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KMID : 0939920180500020506
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대한암학회지
2018 Volume.50 No. 2 p.506 ~ p.517
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Redefining the Positive Circumferential Resection Margin by Incorporating Preoperative Chemoradiotherapy Treatment Response in Locally Advanced Rectal Cancer: A Multicenter Validation Study
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Lee Joo-Ho
Chie Eui-Kyu
Jeong Seung-Yong
Kim Tae-You
Kim Dae-Yong
Kim Tae-Hyun
Kim Sun-Young
Baek Ji-Yeon
Chang Hee-Jin
Kim Min-Ju
Park Sung-Chan
Oh Jae-Hwan
Kim Sung-Hwan
Lee Jong-Hoon
Choi Doo-Ho
Park Hee-Chul
Kang Sung-Bum
Kim Jae-Sung
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Abstract
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Purpose: This study was conducted to validate the prognostic influence of treatment response among patients with positive circumferential resection margin for locally advanced rectal cancer.
Materials and Methods: Clinical data of 197 patientswith positive circumferentialresection margin defined as ≤ 2 mm after preoperative chemoradiotherapy followed by total mesorectal excision between 2004 and 2009were collected forthis multicenter validation study. All patients underwent median 50.4Gy radiationwith concurrentfluoropyrimidine based chemotherapy. Treatmentresponse was dichotomized to good response, including treatmentresponse of grade 2 or 3, and poor response, including grade 0 or 1.
Results: After 52 months median follow-up, 5-year overall survival (OS) for good responders and poor responders was 79.1% and 48.4%, respectively (p < 0.001). In multivariate analysis, circumferential resection margin involvement and treatment response were a prognosticator for OS and locoregional recurrence-free survival. In subgroup analysis, good responders with close margin showed significantly better survival outcomes for survival. Good responders with involved margin and poor responders with close margin shared similar results, whereas poorresponderswith involved margin hadworst survival (5-year OS, 81.2%, 57.0%, 50.0%, and 32.4%, respectively; p < 0.001).
Conclusion: Among patients with positive circumferential resection margin after preoperative chemoradiotherapy, survival of the good responders was significantly better than poor responders. Subgroup analysis revealed that definition of positive circumferential resection margin may be individualized as involvement for good responders, whereas ≤ 2 mm for poor responders.
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KEYWORD
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Rectal neoplasms, Chemoradiotherapy, Neoadjvant therapy, Margins of excision, Treatment response
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