Predictive factors of disease-free survival after complete pathological response to neoadjuvant radiotherapy for rectal adenocarcinoma: retrospective case series

Amine Souadka, Mohammed Anass Majbar, Amine Benkabbou, Badr Serji, Tarik Souiki, Sidi Mohammed Bouchentouf, Mourad Abid, Basma El Khannousi, Tijani El Harroudi, Hadj Omar El Malki, Mohammed Raiss, Lahsen Ifrine, Khalid Mazaz, Aziz Zentar, Raouf Mohsine, Abdelilah Souadka, Abdelkader Belkouchi, Mohammed Ahallat, Abdelmalek Hrora, Moroccan Society of Surgery, Amine Souadka, Mohammed Anass Majbar, Amine Benkabbou, Badr Serji, Tarik Souiki, Sidi Mohammed Bouchentouf, Mourad Abid, Basma El Khannousi, Tijani El Harroudi, Hadj Omar El Malki, Mohammed Raiss, Lahsen Ifrine, Khalid Mazaz, Aziz Zentar, Raouf Mohsine, Abdelilah Souadka, Abdelkader Belkouchi, Mohammed Ahallat, Abdelmalek Hrora, Moroccan Society of Surgery

Abstract

Background: Many data suggest that patients with low rectal adenocarcinoma who achieved ypT0N0 status have improved survival and disease-free survival (DFS) compared to all other stages however only few data are available regarding the specific prognosis factors of this subgroup. This study aimed to evaluate predictive factors for disease free survival after complete pathological response (CPR) in cases of low rectal adenocarcinoma.

Materials and methods: From January 2005 to December 2013, all patients with low rectal adenocarcinoma who underwent neoadjuvant chemoradiotherapy followed by total mesorectal excision and achieved CPR were included at 7 Moroccan and 1 Algerian centres. Predictive factors for disease-free survival were analysed by uni and multivariate analysis.

Results: Eigthy-four (12.1%) patients achieved a CPR (ypT0N0). Multivariate analysis revealed that both poorly differentiated tumors (OR, 9.23; 95 CI 1.35-62.82; P = 0.023) and the occurrence of perineal sepsis (OR, 13.51; 95 CI 1.96-93.12; P = 0.008) were independently associated with impaired DFS.

Conclusions: Patients with low rectal cancer who exhibited a CPR after neoadjuvant therapy have good prognoses; however, the occurrence of perineal sepsis and/or poor initial differentiation may be associated with impaired DFS in these patients.

Trial registration: The study was retrospectively registered the 28th July 2018 in ClinicalTrials.gov register with the reference NCT03601689.

Keywords: Complete pathological response; Disease-free survival; Neoadjuvant treatment; Predictive factors; Rectal neoplasm.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Kaplan-Meier analysis of Disease free survival in patients with CPR according to the occurrence of perineal sepsis
Fig. 2
Fig. 2
Kaplan-Meier analysis of Disease free survival in patients with CPR according to the pretherapeutic histologic differentiation

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