oncologic Impact of Fewer Than 12 Lymph Nodes in Patients Who Underwent Neoadjuvant Chemoradiation Followed by Total Mesorectal Excision for Locally Advanced Rectal Cancer. Medicine 94(28): E1133, 2015

Transanal Total Mesorectal Excision Versus Laparoscopic Surgery for Rectal Cancer Receiving Neoadjuvant Chemoradiation: A Matched Case-Control Study. Annals of Surgical Oncology 23(4): 1169-1176, 2016

Neoadjuvant capecitabine and oxaliplatin followed by synchronous chemoradiation and total mesorectal excision in magnetic resonance imaging-defined poor-risk rectal cancer. Journal of Clinical Oncology 24(4): 668-674, 2006

Oncologic outcomes after neoadjuvant chemoradiation followed by curative resection with tumor-specific mesorectal excision for fixed locally advanced rectal cancer: Impact of postirradiated pathologic downstaging on local recurrence and survival. Annals of Surgery 244(6): 1024-1030, 2006

Factors associated with anastomotic recurrence after total mesorectal excision in rectal cancer patients. Journal of Surgical Oncology 99(1): 58-64, 2009

Total Mesorectal Excision Results in Low Local Recurrence Rates in Lymph Node-Positive Rectal Cancer. Diseases of the Colon & Rectum -1(1): 1, 2004

Total mesorectal excision results in low local recurrence rates in lymph node-positive rectal cancer. Diseases of the Colon and Rectum 47(7): 1145-9; Discussion 1149-50, 2004

Predictors of surgical outcomes and survival in rectal cancer patients undergoing laparoscopic total mesorectal excision after neoadjuvant chemoradiation therapy: the interest of pelvimetry and restaging magnetic resonance imaging studies. Oncotarget 9(38): 25315-25331, 2018

Risk factors for anastomotic leakage after preoperative chemoradiation therapy and low anterior resection with total mesorectal excision for locally advanced rectal cancer. Revista de Investigacion Clinica; Organo del Hospital de Enfermedades de la Nutricion 58(3): 204-210, 2006