Long-term outcomes in ypT0 rectal cancers: an international multi-centric investigation on behalf of Italian Society of Surgical Oncology Young Board (YSICO)

Publication date: Available online 19 May 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): Laura Lorenzon, Dario Parini, Daniela Rega, Alfredo Mellano, Vincenzo Vigorita, Alberto Biondi, Raquel Jaminez-Rosellon, Maximilian Scheiterle, Ivana Giannini, Gaetano Gallo, Graziella Marino, Luca Turati, Patrizia Marsanic, Lorenzo De Franco, Luigi Marano
AimTo investigate the outcome and pattern of survivals of rectal cancer patients presenting a complete or nearly complete tumor response after neo-adjuvant treatment.MethodsYoung surgeons <40years old affiliated to the Italian Society of Surgical Oncology (YSICO) from 13 referral centers for colorectal cancer treatment, were invited to participate a retrospective study. Records from patients treated from 2005 to 2015 with a pathological diagnosis of ypT0/ypTis were retrieved and pooled in a common data-base for statistical purposes. All clinical and pathological variables were reviewed. Univariate and multivariate analyses were conducted with the end-point of survivals.ResultsTwo hundreds and sixty-one patients were analyzed including 237 ypT0 and 24 ypTis. Nodal positive patients were 8.7%. More than sixty-six percent of the patients did not perform adjuvant chemotherapy, with a statistical difference comparing N0 versus N+ patients (66.8% vs 40.9%, p 0.02). Mean follow-up was of 47.6 months. Twenty-two relapses were observed, 91.6% at a distant site. The mean time to recurrence was of 35.3 months. On univariate analysis, the use of adjuvant chemotherapy correlated with better OS exclusively in ypT0N+ patients and not in ypT0N0. Univariate and multivariate analyses documented nodal positivity as the only prognostic factor correlated with a worse OS.ConclusionRecurrences were mostly diagnosed at a distant site and within the third year of follow-up. Nodal positivity was the only variable independently correlated with a worse OS. Univariate analysis documented a benefit for the use of adjuvant chemotherapy treatment exclusively in ypT0N+ rectal cancers.



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