Do pathological variables have prognostic significance in rectal adenocarcinoma treated with neoadjuvant chemoradiotherapy and surgery?

Figure 1 Tumor regression in rectal surgical specimens after neo-adjuvant chemo-radiotherapy. A: Dworak grade 2, corresponding to dominant fibrosis with few neoplastic cells or groups; B: Dworak grade 4, showing no tumor cells (pathological complete response); C: Acellular mucin pools.

Figure 2 Distribution of Dworak regression score according to clinical Tumor Node Metastasis stage. Rectal cancers with cTNM stage II had a high proportion of Dworak grade 4 cases while tumors with cTNM stage III mainly had Dworak grade 1 regression.

Figure 3 cTNM stage II rectal cancers mainly showed downstaging to yT0N0M0 or yTNM stage I. On the other hand, the majority of cTNM stage III cases had unchanged TNM stage after therapy, and some even showed upstaging to yTNM stage IV after therapy.

Figure 4 Kaplan Meier curves showing cancer specific survival according to craniocaudal extension. Compared to tumors with craniocaudal extension lower than 3 cm rectal carcinomas with craniocaudal extension with higher cms had significantly shorter cancer specific survival (CSS).

Figure 5 Kaplan Meier curves showing cancer specific survival according to yN status. Compared to tumors with the presence of nodal metastases, rectal carcinomas with the absence of nodal metastases at histological examination of surgical specimen after chemo-radiotherapy (CRT) had significantly longer cancer specific survival (CSS).

Figure 6 Kaplan Meier curves showing cancer specific survival according to Dworak grade. Compared to tumors with Dworak grades 0, 1 or 2, rectal carcinomas with Dworak grades 3 and 4 had significantly longer cancer specific survival (CSS).

Figure 7 Kaplan Meier curves showing ancer specific survival according to tumor regression. Compared to tumors with absent/partial regression (Dworak 0, 1 and 2), rectal carcinomas with subtotal/total regression (Dworak 3 and 4) had significantly longer cancer specific survival (CSS).