Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Apr 15, 2021; 13(4): 252-264
Published online Apr 15, 2021. doi: 10.4251/wjgo.v13.i4.252
Predictive factors for early distant metastasis after neoadjuvant chemoradiotherapy in locally advanced rectal cancer
Hyojung Park
Hyojung Park, Departments of Radiation Oncology, Dankook University Hospital, Dankook University College of Medicine, Cheonan 46115, South Korea
Author contributions: Park H analyzed the data and wrote the manuscript.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Dankook University Hospital.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: The authors have no conflicts to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hyojung Park, MD, Doctor, Departments of Radiation Oncology, Dankook University Hospital, Dankook University College of Medicine, 201 Manghyang-ro, Dongnam-gu, Cheonan 46115, South Korea. hj0714.park@dkuh.co.kr
Received: September 10, 2020
Peer-review started: September 10, 2020
First decision: November 3, 2020
Revised: January 11, 2021
Accepted: March 16, 2021
Article in press: March 16, 2021
Published online: April 15, 2021
Processing time: 211 Days and 0.8 Hours
ARTICLE HIGHLIGHTS
Research background

Distant relapse has become the leading cause of cancer death in locally advanced rectal cancer. The standard treatment of locally advanced rectal cancer, neoadjuvant chemoradiation (NACRT) followed by surgery, inevitably delays delivery of systemic treatment.

Research motivation

This study investigated prognostic factors for distant metastasis, especially early distant metastasis, using the standard treatment paradigm to identify the most effective treatments according to recurrence risk.

Research objectives

We investigated prognostic factors for early distant metastasis, using the standard treatment paradigm to identify the most effective neoadjuvant treatments according to recurrence risk.

Research methods

The authors retrieved data from 148 consecutive rectal cancer patients from January 2015 through December 2019 who underwent NACRT for having clinical T 3-4 or clinical N 1-2 disease according to the 8th American Joint Committee on Cancer staging system.

Research results

Patients with early distant metastasis were more likely to have poorly differentiated tumor (P = 0.025), tumors with involved mesorectal fascia (P = 0.002), and extramural venous invasion (P = 0.012) than those who did not. Due to the small number of patients who received magnetic resonance imaging and inherent limitation of retrospective study, prospective studies with large number of patients are needed.

Research conclusions

For patients with risk factors for early distant metastasis, early systemic chemotherapy could be beneficial. According to the risk factors, neoadjuvant treatment should be individualized.

Research perspectives

Future studies that include carefully applied imaging and randomized design are required.