Predictive Factors of Pathologic Complete Response After Neoadjuvant Chemoradiation for Rectal Cancer

Objective: This study evaluates factors associated with a pathologic complete response (pCR) after neoadjuvant chemoradiation for rectal cancer Summary Background Data: Approximately 2004 of rectal cancer patients undergoing neoadjuvant chemoradiation achieve pCR, which has been associated with decreased local recurrence and improved recurrence-free survival Means of predicting pCR remain incompletely defined Methods: A total of 306 consecutive patients with stage II or stage III rectal cancer who underwent neoadjuvant chemoradiation then surgery between 1997 and 2007 were identified from a single-institution Sixty-four patients with concurrent inflammatory bowel disease, bereditary colorectal cancer, other malignancy, urgent surgery, incomplete chemoradiation, or insufficient data were excluded All patients received neoadjuvant 5-FU-based chemotherapy and external beam radiation Histologic response was categorized as pCR or not-pCR, which defined the 2 study cohorts. Variables were analyzed by univariate and multivariate analysis with pCR as the dependent variable Fisher exact test, chi(2). Wilcoxon rank-sum, and logistic regression were used for analysis. P < 0.05 was considered statistically significant Results: Of the total patients, 242 were studied. including 58 (24%) that achieved pCR The 2 groups were statistically similar in terms of age, gender. body mass index, tumor differentiation, radiation dose. and pretreatment stage On multivariate analysis, an interval :8 weeks between treatment completion and surgical resection was significantly associated with a higher rate of pCR, which correlated with decreased local recurience and improved overall survival. Conclusion: Despite traditional beliefs that certain patient and tumor factors influence pCR, an extended interval between completion of neoadjuvant therapy and surgery was the single most important determinant in achieving a pCR.