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Abstract
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.

Author information

Lee JH1, Chie EK1, Jeong SY2, Kim TY3, Kim DY4, Kim TH4, Kim SY4, Baek JY4, Chang HJ4, Kim MJ4, Park SC4, Oh JH4, Kim SH5, Lee JH5, Choi DH6, Park HC6, Kang SB7, Kim JS8.
1
Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea.
2
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
3
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
4
Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
5
Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
6
Department of Radiation Oncology, Samsung Medical Center, Sung-kyunkwan University School of Medicine, Seoul, Korea.
7
Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
8
Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Korea.