Downstaging after preoperative chemoradiation for locally advanced rectal cancer is associated with better survival than pathologic stage 0–1 disease treated with upfront surgery

Background and objectives It is unknown how patients with locally advanced rectal cancer with significant response to preoperative radiotherapy/chemoradiotherapy fare relative to patients with true pathologic 0–1 disease undergoing upfront surgery. We aimed to determine whether survival is improved in locally advanced rectal cancer downstaged to pathologic stage 0–1 disease compared to true pathologic stage 0–1 tumors. Methods A retrospective review of the National Cancer Database between 2004 and 2016 was conducted. Three groups were identified: (1) clinical stage 2–3 disease downstaged to pathologic stage 0–1 disease after radiotherapy, (2) clinical stage 2–3 disease not downstaged after radiotherapy, and (3) true pathologic 0–1 tumors undergoing upfront surgery. The primary endpoint was overall survival and was compared using Kaplan–Meier and multivariate Cox regression analyses. Results The study population consisted of 59,884 patients. Of the 40,130 patients with locally advanced rectal cancer treated with preoperative radiation, 12,670 (31.5%) had significant downstaging (group 1), while 27,460 (68.4%) had no significant downstaging (group 2). A total of 19,754 had pathologic 0–1 disease treated with upfront resection (group 3). On Kaplan–Meier analysis, downstaged patients had significantly better overall survival compared to both non-downstaged and true pathologic stage 0–1 patients (median 156 vs. 99 and 136 months, respectively, p < 0.001). On multivariate analysis, downstaged patients had significantly better survival (HR 0.88, p < 0.001) compared to true pathologic 0–1 patients. Conclusions Locally advanced rectal cancer downstaged after preoperative radiotherapy has significantly better survival compared to true pathologic stage 0–1 disease treated with upfront surgery. Response to chemoradiotherapy likely identifies a subset of patients with a particularly good prognosis. Ausführliche Beschreibung

Gespeichert in:

Autor*in:	Kasheri, Eli [verfasserIn] Artinyan, Avo Oka, Kimberly Zhu, Ruoyan Seiser, Natalie Shirinian, Mihran Barnajian, Moshe Cohen, Jason Ellenhorn, Joshua Nasseri, Yosef

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2024

Schlagwörter:	Downstage Survival Locally advanced rectal cancer NCDB

Anmerkung:	© The Author(s) 2024

Übergeordnetes Werk:	Enthalten in: International journal of colorectal disease - Berlin : Springer, 1986, 39(2024), 1 vom: 08. Jan.
Übergeordnetes Werk:	volume:39 ; year:2024 ; number:1 ; day:08 ; month:01

Links:	Volltext

DOI / URN:	10.1007/s00384-023-04589-1

Katalog-ID:	SPR054301807

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allfields	10.1007/s00384-023-04589-1 doi (DE-627)SPR054301807 (SPR)s00384-023-04589-1-e DE-627 ger DE-627 rakwb eng Kasheri, Eli verfasserin (orcid)0000-0002-1209-7511 aut Downstaging after preoperative chemoradiation for locally advanced rectal cancer is associated with better survival than pathologic stage 0–1 disease treated with upfront surgery 2024 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2024 Background and objectives It is unknown how patients with locally advanced rectal cancer with significant response to preoperative radiotherapy/chemoradiotherapy fare relative to patients with true pathologic 0–1 disease undergoing upfront surgery. We aimed to determine whether survival is improved in locally advanced rectal cancer downstaged to pathologic stage 0–1 disease compared to true pathologic stage 0–1 tumors. Methods A retrospective review of the National Cancer Database between 2004 and 2016 was conducted. Three groups were identified: (1) clinical stage 2–3 disease downstaged to pathologic stage 0–1 disease after radiotherapy, (2) clinical stage 2–3 disease not downstaged after radiotherapy, and (3) true pathologic 0–1 tumors undergoing upfront surgery. The primary endpoint was overall survival and was compared using Kaplan–Meier and multivariate Cox regression analyses. Results The study population consisted of 59,884 patients. Of the 40,130 patients with locally advanced rectal cancer treated with preoperative radiation, 12,670 (31.5%) had significant downstaging (group 1), while 27,460 (68.4%) had no significant downstaging (group 2). A total of 19,754 had pathologic 0–1 disease treated with upfront resection (group 3). On Kaplan–Meier analysis, downstaged patients had significantly better overall survival compared to both non-downstaged and true pathologic stage 0–1 patients (median 156 vs. 99 and 136 months, respectively, p < 0.001). On multivariate analysis, downstaged patients had significantly better survival (HR 0.88, p < 0.001) compared to true pathologic 0–1 patients. Conclusions Locally advanced rectal cancer downstaged after preoperative radiotherapy has significantly better survival compared to true pathologic stage 0–1 disease treated with upfront surgery. Response to chemoradiotherapy likely identifies a subset of patients with a particularly good prognosis. Downstage (dpeaa)DE-He213 Survival (dpeaa)DE-He213 Locally advanced rectal cancer (dpeaa)DE-He213 NCDB (dpeaa)DE-He213 Artinyan, Avo (orcid)0000-0003-0353-4094 aut Oka, Kimberly aut Zhu, Ruoyan aut Seiser, Natalie (orcid)0000-0002-0950-7823 aut Shirinian, Mihran aut Barnajian, Moshe aut Cohen, Jason aut Ellenhorn, Joshua (orcid)0000-0001-8057-6488 aut Nasseri, Yosef (orcid)0000-0002-9186-5717 aut Enthalten in International journal of colorectal disease Berlin : Springer, 1986 39(2024), 1 vom: 08. Jan. (DE-627)253724244 (DE-600)1459217-4 1432-1262 nnns volume:39 year:2024 number:1 day:08 month:01 https://dx.doi.org/10.1007/s00384-023-04589-1 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_138 GBV_ILN_150 GBV_ILN_151 GBV_ILN_152 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_267 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_702 GBV_ILN_711 GBV_ILN_2005 GBV_ILN_2014 GBV_ILN_2153 GBV_ILN_2188 GBV_ILN_2190 GBV_ILN_2336 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4246 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 39 2024 1 08 01
spelling	10.1007/s00384-023-04589-1 doi (DE-627)SPR054301807 (SPR)s00384-023-04589-1-e DE-627 ger DE-627 rakwb eng Kasheri, Eli verfasserin (orcid)0000-0002-1209-7511 aut Downstaging after preoperative chemoradiation for locally advanced rectal cancer is associated with better survival than pathologic stage 0–1 disease treated with upfront surgery 2024 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2024 Background and objectives It is unknown how patients with locally advanced rectal cancer with significant response to preoperative radiotherapy/chemoradiotherapy fare relative to patients with true pathologic 0–1 disease undergoing upfront surgery. We aimed to determine whether survival is improved in locally advanced rectal cancer downstaged to pathologic stage 0–1 disease compared to true pathologic stage 0–1 tumors. Methods A retrospective review of the National Cancer Database between 2004 and 2016 was conducted. Three groups were identified: (1) clinical stage 2–3 disease downstaged to pathologic stage 0–1 disease after radiotherapy, (2) clinical stage 2–3 disease not downstaged after radiotherapy, and (3) true pathologic 0–1 tumors undergoing upfront surgery. The primary endpoint was overall survival and was compared using Kaplan–Meier and multivariate Cox regression analyses. Results The study population consisted of 59,884 patients. Of the 40,130 patients with locally advanced rectal cancer treated with preoperative radiation, 12,670 (31.5%) had significant downstaging (group 1), while 27,460 (68.4%) had no significant downstaging (group 2). A total of 19,754 had pathologic 0–1 disease treated with upfront resection (group 3). On Kaplan–Meier analysis, downstaged patients had significantly better overall survival compared to both non-downstaged and true pathologic stage 0–1 patients (median 156 vs. 99 and 136 months, respectively, p < 0.001). On multivariate analysis, downstaged patients had significantly better survival (HR 0.88, p < 0.001) compared to true pathologic 0–1 patients. Conclusions Locally advanced rectal cancer downstaged after preoperative radiotherapy has significantly better survival compared to true pathologic stage 0–1 disease treated with upfront surgery. Response to chemoradiotherapy likely identifies a subset of patients with a particularly good prognosis. Downstage (dpeaa)DE-He213 Survival (dpeaa)DE-He213 Locally advanced rectal cancer (dpeaa)DE-He213 NCDB (dpeaa)DE-He213 Artinyan, Avo (orcid)0000-0003-0353-4094 aut Oka, Kimberly aut Zhu, Ruoyan aut Seiser, Natalie (orcid)0000-0002-0950-7823 aut Shirinian, Mihran aut Barnajian, Moshe aut Cohen, Jason aut Ellenhorn, Joshua (orcid)0000-0001-8057-6488 aut Nasseri, Yosef (orcid)0000-0002-9186-5717 aut Enthalten in International journal of colorectal disease Berlin : Springer, 1986 39(2024), 1 vom: 08. Jan. (DE-627)253724244 (DE-600)1459217-4 1432-1262 nnns volume:39 year:2024 number:1 day:08 month:01 https://dx.doi.org/10.1007/s00384-023-04589-1 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_138 GBV_ILN_150 GBV_ILN_151 GBV_ILN_152 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_267 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_702 GBV_ILN_711 GBV_ILN_2005 GBV_ILN_2014 GBV_ILN_2153 GBV_ILN_2188 GBV_ILN_2190 GBV_ILN_2336 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4246 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 39 2024 1 08 01
allfields_unstemmed	10.1007/s00384-023-04589-1 doi (DE-627)SPR054301807 (SPR)s00384-023-04589-1-e DE-627 ger DE-627 rakwb eng Kasheri, Eli verfasserin (orcid)0000-0002-1209-7511 aut Downstaging after preoperative chemoradiation for locally advanced rectal cancer is associated with better survival than pathologic stage 0–1 disease treated with upfront surgery 2024 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2024 Background and objectives It is unknown how patients with locally advanced rectal cancer with significant response to preoperative radiotherapy/chemoradiotherapy fare relative to patients with true pathologic 0–1 disease undergoing upfront surgery. We aimed to determine whether survival is improved in locally advanced rectal cancer downstaged to pathologic stage 0–1 disease compared to true pathologic stage 0–1 tumors. Methods A retrospective review of the National Cancer Database between 2004 and 2016 was conducted. Three groups were identified: (1) clinical stage 2–3 disease downstaged to pathologic stage 0–1 disease after radiotherapy, (2) clinical stage 2–3 disease not downstaged after radiotherapy, and (3) true pathologic 0–1 tumors undergoing upfront surgery. The primary endpoint was overall survival and was compared using Kaplan–Meier and multivariate Cox regression analyses. Results The study population consisted of 59,884 patients. Of the 40,130 patients with locally advanced rectal cancer treated with preoperative radiation, 12,670 (31.5%) had significant downstaging (group 1), while 27,460 (68.4%) had no significant downstaging (group 2). A total of 19,754 had pathologic 0–1 disease treated with upfront resection (group 3). On Kaplan–Meier analysis, downstaged patients had significantly better overall survival compared to both non-downstaged and true pathologic stage 0–1 patients (median 156 vs. 99 and 136 months, respectively, p < 0.001). On multivariate analysis, downstaged patients had significantly better survival (HR 0.88, p < 0.001) compared to true pathologic 0–1 patients. Conclusions Locally advanced rectal cancer downstaged after preoperative radiotherapy has significantly better survival compared to true pathologic stage 0–1 disease treated with upfront surgery. Response to chemoradiotherapy likely identifies a subset of patients with a particularly good prognosis. Downstage (dpeaa)DE-He213 Survival (dpeaa)DE-He213 Locally advanced rectal cancer (dpeaa)DE-He213 NCDB (dpeaa)DE-He213 Artinyan, Avo (orcid)0000-0003-0353-4094 aut Oka, Kimberly aut Zhu, Ruoyan aut Seiser, Natalie (orcid)0000-0002-0950-7823 aut Shirinian, Mihran aut Barnajian, Moshe aut Cohen, Jason aut Ellenhorn, Joshua (orcid)0000-0001-8057-6488 aut Nasseri, Yosef (orcid)0000-0002-9186-5717 aut Enthalten in International journal of colorectal disease Berlin : Springer, 1986 39(2024), 1 vom: 08. Jan. (DE-627)253724244 (DE-600)1459217-4 1432-1262 nnns volume:39 year:2024 number:1 day:08 month:01 https://dx.doi.org/10.1007/s00384-023-04589-1 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_138 GBV_ILN_150 GBV_ILN_151 GBV_ILN_152 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_267 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_702 GBV_ILN_711 GBV_ILN_2005 GBV_ILN_2014 GBV_ILN_2153 GBV_ILN_2188 GBV_ILN_2190 GBV_ILN_2336 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4246 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 39 2024 1 08 01
allfieldsGer	10.1007/s00384-023-04589-1 doi (DE-627)SPR054301807 (SPR)s00384-023-04589-1-e DE-627 ger DE-627 rakwb eng Kasheri, Eli verfasserin (orcid)0000-0002-1209-7511 aut Downstaging after preoperative chemoradiation for locally advanced rectal cancer is associated with better survival than pathologic stage 0–1 disease treated with upfront surgery 2024 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2024 Background and objectives It is unknown how patients with locally advanced rectal cancer with significant response to preoperative radiotherapy/chemoradiotherapy fare relative to patients with true pathologic 0–1 disease undergoing upfront surgery. We aimed to determine whether survival is improved in locally advanced rectal cancer downstaged to pathologic stage 0–1 disease compared to true pathologic stage 0–1 tumors. Methods A retrospective review of the National Cancer Database between 2004 and 2016 was conducted. Three groups were identified: (1) clinical stage 2–3 disease downstaged to pathologic stage 0–1 disease after radiotherapy, (2) clinical stage 2–3 disease not downstaged after radiotherapy, and (3) true pathologic 0–1 tumors undergoing upfront surgery. The primary endpoint was overall survival and was compared using Kaplan–Meier and multivariate Cox regression analyses. Results The study population consisted of 59,884 patients. Of the 40,130 patients with locally advanced rectal cancer treated with preoperative radiation, 12,670 (31.5%) had significant downstaging (group 1), while 27,460 (68.4%) had no significant downstaging (group 2). A total of 19,754 had pathologic 0–1 disease treated with upfront resection (group 3). On Kaplan–Meier analysis, downstaged patients had significantly better overall survival compared to both non-downstaged and true pathologic stage 0–1 patients (median 156 vs. 99 and 136 months, respectively, p < 0.001). On multivariate analysis, downstaged patients had significantly better survival (HR 0.88, p < 0.001) compared to true pathologic 0–1 patients. Conclusions Locally advanced rectal cancer downstaged after preoperative radiotherapy has significantly better survival compared to true pathologic stage 0–1 disease treated with upfront surgery. Response to chemoradiotherapy likely identifies a subset of patients with a particularly good prognosis. Downstage (dpeaa)DE-He213 Survival (dpeaa)DE-He213 Locally advanced rectal cancer (dpeaa)DE-He213 NCDB (dpeaa)DE-He213 Artinyan, Avo (orcid)0000-0003-0353-4094 aut Oka, Kimberly aut Zhu, Ruoyan aut Seiser, Natalie (orcid)0000-0002-0950-7823 aut Shirinian, Mihran aut Barnajian, Moshe aut Cohen, Jason aut Ellenhorn, Joshua (orcid)0000-0001-8057-6488 aut Nasseri, Yosef (orcid)0000-0002-9186-5717 aut Enthalten in International journal of colorectal disease Berlin : Springer, 1986 39(2024), 1 vom: 08. Jan. (DE-627)253724244 (DE-600)1459217-4 1432-1262 nnns volume:39 year:2024 number:1 day:08 month:01 https://dx.doi.org/10.1007/s00384-023-04589-1 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_138 GBV_ILN_150 GBV_ILN_151 GBV_ILN_152 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_267 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_702 GBV_ILN_711 GBV_ILN_2005 GBV_ILN_2014 GBV_ILN_2153 GBV_ILN_2188 GBV_ILN_2190 GBV_ILN_2336 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4246 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 39 2024 1 08 01
allfieldsSound	10.1007/s00384-023-04589-1 doi (DE-627)SPR054301807 (SPR)s00384-023-04589-1-e DE-627 ger DE-627 rakwb eng Kasheri, Eli verfasserin (orcid)0000-0002-1209-7511 aut Downstaging after preoperative chemoradiation for locally advanced rectal cancer is associated with better survival than pathologic stage 0–1 disease treated with upfront surgery 2024 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2024 Background and objectives It is unknown how patients with locally advanced rectal cancer with significant response to preoperative radiotherapy/chemoradiotherapy fare relative to patients with true pathologic 0–1 disease undergoing upfront surgery. We aimed to determine whether survival is improved in locally advanced rectal cancer downstaged to pathologic stage 0–1 disease compared to true pathologic stage 0–1 tumors. Methods A retrospective review of the National Cancer Database between 2004 and 2016 was conducted. Three groups were identified: (1) clinical stage 2–3 disease downstaged to pathologic stage 0–1 disease after radiotherapy, (2) clinical stage 2–3 disease not downstaged after radiotherapy, and (3) true pathologic 0–1 tumors undergoing upfront surgery. The primary endpoint was overall survival and was compared using Kaplan–Meier and multivariate Cox regression analyses. Results The study population consisted of 59,884 patients. Of the 40,130 patients with locally advanced rectal cancer treated with preoperative radiation, 12,670 (31.5%) had significant downstaging (group 1), while 27,460 (68.4%) had no significant downstaging (group 2). A total of 19,754 had pathologic 0–1 disease treated with upfront resection (group 3). On Kaplan–Meier analysis, downstaged patients had significantly better overall survival compared to both non-downstaged and true pathologic stage 0–1 patients (median 156 vs. 99 and 136 months, respectively, p < 0.001). On multivariate analysis, downstaged patients had significantly better survival (HR 0.88, p < 0.001) compared to true pathologic 0–1 patients. Conclusions Locally advanced rectal cancer downstaged after preoperative radiotherapy has significantly better survival compared to true pathologic stage 0–1 disease treated with upfront surgery. Response to chemoradiotherapy likely identifies a subset of patients with a particularly good prognosis. Downstage (dpeaa)DE-He213 Survival (dpeaa)DE-He213 Locally advanced rectal cancer (dpeaa)DE-He213 NCDB (dpeaa)DE-He213 Artinyan, Avo (orcid)0000-0003-0353-4094 aut Oka, Kimberly aut Zhu, Ruoyan aut Seiser, Natalie (orcid)0000-0002-0950-7823 aut Shirinian, Mihran aut Barnajian, Moshe aut Cohen, Jason aut Ellenhorn, Joshua (orcid)0000-0001-8057-6488 aut Nasseri, Yosef (orcid)0000-0002-9186-5717 aut Enthalten in International journal of colorectal disease Berlin : Springer, 1986 39(2024), 1 vom: 08. Jan. (DE-627)253724244 (DE-600)1459217-4 1432-1262 nnns volume:39 year:2024 number:1 day:08 month:01 https://dx.doi.org/10.1007/s00384-023-04589-1 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_138 GBV_ILN_150 GBV_ILN_151 GBV_ILN_152 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_267 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_702 GBV_ILN_711 GBV_ILN_2005 GBV_ILN_2014 GBV_ILN_2153 GBV_ILN_2188 GBV_ILN_2190 GBV_ILN_2336 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4246 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 39 2024 1 08 01
language	English
source	Enthalten in International journal of colorectal disease 39(2024), 1 vom: 08. Jan. volume:39 year:2024 number:1 day:08 month:01
sourceStr	Enthalten in International journal of colorectal disease 39(2024), 1 vom: 08. Jan. volume:39 year:2024 number:1 day:08 month:01
format_phy_str_mv	Article
institution	findex.gbv.de
topic_facet	Downstage Survival Locally advanced rectal cancer NCDB
isfreeaccess_bool	true
container_title	International journal of colorectal disease
authorswithroles_txt_mv	Kasheri, Eli @@aut@@ Artinyan, Avo @@aut@@ Oka, Kimberly @@aut@@ Zhu, Ruoyan @@aut@@ Seiser, Natalie @@aut@@ Shirinian, Mihran @@aut@@ Barnajian, Moshe @@aut@@ Cohen, Jason @@aut@@ Ellenhorn, Joshua @@aut@@ Nasseri, Yosef @@aut@@
publishDateDaySort_date	2024-01-08T00:00:00Z
hierarchy_top_id	253724244
id	SPR054301807
language_de	englisch
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We aimed to determine whether survival is improved in locally advanced rectal cancer downstaged to pathologic stage 0–1 disease compared to true pathologic stage 0–1 tumors. Methods A retrospective review of the National Cancer Database between 2004 and 2016 was conducted. Three groups were identified: (1) clinical stage 2–3 disease downstaged to pathologic stage 0–1 disease after radiotherapy, (2) clinical stage 2–3 disease not downstaged after radiotherapy, and (3) true pathologic 0–1 tumors undergoing upfront surgery. The primary endpoint was overall survival and was compared using Kaplan–Meier and multivariate Cox regression analyses. Results The study population consisted of 59,884 patients. Of the 40,130 patients with locally advanced rectal cancer treated with preoperative radiation, 12,670 (31.5%) had significant downstaging (group 1), while 27,460 (68.4%) had no significant downstaging (group 2). A total of 19,754 had pathologic 0–1 disease treated with upfront resection (group 3). On Kaplan–Meier analysis, downstaged patients had significantly better overall survival compared to both non-downstaged and true pathologic stage 0–1 patients (median 156 vs. 99 and 136 months, respectively, p < 0.001). On multivariate analysis, downstaged patients had significantly better survival (HR 0.88, p < 0.001) compared to true pathologic 0–1 patients. Conclusions Locally advanced rectal cancer downstaged after preoperative radiotherapy has significantly better survival compared to true pathologic stage 0–1 disease treated with upfront surgery. 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author	Kasheri, Eli
spellingShingle	Kasheri, Eli misc Downstage misc Survival misc Locally advanced rectal cancer misc NCDB Downstaging after preoperative chemoradiation for locally advanced rectal cancer is associated with better survival than pathologic stage 0–1 disease treated with upfront surgery
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topic_title	Downstaging after preoperative chemoradiation for locally advanced rectal cancer is associated with better survival than pathologic stage 0–1 disease treated with upfront surgery Downstage (dpeaa)DE-He213 Survival (dpeaa)DE-He213 Locally advanced rectal cancer (dpeaa)DE-He213 NCDB (dpeaa)DE-He213
topic	misc Downstage misc Survival misc Locally advanced rectal cancer misc NCDB
topic_unstemmed	misc Downstage misc Survival misc Locally advanced rectal cancer misc NCDB
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title	Downstaging after preoperative chemoradiation for locally advanced rectal cancer is associated with better survival than pathologic stage 0–1 disease treated with upfront surgery
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title_full	Downstaging after preoperative chemoradiation for locally advanced rectal cancer is associated with better survival than pathologic stage 0–1 disease treated with upfront surgery
author_sort	Kasheri, Eli
journal	International journal of colorectal disease
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author_browse	Kasheri, Eli Artinyan, Avo Oka, Kimberly Zhu, Ruoyan Seiser, Natalie Shirinian, Mihran Barnajian, Moshe Cohen, Jason Ellenhorn, Joshua Nasseri, Yosef
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title_sort	downstaging after preoperative chemoradiation for locally advanced rectal cancer is associated with better survival than pathologic stage 0–1 disease treated with upfront surgery
title_auth	Downstaging after preoperative chemoradiation for locally advanced rectal cancer is associated with better survival than pathologic stage 0–1 disease treated with upfront surgery
abstract	Background and objectives It is unknown how patients with locally advanced rectal cancer with significant response to preoperative radiotherapy/chemoradiotherapy fare relative to patients with true pathologic 0–1 disease undergoing upfront surgery. We aimed to determine whether survival is improved in locally advanced rectal cancer downstaged to pathologic stage 0–1 disease compared to true pathologic stage 0–1 tumors. Methods A retrospective review of the National Cancer Database between 2004 and 2016 was conducted. Three groups were identified: (1) clinical stage 2–3 disease downstaged to pathologic stage 0–1 disease after radiotherapy, (2) clinical stage 2–3 disease not downstaged after radiotherapy, and (3) true pathologic 0–1 tumors undergoing upfront surgery. The primary endpoint was overall survival and was compared using Kaplan–Meier and multivariate Cox regression analyses. Results The study population consisted of 59,884 patients. Of the 40,130 patients with locally advanced rectal cancer treated with preoperative radiation, 12,670 (31.5%) had significant downstaging (group 1), while 27,460 (68.4%) had no significant downstaging (group 2). A total of 19,754 had pathologic 0–1 disease treated with upfront resection (group 3). On Kaplan–Meier analysis, downstaged patients had significantly better overall survival compared to both non-downstaged and true pathologic stage 0–1 patients (median 156 vs. 99 and 136 months, respectively, p < 0.001). On multivariate analysis, downstaged patients had significantly better survival (HR 0.88, p < 0.001) compared to true pathologic 0–1 patients. Conclusions Locally advanced rectal cancer downstaged after preoperative radiotherapy has significantly better survival compared to true pathologic stage 0–1 disease treated with upfront surgery. Response to chemoradiotherapy likely identifies a subset of patients with a particularly good prognosis. © The Author(s) 2024
abstractGer	Background and objectives It is unknown how patients with locally advanced rectal cancer with significant response to preoperative radiotherapy/chemoradiotherapy fare relative to patients with true pathologic 0–1 disease undergoing upfront surgery. We aimed to determine whether survival is improved in locally advanced rectal cancer downstaged to pathologic stage 0–1 disease compared to true pathologic stage 0–1 tumors. Methods A retrospective review of the National Cancer Database between 2004 and 2016 was conducted. Three groups were identified: (1) clinical stage 2–3 disease downstaged to pathologic stage 0–1 disease after radiotherapy, (2) clinical stage 2–3 disease not downstaged after radiotherapy, and (3) true pathologic 0–1 tumors undergoing upfront surgery. The primary endpoint was overall survival and was compared using Kaplan–Meier and multivariate Cox regression analyses. Results The study population consisted of 59,884 patients. Of the 40,130 patients with locally advanced rectal cancer treated with preoperative radiation, 12,670 (31.5%) had significant downstaging (group 1), while 27,460 (68.4%) had no significant downstaging (group 2). A total of 19,754 had pathologic 0–1 disease treated with upfront resection (group 3). On Kaplan–Meier analysis, downstaged patients had significantly better overall survival compared to both non-downstaged and true pathologic stage 0–1 patients (median 156 vs. 99 and 136 months, respectively, p < 0.001). On multivariate analysis, downstaged patients had significantly better survival (HR 0.88, p < 0.001) compared to true pathologic 0–1 patients. Conclusions Locally advanced rectal cancer downstaged after preoperative radiotherapy has significantly better survival compared to true pathologic stage 0–1 disease treated with upfront surgery. Response to chemoradiotherapy likely identifies a subset of patients with a particularly good prognosis. © The Author(s) 2024
abstract_unstemmed	Background and objectives It is unknown how patients with locally advanced rectal cancer with significant response to preoperative radiotherapy/chemoradiotherapy fare relative to patients with true pathologic 0–1 disease undergoing upfront surgery. We aimed to determine whether survival is improved in locally advanced rectal cancer downstaged to pathologic stage 0–1 disease compared to true pathologic stage 0–1 tumors. Methods A retrospective review of the National Cancer Database between 2004 and 2016 was conducted. Three groups were identified: (1) clinical stage 2–3 disease downstaged to pathologic stage 0–1 disease after radiotherapy, (2) clinical stage 2–3 disease not downstaged after radiotherapy, and (3) true pathologic 0–1 tumors undergoing upfront surgery. The primary endpoint was overall survival and was compared using Kaplan–Meier and multivariate Cox regression analyses. Results The study population consisted of 59,884 patients. Of the 40,130 patients with locally advanced rectal cancer treated with preoperative radiation, 12,670 (31.5%) had significant downstaging (group 1), while 27,460 (68.4%) had no significant downstaging (group 2). A total of 19,754 had pathologic 0–1 disease treated with upfront resection (group 3). On Kaplan–Meier analysis, downstaged patients had significantly better overall survival compared to both non-downstaged and true pathologic stage 0–1 patients (median 156 vs. 99 and 136 months, respectively, p < 0.001). On multivariate analysis, downstaged patients had significantly better survival (HR 0.88, p < 0.001) compared to true pathologic 0–1 patients. Conclusions Locally advanced rectal cancer downstaged after preoperative radiotherapy has significantly better survival compared to true pathologic stage 0–1 disease treated with upfront surgery. Response to chemoradiotherapy likely identifies a subset of patients with a particularly good prognosis. © The Author(s) 2024
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title_short	Downstaging after preoperative chemoradiation for locally advanced rectal cancer is associated with better survival than pathologic stage 0–1 disease treated with upfront surgery
url	https://dx.doi.org/10.1007/s00384-023-04589-1
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author2	Artinyan, Avo Oka, Kimberly Zhu, Ruoyan Seiser, Natalie Shirinian, Mihran Barnajian, Moshe Cohen, Jason Ellenhorn, Joshua Nasseri, Yosef
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Downstaging after preoperative chemoradiation for locally advanced rectal cancer is associated with better survival than pathologic stage 0–1 disease treated with upfront surgery

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