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International Journal of Colorectal Disease

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Open Access 01-12-2024 | Rectal Cancer | RESEARCH

Downstaging after preoperative chemoradiation for locally advanced rectal cancer is associated with better survival than pathologic stage 0–1 disease treated with upfront surgery

Authors: Eli Kasheri, Avo Artinyan, Kimberly Oka, Ruoyan Zhu, Natalie Seiser, Mihran Shirinian, Moshe Barnajian, Jason Cohen, Joshua Ellenhorn, Yosef Nasseri

Published in: International Journal of Colorectal Disease | Issue 1/2024

Abstract

Background and objectives

It is unknown how patients with locally advanced rectal cancer with significant response to preoperative radiotherapy/chemoradiotherapy fare relative to patients with true pathologic 0–1 disease undergoing upfront surgery. We aimed to determine whether survival is improved in locally advanced rectal cancer downstaged to pathologic stage 0–1 disease compared to true pathologic stage 0–1 tumors.

Methods

A retrospective review of the National Cancer Database between 2004 and 2016 was conducted. Three groups were identified: (1) clinical stage 2–3 disease downstaged to pathologic stage 0–1 disease after radiotherapy, (2) clinical stage 2–3 disease not downstaged after radiotherapy, and (3) true pathologic 0–1 tumors undergoing upfront surgery. The primary endpoint was overall survival and was compared using Kaplan–Meier and multivariate Cox regression analyses.

Results

The study population consisted of 59,884 patients. Of the 40,130 patients with locally advanced rectal cancer treated with preoperative radiation, 12,670 (31.5%) had significant downstaging (group 1), while 27,460 (68.4%) had no significant downstaging (group 2). A total of 19,754 had pathologic 0–1 disease treated with upfront resection (group 3). On Kaplan–Meier analysis, downstaged patients had significantly better overall survival compared to both non-downstaged and true pathologic stage 0–1 patients (median 156 vs. 99 and 136 months, respectively, p < 0.001). On multivariate analysis, downstaged patients had significantly better survival (HR 0.88, p < 0.001) compared to true pathologic 0–1 patients.

Conclusions

Locally advanced rectal cancer downstaged after preoperative radiotherapy has significantly better survival compared to true pathologic stage 0–1 disease treated with upfront surgery. Response to chemoradiotherapy likely identifies a subset of patients with a particularly good prognosis.

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Title: Downstaging after preoperative chemoradiation for locally advanced rectal cancer is associated with better survival than pathologic stage 0–1 disease treated with upfront surgery
Authors: Eli Kasheri
Avo Artinyan
Kimberly Oka
Ruoyan Zhu
Natalie Seiser
Mihran Shirinian
Moshe Barnajian
Jason Cohen
Joshua Ellenhorn
Yosef Nasseri
Publication date: 01-12-2024
Publisher: Springer Berlin Heidelberg
Keywords: Rectal Cancer
Rectal Cancer
Published in: International Journal of Colorectal Disease / Issue 1/2024
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-023-04589-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Downstaging after preoperative chemoradiation for locally advanced rectal cancer is associated with better survival than pathologic stage 0–1 disease treated with upfront surgery

Abstract

Background and objectives

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background and objectives

Methods

Results

Conclusions

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