Background: Stage II rectal cancer (pT3-4N0) comprises a considerably heterogenous group of patients in terms of disease recurrence and long-term survival. Therefore, several pathological and molecular features have been associated with poor prognosis among these patients and may ultimately be used for adjuvant therapy recommendations. However, neoadjuvant CRT has been considered the preferred initial treatment strategy for distal rectal. This neoadjuvant approach leads to significant tumor downstaging and may ultimately influence pathological features in this subgroup of patients and difficult identification of “high risk” patients. The purpose of this study was to determine clinico-patholgical features associated with increased risk of recurrence development in stage rectal cancer after neoadjuvant CRT and radical surgery.
Methods: Patients with non-metastatic distal rectal cancer who underwent neoadjuvant CRT (50.4Gy and 5FU/Leucovorin) followed by radical surgery (TME) were eligible for the study. All patients with ypT3-4N0 rectal cancer managed by neoadjuvant CRT and radical surgery were retrospectively reviewed in order to determine risk factors for recurrent disease by univariate and multivariate analysis.
Results: 435 patients with distal rectal cancer managed by neoadjuvant CRT were included in the study. Overall, 108 patients had ypT3-4N0 rectal cancer after radical surgery and TME. None of the clinical (age, gender, initial disease staging, distance from anal verge or initial tumor size) or pathological findings (ypT, tumor grade, final tumor size, mucinous component, number of recovered nodes, perineural invasion and vascular invasion) were associated with increased risk for recurrent disease (p>0.05).
Conclusions: Current recommended high risk features for stage II rectal cancer should not be considered in management decision of these patients in regards to additional therapy after neoadjuvant CRT and radical surgery.