Endoscopic assessment of tumor regression after preoperative chemoradiotherapy as a prognostic marker in locally advanced rectal cancer.

PURPOSE: This study was designed to evaluate tumor regression endoscopic criteria for predicting the post-chemoradiotherapy (CRT) prognosis of patients with locally advanced rectal cancer.

MATERIAL AND METHODS: A total of 425 patients with rectal cancer who received radical surgery after CRT were included in this study. All patients were divided into two groups according to post-CRT preoperative endoscopic findings: 1) good response (E-GR): scar, telangiectasia, or erythema; 2) minimal or no response (E-MR): nodules, ulcers, strictures, or remnant tumor. Cox proportional hazard models were used to analyze the effect of preoperative clinicopathological variables on disease-free survival (DFS) and overall survival (OS).

RESULTS: The independent prognostic factors for DFS were tumor location less than 5 cm from anal verge (hazard ratio [HR] 1.92, 95% confidence interval [CI] 1.27 to 2.88), pre-CRT carcinoembryonic antigen (CEA) > 5 ng/mL (HR 2.10, 95% CI 1.41 to 3.14), histologic high grade (HR 2.96, 95% CI 1.51 to 5.81), and E-GR (HR 0.26, 95% CI 0.08 to 0.83). The independent prognostic factors for OS were age over 65 years, tumor location, pre-CRT CEA, histologic grade, and E-GR (HR 0.13, 95% CI 0.02 to 0.99).

CONCLUSIONS: Post-CRT endoscopic findings were predictors of prognosis in patients with rectal cancer. If endoscopic findings are simultaneously used with certain preoperative prognostic factors, rectal cancer patients will potentially have more treatment options.