Abstract:Background:The pTNM staging system is widely recognized as the most effective prognostic indicator for cancer.The latest update of this staging system introduced a new pathological staging system(ypTNM)for pa...Abstract:Background:The pTNM staging system is widely recognized as the most effective prognostic indicator for cancer.The latest update of this staging system introduced a new pathological staging system(ypTNM)for patients receiving neoadjuvant chemoradiotherapy(NACRT).However,whether the prognostic value of the ypTNM staging system for rectal cancer is similar to that of the pTNM staging system remains unclear.This study was conducted to compare the ypTNM and pTNM staging systems in terms of their prognostic value for patients with nonmetastatic rectal cancer undergoing proctectomy.Material and Methods:This study was conducted at a large teaching hospital.Between January 2014 and December 2022,542 patients with rectal cancer were analyzed(median follow-up period,60 months;range,6–105 months).Of them,258 and 284 were included in the pTNM and ypTNM groups,respectively.Inverse probability of treatment weighting(IPTW)was performed to account for the effects of confounders.Cox proportional-hazards regression was performed for the between-group comparison of overall survival(OS).Results:The crude model revealed that OS was similar between the two groups(p=0.607).After performing IPTW,we found that patients with the same ypTNM-and pTNM-classified stages had similar overall survival(hazard ratio=1.15;95%CI=0.76–1.73;p=0.5074).Conclusions:For patients with rectal cancer who have received preoperative NACRT,the prognostic value of ypTNM staging appears to be similar to that of pTNM staging,mostly because of the downstaging effect of neoadjuvant chemoradiotherapy。展开更多
S versitCattolica del Sacro Cuore-Poclinico A.Gemelli,Largo A.Gemelli,8,00168 Rome,ItalyAbstract:PURPOSE:This study was designed to evaluate long-term outcome in locally advanced resectable extraperitoneal rectal ca...S versitCattolica del Sacro Cuore-Poclinico A.Gemelli,Largo A.Gemelli,8,00168 Rome,ItalyAbstract:PURPOSE:This study was designed to evaluate long-term outcome in locally advanced resectable extraperitoneal rectal cancer treated by preoperative radiochemotherapy.METHODS:Eighty-three consecutive patients who developed locally advanced resectable extraperitoneal rectal cancer underwent preoperative concomitant radiochemothe-rapy followed by surgery,including total mesorectal excision.RESULTS:Median follow-up was 108(range,10-169)months.The living patients underwent complete follow-up of,at least,nine years.Fourteen patients developed local recurrence.The time to detection was longer than two years in eight cases and longer than five years in four.Twenty-one patients developed metastases,19 within the first five years from surgery.At the univariate analysis,clinical stage at presentation,lymph node involvement at clinical restaging after neoadjuvant therapy,and pT and pN stage were found positively correlated to the incidence of metastases.At the multivariate analysis,the only factors which confirmed a positive correlation were pT stage and pN stage.The actuarial overall survival at five,seven,and ten years was 75.5,67.8,and 60.4 percent,respectively.The same figures for cancer-related survival were 77.9,70,and 65.8 percent.At the univariate analysis,factors directly correlated with worse survival were:TNM stage at clinical restaging after neoadjuvant therapy(in particular lymph node involvement)pTNM,pT,and pN.At the multivariate analysis the only factors that confirmed a correlation with worse survival were pTNM,pT,and pN.CONCLUSIONS:Long-term follow-up allows to individuate 28 percent of all local relapses after the first five years from surgery.Postoperative stage is highly predictive of prognosis.展开更多
基金supported by grants through funding from the National Science and Technology Council(MOST 111-2314-B-037-070-MY3,NSTC 112-2314-B-037-090,NSTC 112-2314-B-037-050-MY3)the Ministry of Health and Welfare(12D1-IVMOHW02)and funded by the Health and Welfare Surcharge of on Tobacco Products,and the Kaohsiung Medical University Hospital(KMUH112-2R37,KMUH112-2R38,KMUH112-2R39,KMUH112-2M27,KMUH112-2M28,KMUH112-2M29,KMUH-SH11207)Kaohsiung Medical University Research Center Grant(KMU-TC112A04).
文摘Abstract:Background:The pTNM staging system is widely recognized as the most effective prognostic indicator for cancer.The latest update of this staging system introduced a new pathological staging system(ypTNM)for patients receiving neoadjuvant chemoradiotherapy(NACRT).However,whether the prognostic value of the ypTNM staging system for rectal cancer is similar to that of the pTNM staging system remains unclear.This study was conducted to compare the ypTNM and pTNM staging systems in terms of their prognostic value for patients with nonmetastatic rectal cancer undergoing proctectomy.Material and Methods:This study was conducted at a large teaching hospital.Between January 2014 and December 2022,542 patients with rectal cancer were analyzed(median follow-up period,60 months;range,6–105 months).Of them,258 and 284 were included in the pTNM and ypTNM groups,respectively.Inverse probability of treatment weighting(IPTW)was performed to account for the effects of confounders.Cox proportional-hazards regression was performed for the between-group comparison of overall survival(OS).Results:The crude model revealed that OS was similar between the two groups(p=0.607).After performing IPTW,we found that patients with the same ypTNM-and pTNM-classified stages had similar overall survival(hazard ratio=1.15;95%CI=0.76–1.73;p=0.5074).Conclusions:For patients with rectal cancer who have received preoperative NACRT,the prognostic value of ypTNM staging appears to be similar to that of pTNM staging,mostly because of the downstaging effect of neoadjuvant chemoradiotherapy。
文摘S versitCattolica del Sacro Cuore-Poclinico A.Gemelli,Largo A.Gemelli,8,00168 Rome,ItalyAbstract:PURPOSE:This study was designed to evaluate long-term outcome in locally advanced resectable extraperitoneal rectal cancer treated by preoperative radiochemotherapy.METHODS:Eighty-three consecutive patients who developed locally advanced resectable extraperitoneal rectal cancer underwent preoperative concomitant radiochemothe-rapy followed by surgery,including total mesorectal excision.RESULTS:Median follow-up was 108(range,10-169)months.The living patients underwent complete follow-up of,at least,nine years.Fourteen patients developed local recurrence.The time to detection was longer than two years in eight cases and longer than five years in four.Twenty-one patients developed metastases,19 within the first five years from surgery.At the univariate analysis,clinical stage at presentation,lymph node involvement at clinical restaging after neoadjuvant therapy,and pT and pN stage were found positively correlated to the incidence of metastases.At the multivariate analysis,the only factors which confirmed a positive correlation were pT stage and pN stage.The actuarial overall survival at five,seven,and ten years was 75.5,67.8,and 60.4 percent,respectively.The same figures for cancer-related survival were 77.9,70,and 65.8 percent.At the univariate analysis,factors directly correlated with worse survival were:TNM stage at clinical restaging after neoadjuvant therapy(in particular lymph node involvement)pTNM,pT,and pN.At the multivariate analysis the only factors that confirmed a correlation with worse survival were pTNM,pT,and pN.CONCLUSIONS:Long-term follow-up allows to individuate 28 percent of all local relapses after the first five years from surgery.Postoperative stage is highly predictive of prognosis.
