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  • [Cancer Res Treat.] Endoscopic criteria for evaluating tumor stage after preoperative chemoradiation therapy in locally advanced rectal cancer

    [Cancer Res Treat.] Endoscopic criteria for evaluating tumor stage after preoperative chemoradiation therapy in locally advanced rectal cancer

    국립암센터 / 한경수, 손대경*

  • 출처
    Cancer Res Treat.
  • 등재일
    2016 Apr
  • 저널이슈번호
    48(2):567-73. doi: 10.4143/crt.2015.195. Epub 2015 Sep 22.
  • 내용

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    Abstract

    PURPOSE:

    Local excision may be an another option for selected patients with markedly down-staged rectal cancer after preoperative chemoradiation therapy (CRT), and proper evaluation of post-CRT tumor stage (ypT) is essential prior to local excision of these tumors. This study was designed to determine the correlations between endoscopic findings and ypT of rectal cancer.


    MATERIALS AND METHODS:

    In this study, 481 patients with locally advanced rectal cancer who underwent preoperative CRT followed by surgical resection between 2004 and 2013 at a single institution were evaluated retrospectively. Pathological good response (p-GR) was defined as ypT ≤ 1, and pathological minimal or no response (p-MR) as ypT ≥ 2. The patients were randomly classified according to two groups, a testing (n=193) and a validation (n=288) group. Endoscopic criteria were determined from endoscopic findings and ypT in the testing group and used in classifying patients in the validation group as achieving or not achieving p-GR.

     

    RESULTS:

    Based on findings in the testing group, the endoscopic criteria for p-GR included scarring, telangiectasia, and erythema, whereas criteria for p-MR included nodules, ulcers, strictures, and remnant tumors. In the validation group, the kappa statistic was 0.965 (p < 0.001), and the sensitivity, specificity, positive predictive value, and negative predictive value were 0.362, 0.963, 0.654, and 0.885, respectively.

     

    CONCLUSION:

    The endoscopic criteria presented are easily applicable for evaluation of ypT after preoperative CRT for rectal cancer. These criteria may be used for selection of patients for local excision of down-staged rectal tumors, because patients with p-MR could be easily ruled out. 

     

    Author information

    Han KS1, Sohn DK1, Kim DY1, Kim BC1, Hong CW1, Chang HJ1, Kim SY1, Baek JY1, Park SC1,
    Kim MJ1, Oh JH1.

    1Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.

     

  • 키워드
    Chemoradiotherapy; Endoscopy; Neoadjuvant therapy; Rectal neoplasms; Response Evaluation Criteria in Solid Tumors
  • 연구소개
    수술전 화학방사선 요법은 국내에서 진행성 하부 직장암의 표준 치료법으로 자리매김 되었다. 최근, 완전 관해 (complete remission)를 보인 경우에는 근치적 절제 대신 국소 절제 만으로도 만족할만한 치료 결과를 보인다는 연구들이 보고되고 있다. 완전 관해를 보인 경우에 선택적으로 국소 절제를 시행한다면, 완전 관해 여부를 정확하게 예측할 수 있어야 한다. 그러나 수술전 화학방사선 요법후 종양 병기 예측을 위한 진단 방법으로 주로 이용되고 있는 자기공명영상 및 초음파검사 등은 그 정확도가 낮은 것으로 알려져 있다. 본 논문은 내시경 소견을 이용해서 수술전 화학방사선 요법후 종양 병기를 예측할 수 있는 새로운 방법을 제시하고 있다. 향후, 완전 관해를 보인 직장암의 국소절제가 표준 치료법으로 자리매김 된다면, 대상 환자 선택에 많은 정보를 제공할 수 있을 것으로 생각된다.
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