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Radiologic and pathologic prognostic factors after neoadyuvant chemotherapy for T3 rectal cancer (RC): 3-year update GEMCAD 0801-trial.

Abstract

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Background: Prognostic factors in RC treated only with neoadjuvant chemotherapy, have not been explored. We analized the prognostic value of clinical-radiological and pathological factors for disease-free, (DFS) and cumulative incidence of distant metastases (DM), for patients treated with preoperative capecitabine, oxaliplatin and bevacizumab (CAPOX-B) within our multicentre phase II GEMCAD 0801 trial. Methods: 46 patients were enrolled to evaluate safety and efficacy of neoadjuvant CAPOX-B followed by surgery. Results have been recently published (Oncologist 2014;19:1-2). Eligibility included baseline magnetic resonance (MR) showing a T3 tumour with mesorectal fascia potentially clear. Clinical, pathologic (ypN+, T or N downstaging, tumor regression grade [TRG], pathologic complete response [pCR]) and radiologic factors both at baseline (mr extramural venous invasion [EMVI]) and post neoadjuvant chemotherapy (ymr TRG, ymr lengh change [RECIST]), were analyzed. Univariate and multivariate analysis was performed. Results: With a median follow up of 36 months, fourteen patients experienced relapse (2 local, 11 distant, 1both). 3-year DFS was 69%. It was 95%/49% for T downstaging/no T downstaging (p=0.0009) and 95%/43% for mrEMVI positive/negative (p=0.0001), respectively. ymrTRG (Mandard) ranging from no regression, TRG 5, to complete response, TRG 1, p=0.0108 and ypN0/ypN+ (p=.02) were also significantly related to DFS in univariate analysis. The same factors and N-downstaging were also significant for cumulative incidence of DM. On Cox multivariate analysis, T downstaging and mrEMVI were the only independent prognostic factors for DM ( p=0.0363 and 0.0111 respectively) and DFS (p=0.0315 and 0.0277 respectively). Conclusions: T3 rectal cancer with MR detected EMVI positive and those without downstaging after neoadjuvant chemotherapy are associated with unfavourable prognosis. This suggests that future strategies for treatment intensification and surveillance could be based on EMVI and T staging. Clinical trial information: NCT00909987.

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Journal of Clinical Oncology
Pages: 643

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Published online: January 20, 2015
Published in print: January 20, 2015

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Isidro Machado
Fundación Instituto Valenciano de Oncología, Valencia, Spain
Gina Brown
Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
Rafael Estevan
Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
Antonieta Salud
Hospital Arnau de Vilanova, Lleida, Lleida, Spain
Mabel Gil
Hospital Arnau de Villanova, Lleida, Spain
Clara Montagut
Hospital del Mar, Barcelona, Barcelona, Spain
Marcos Busto
Hospital del Mar, Barcelona, Barcelona, Spain
Maria Jose Safont
Hospital General de Valencia, Valencia, Spain
Joan Maurel
Hospital Clinic, Barcelona, Spain
Juan Ramón Ayuso
Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain
Jorge Aparicio
Hospital La Fe Oncologia Medica, Valencia, Spain
Jaime Feliu
Hospital Universitario La Paz, Madrid, Spain
Ruth Vera
Complejo Hospitalario de Navarra, Medical Oncology, Pamplona, Spain
Vicente Alonso
Hospital Universitario Miguel Servet, Zaragoza, Spain
Javier Gallego
Hospital General de Elche, Elche, Spain
Martha Martin
Hospital Santa Creu y Sant Pau, Barcelona, Spain
Carles Pericay
Hospital de Sabadell, Corporació Sanitària Parc Taulí, Sabadell, Spain
Eva Ballesteros
Corporación Sanitaria Parc Taulí, Barcelona, Spain
Jesus Santos
Fundación Instituto Valenciano de Oncología, Valencia, Spain
Carlos Fernandez-Martos
Medical Oncology Department, Fundacion Instituto Valenciano De Oncologia, Valencia, Spain
Fundación Instituto Valenciano de Oncología, Valencia, Spain; Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom; Fundacion Instituto Valenciano de Oncologia, Valencia, Spain; Hospital Arnau de Vilanova, Lleida, Lleida, Spain; Hospital Arnau de Villanova, Lleida, Spain; Hospital del Mar, Barcelona, Barcelona, Spain; Hospital General de Valencia, Valencia, Spain; Hospital Clinic, Barcelona, Spain; Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain; Hospital La Fe Oncologia Medica, Valencia, Spain; Hospital Universitario La Paz, Madrid, Spain; Complejo Hospitalario de Navarra, Medical Oncology, Pamplona, Spain; Hospital Universitario Miguel Servet, Zaragoza, Spain; Hospital General de Elche, Elche, Spain; Hospital Santa Creu y Sant Pau, Barcelona, Spain; Hospital de Sabadell, Corporació Sanitària Parc Taulí, Sabadell, Spain; Corporación Sanitaria Parc Taulí, Barcelona, Spain; Medical Oncology Department, Fundacion Instituto Valenciano De Oncologia, Valencia, Spain

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Isidro Machado, Gina Brown, Rafael Estevan, Antonieta Salud, Mabel Gil, Clara Montagut, Marcos Busto, Maria Jose Safont, Joan Maurel, Juan Ramón Ayuso, Jorge Aparicio, Jaime Feliu, Ruth Vera, Vicente Alonso, Javier Gallego, Martha Martin, Carles Pericay, Eva Ballesteros, Jesus Santos, Carlos Fernandez-Martos
Journal of Clinical Oncology 2015 33:3_suppl, 643-643

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